Management of superficial venous thrombosis in varicose

veins using thermal obliteration.

Serhii Shchukin, V. Goncharov. LTD "Medical Center

of Phlebology and aesthetic medicine “Phlebos”,
Kyiv, Ukraine.
Вackground
Treatment of superficial vein thrombosis
(SVT) is poorly defined and generally
controversial. SVT has long been considered a
benign, self-limiting disease, but recent
studies have shown that SVT carries a latent
risk of recurrence, deep vein thrombosis, or
pulmonary embolism.

Ascending forms of SVT can lead to deep

vein thrombosis and pulmonary embolism.
Conservative treatment does not always
stop the thrombosis process and does not
insure the patient against thromboembolic
complications.
The pathophysiology of SVT in VV
of the lower extremities and
without VV is radically different.
Pathological changes in
hemodynamics, which are caused
by reflux, significantly affect the
results of conservative treatment
of SVT.

It is more appropriate to use

the term
"varicothrombophlebitis" (VTP)
when we mean about problem
of SVT in VV.
• Anticoagulant therapy allows safe
management of patients with VTP
in an outpatient setting.
• Fondaparinux reduces the
incidence of symptomatic cases of
venous thromboembolic
complications by 85%, extension of
SVT by 92%, and recurrence of SVT
by 79%.
• Replacing subcutaneous injections
with tablets significantly improves
the quality of life of patients.
• Rivaroxaban was not inferior to
fondaparinux for the treatment of
superficial venous thrombosis in
terms of symptomatic DVT or
pulmonary embolism, progression or
recurrence of SVT and all-cause
mortality, and did not cause severe
bleeding.
The use of NOAСs allows for minimally invasive interventions (EVLT, RFA, UGST) in the
acute SVT without the risk of VTEC and surgical bleeding (there is no surgical wound, only a
puncture hole ).
Performing early occlusion of the veins that conduct reflux in VV, we solve two problems at
once:

• We block the probable path of thrombus migration to the deep venous system;
• We reduce phlebohypertension, which significantly improves the clinical course
of the disease.
Hemorrhagic complications are the
most dangerous side effect of
anticoagulant therapy. This must be
taken into account when choosing
patients.
There are several questionnaires on
this topic.
We use the HAS-BLED scale:

1. Hypertension.
2. Liver function abnormalities.
3. Abnormalities of kidney function.
4. A stroke.
5. Bleeding tendency.
6. Labile International Normalization Ratio.
7. Old age: more than 65 years.
8. Drugs: concomitant antiplatelet therapy or
NSAIDs
9. Alcohol abuse.
 Patients
The results of the treatment of 132 patients
(70% women, average age 56 ± 13.5 years),
who were operated on from 2013 to 2021,
using EVLT and RFA, are presented. • in 113 (86%) cases (group A),
the SVT of the GSV and its
tributaries was observed. In 19
cases (14%) – SVT SSV and its
tributaries. In 75 (57%) cases,
the SVT of the GSV area spread
to the thigh.
• 22 (16%) patients (group B) have ascending
forms of SVT, incl. spread to the junctions (SPJ
– 6 patients, SFJ – 16 patients).

• The duration of the SVT ranged from 2 weeks to 4

months.
VENOUS INSUFFICIENCY
58 (44%) patients had venous
insufficiency C 3, 48 (36%) – C 4-5, 26
(2%) – C 6 (SEAP).

C6

62%

C4-5

C3
TREATMENT
• 46 (35%) patients underwent
RFA. The diameter of the GSV in
the SFJ area is 14.7 ± 4.8 mm.

• EVLT was performed in 86

(65%) patients. The diameter of
the GSV in the SFJ area is 11.5 ±
4.2 mm. The diameter of the
SSV in the SPJ area is 9.3 ± 3.2
mm.
 TREATMENT
Group B patients received
anticoagulant therapy (Xarelto 10-20
mg/day) for 1 to 2 months. We
performed ultrasound control on 3, 7,
10, 15 days, then after 1, 1.5 and 2
months.

In the period from 3 weeks to 2

months, recanalization of the
proximal parts of the GSV (16
patients) and SSV (6 patients) was
observed, which allowed to perform
EVLT.
Venous puncture
was performed
proximal to
thrombotic masses

All patients were examined with the

ultrasound examination. All patients were
operated under local anesthesia with
ultrasound control.
EVLT
It was performed with a 1470 nm
diode laser (Biolitec) and 2-ring
radial fibers.

Power 9-10 W, with

automatic fiber traction
(0.7 mm / s); LEED - 130 J /
cm.
RFA
It was performed according to the
VNUS Closure FAST method.
 CLINICAL CASE

Patient female. 43 years old.

The duration of SVT 2 weeks.
Thrombosis of SSV and SPJ.
Prescribed ACT: Xarelto 15 mg.
1 t. 2 times a day. - 3 weeks,
with a transition to 20 mg. 1 t
per day.
30th day - EVLT SSV
30th day - EVLT SSV
Next day after
EVLT SSV:
occlusion SSV
CLINICAL CASE
Patient female 66 years old. The duration of SVT is 14 days. After ACT (xarelto
15 mg/d) on the 14th day – EVLT SSV
CLINICAL CASE
Examination after 3 years. ACT+EVLT SSV
Result after 3 years
Additional interventions
40 (30%) patients underwent miniphlebectomy (MFE) according to Varady, 28
(21%) patients underwent phlebocentesis (removal of blood clots through small
punctures).
" Office surgery " Prescriptions
In all cases, the treatment took All patients received anticoagulant therapy for 20–45 days. Class
place in the conditions of "Office 2 compression stockings were intended for daily use for 1 month.
Surgery". 30 minutes after the NSAIDs were used for analgesia in 12 (9%) patients after MFE
operation, the patients left the clinic
on their own.
Over a period of 3 to 6 months, the
recanalization of areas of veins that were
affected by the thrombotic process was
observed. 106 (80%) patients underwent UGST
of such veins (polydocanol foam 3% 3-6 ml per
session).
The results
Ultrasound examinations was performed in all
patients the day after surgery, 1 week, 1, 3, 6
months, and annually. DVT and PE were not
detected during the entire observation period.

In all cases, a complete occlusion of

the veins, which were subject to
thermal ablation methods, was
observed.
Conclusions
RFA Closure FAST and EVLT with the 1470 nm diode
laser and a 2-ring radial light guide in acute SVT on
the background of anticoagulant therapy is a
minimally invasive alternative to traditional surgical
interventions.

The use of this technique in patients with acute SVT

can shorten the rehabilitation period and significantly
improve the cosmetic result of the intervention.
Thank you for your attention!