Systematic review deems ablation of superficial venous reflux safe for patients with concurrent deep venous obstruction 

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In patients with concurrent deep venous obstruction (DVO), superficial venous reflux (SVR) ablation is suggested to be safe, according to a recent systematic review. The authors of the study published in the Journal of Vascular Surgery: Venous and Lymphatic Disorders, Bright Benfor and Eric Peden (both DeBakey Heart & Vascular Center, Houston, USA), detail that the treatment of iliac vein obstruction combined with superficial reflux ablation produces “better results” in patients with both advanced chronic venous disease (CVD) and iliac vein obstruction.   

According to Benfor and Peden, physicians commonly believe that DVO is a contraindication for the treatment of SVR. In light of this, the authors detail a literature search performed on PubMed, Web of Science, and Google Scholar for the identification of clinical research studies between 1991 and 2021, to evaluate the concomitant management of superficial reflux and DVO. The authors point out that studies were excluded from the review if the patient number was less than five, they had no specifications of interventions to treat superficial reflux, or if there were no follow-up data available. Additionally, all studies included in the review were observational, with the Newcastle-Ottawa scale assessing quality.   

A total of 10 retrospective cohort studies were included in the review, the authors relay—consisting of 2,476 limbs in 2,428 patients, of which SVR and DVO or a known history of deep vein thrombosis (DVT) were managed in 944 limbs. In addition, the authors note that eight of these studies were of a comparative nature.   

The review reports that the level of DVO was suprainguinal when specified in most cases, with advanced CVD present in 614 (70%) limbs. The mean patient age was between 42 and 65 years, and 1,432 (59%) of the patients were female. Among the limbs treated for associated SVR and DVO (n=944), a combined approach of saphenous vein ablative procedures and deep venous stenting (DVS) occurred in 483 (51.2%) limbs, saphenous vein ablative procedures alone in 293 (31%) limbs, and DVS alone in 168 (17.8%) limbs.   

Of the studies comparing treatment approaches of concurrent SVR and DVO, better outcomes following combined DVS and saphenous vein ablation were observed in four out of five studies in comparison to ablation alone. In addition, the authors note that when comparing the outcomes of saphenous ablation in patients with reflux alone, compared to patients with concurrent reflux and DVO, there were no significant differences in either clinical improvements or postoperative complication rates.   

The authors conclude that, despite a limited number of studies and small sample size, the data suggest ablation of SVR is safe in patients with concurrent DVO. In addition, they find that those patients with both CVD and iliac vein obstruction experience improved outcomes when superficial reflux ablation is combined with the treatment of iliac vein obstruction. 

Looking ahead, Benfor and Peden stress that future studies are required to further analyse the role of superficial reflux ablation for the relief of symptoms in patients with concurrent infrainguinal obstruction.   


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