Does endovenous radiofrequency ablation cause endothermal heat-induced thrombosis?

Demir İ., Kamar M. A., karacan i. s.

Cardiovascular surgery and interventions, cilt.13, sa.2, ss.55-60, 2026 (TRDizin)

Özet

Objectives: Endovenous radiofrequency ablation (RFA) is widely used for the treatment of chronic venous disease. However, concerns regarding endothermal heat-induced thrombosis (EHIT) have traditionally led to avoidance of ablation close to the saphenofemoral junction (SFJ). This study aimed to evaluate the incidence of EHIT and early anatomic outcomes following flush RFA at the SFJ. Patients and methods: This single-center retrospective study included 60 limbs treated with endovenous RFA for great saphenous vein incompetence. Patients with CEAP class C2-C6 and no concomitant deep venous insufficiency were included. Ablation was performed using a standardized technique, and limbs were categorized according to flush strategy as optimal flush (+1 to -2 mm) or flush free (>-2 mm). Duplex ultrasonography was performed on postoperative day 1 to assess EHIT and at 1 month to evaluate early anatomic outcome. Results: No cases of EHIT were detected (0/60; exact 95% confidence interval, 0-5.96%). At 1 month, complete vein occlusion was observed in 41 limbs (68.3%). Complete occlusion was significantly more frequent in the optimal flush group compared with the flush free group (85.4% vs. 31.6%; p<0.001). The likelihood of achieving complete occlusion was higher with optimal flush (risk ratio, 2.70; 95% confidence interval, 1.38-5.30). Early anatomic outcomes did not differ between high-risk and low-risk EHIT subgroups. Conclusion: Flush endovenous RFA at the SFJ appears to be safe in the short term and is not associated with an increased risk of EHIT. Optimal flush positioning is associated with significantly improved early anatomic outcomes.