Chronic venous insufficiency (CVI) affects up to 40% of the US population and thus, intervention for symptomatic venous disease comprises a large portion of many vascular practices. Treatment of chronic superficial venous insufficiency has evolved from open surgical treatment to minimally invasive endovenous closure, which includes both thermal and non-thermal techniques. Thrombotic complications of thermal ablation are well reported with an overall complication rate of <2%. However, there is a paucity of high-powered, real-world data on the thrombotic outcomes of non-thermal techniques. This study aims to compare the incidence of endovenous heat induce thrombosis (EHIT) and endovenous glue induced thrombosis (EGIT) in a large cohort of patients with chronic venous insufficiency.

A retrospective review was conducted at two tertiary-level institutions on patients who underwent superficial endovenous ablation from 2018-2021. Patient demographics, comorbidities, and peri-procedural outcomes were collected through chart review. A Caprini score was assigned with information available from the electronic medical record. Patients were categorized by procedure type [ClosureFastTM radiofrequency ablation (RFA) vs VenaSealTM cyanoacrylate glue closure (CAG)]. The primary endpoint was incidence of EHIT or EGIT. The secondary endpoint was incidence of deep venous thrombosis and/or pulmonary embolism.

A total of 803 patients underwent 1096 procedures during the study period. The mean age was 62 ± 15 and 67% were female. There were 700 RFA procedures and 396 CAG procedures with a combined closure rate of 98% on post-procedure duplex at 7 days. Average Caprini score was 5.2 ± 1.8 (5.0 RFA vs 5.4 CAG; p <0.001). The incidence of EHIT and EGIT was 1.9% and 1.3% (p = 0.57), respectively; and DVT rate was 0.1% in the RFA cohort and 0.3% in the CAG cohort (p = 0.81). A comparative analysis of thermal versus nonthermal techniques was performed. Univariate analysis of risk factors for EHIT/EGIT revealed no significant factors predisposing to thrombotic events.

This study demonstrates the safety of RFA and CAG closure techniques for CVI as well as lower thrombotic rates than what is reported in the current literature. Further work may help to identify how these results can be achieved across all venous ablative techniques for CVI, even in patient populations with advanced venous disease who may be at higher than average risk for thrombotic events.