Objectives: Endovenous ablation of the lower extremity veins has become the primary treatment for symptomatic venous reflux disease. Endovenous heat-induced thrombosis (EHIT) and recanalization are two well known complications of these venous ablative procedures. Since the elderly represent the fastest growing demographic, our goal is to look at whether or not there is a difference between these complications and age distribution of octogenarians, nonagenarians, and centenarians versus the younger population.
Methods: Retrospective analysis of data was collected from March 2012 to September of 2018, 10,029 limbs, across 3,218 patients, that underwent endovenous ablation for lower extremity venous reflux. 6,091 procedures were performed with Radiofrequency Ablation (RFA) and 3,938 were performed with Endovenous Laser Ablation (EVLA). We reviewed charts of all patients who underwent radiofrequency ablation or endovenous laser treatment during this time period. Post-procedural venous duplex was performed three to seven days to check for EHIT and recanalization, every three months for the first year, and every six to twelve months thereafter. Chi-square analysis was used for statistical analysis.
Results: Ages ranged from 15 years old to 103 years old. The average age of the patients was 61.9 ±15.19. Of the 3,218 patients,2700 were under 80 years of age,380 were aged between 80 and 89, 132 were aged between 90 and 99 and six were aged 100 or over. Of the 10,029 limbs, 8,730 were performed on patients under the age of 80, 1,124 were performed on ages 80 to 89, 159 were 90 to 99 and 16 were aged 100 or over.
Results of the EHITs and recanalizations can be seen in the table below. There were statistically significant increases in EHIT rates between octogenarians and those in the<80 age group(p=.047),nonagenarians and those in the <80 group(p=.04),and combined octogenarians, nonagenarians, and centenarians vs.<80 age group(p=.012).No statistical difference was found in rates of EHIT between octogenarians and nonagenarians(p=.5). Overall age is a risk factor for the development of EHIT (p<.00001); Odd ratio = 1.03 (CI 1.02 – 1.04). RFA was found to be a risk factor for the development of EHIT (p=.034); Odd ratio = 1.52 (CI 1.03 – 2.24).
There were statistically significant increases in recanalization rates between octogenarians and those in the <80 age group(p=.000013),nonagenarians and those in the <80 group(p=.00022),and combined octogenarians, nonagenarians, and centenarians vs.<80 age group(p<.00001).No statistical difference was found in rates of recanalization between octogenarians and nonagenarians(p=.48).Statistical analysis of centenarians alone was not done due zero patients available in the EHIT or recanalization category. Overall age was found to be a risk factor for recanalization (p<.00002) Odds ratio = 1.03 (CI 1.01 -1.04)
Conclusions: Our study suggests higher rates of EHIT and recanalizations in the >80 age group.
|Age (in years)||Any EHIT (# of Limbs)||EHIT Class 1||EHIT Class 2||EHIT Class 3||EHIT Class 4||Total recanalization (# of Limbs)|
|80-89||33/1124 (2.9%)||19||14||0||0||47/1124 (4.2%)|
|90-99||14/159 (8.8%)||10||3||0||1||16/159 (10%)|
|≥ 100||0/16 (0%)||0||0||0||0||0/16 (0%)|