Varicose vein surgery after acute isolated superficial vein thrombosis in daily practice: INSIGHTS-SVT study

Abstract

Objective: The aim of this study was to assess the utilization of surgical interventions in patients diagnosed with superficial vein thrombosis (SVT) and its potential association with the occurrence of venous thromboembolism (VTE) and bleeding events.

Methods: INSIGHTS-SVT, a prospective, non-interventional, multicenter study in Germany, investigated the management and outcomes of patients with acute SVT who received conservative and/or invasive treatments at the discretion of the treating physician.

Results: Among the 872 patients with 12-month data, 657 had medical therapy only, and 215 patients underwent vascular surgery (70 within 3 months of SVT diagnosis, 136 between months 4 and 12, and nine had an intervention in both periods). The most commonly performed procedures included endovenous thermal ablation, ligation of the saphenofemoral or saphenopopliteal junction, and vein stripping. The primary outcome of symptomatic VTE was observed in 5.8% of conservatively treated patients and 6.3% of those who underwent surgical intervention. Additionally, the secondary outcome of recurrent or extended SVT was documented in 4.7% of conservatively treated patients and 5.3% of invasively treated patients. Bleeding events occurred in 1.4% of conservatively treated patients and 2.1% of surgically treated patients. These differences were statistically not significant. Furthermore, our analysis indicated a potential protective effect associated with surgical treatments, such as ligation of the saphenofemoral or saphenopopliteal junction, stripping and endovenous thermal ablation, concerning the endpoint of VTE for patients when applied after 3 months from the index SVT event.

Conclusions: In line with previous research, our study suggests that surgical interventions are not frequently employed in the management of SVT, although they may be warranted in select cases. Nevertheless, additional research is essential to gain a deeper understanding of the indications, criteria, and benefit of surgical interventions in the treatment of SVT.

Keywords: Fondaparinux; Low-molecular weight heparin; Prognosis; Risk assessment; Superficial vein thrombosis; Surgical intervention; Venous thrombosis.

Fig 1

Study flowchart. In addition, there were nine patients who received invasive treatment twice, spanning both periods.

Fig 2

Lines represent cumulative event rates in percent, along with their 95% confidence intervals (CIs) over time until 12 months, categorized by type of intervention. EVTA, Endovenous thermal ablation; SFJ/SPJ, ligation of the saphenofemoral or saphenopopliteal junction.

Fig 3

The figure shows incidence rates (IRs) of venous thromboembolism events (VTEs) per 100 patient-years, by intervention type. The black squares show VTE incidence rates along with 95% confidence intervals (CIs) for patients with no intervention or before intervention, whereas the gray diamonds show VTE IRs with 95% CIs for patients after intervention over 12 months. IRs for the different interventions: Sclerotherapy: IR, 2.09; 95% CI, 0.52-8.50; P = .302; endovenous thermal ablation (EVTA): IR, 0.37; 95% CI, 0.12-1.18; P = .092; ligation of the saphenofemoral or saphenopopliteal junction (SFJ/SPJ): IR, 1.03; 95% CI, 0.38-2.91; P = .952; vein stripping: IR, 0.44; 95% CI, 0.11-1.78; P = .248; thrombectomy: IR, 1.77; 95% CI, 0.25-12.72; P = .570; phlebectomy: IR, 1.03; 95% CI, 0.33-3.25; P = .960.