From the Guidelines
It is strongly advised that patients inform their doctor about the great saphenous (GS) vein closure procedure before getting pregnant, as this can impact pregnancy management and outcomes [ 1 ].
Key Considerations
- The GS vein closure procedure, such as endovenous thermal ablation, is recommended as first-line treatment for nonpregnant patients with symptomatic varicose veins and documented valvular reflux [ 1 ].
- Patients should wait at least 3-6 months after the procedure before becoming pregnant to minimize potential risks, although the exact timing may vary depending on individual circumstances [no direct evidence, but based on general medical knowledge].
- During pregnancy, it's essential to monitor for signs of deep vein thrombosis (DVT) or other complications, and to follow up with a vascular specialist [ 1 ].
- Medications such as low-dose aspirin or compression stockings may be prescribed to reduce the risk of blood clots [no direct evidence, but based on general medical knowledge].
- Regular check-ups with a vascular specialist and obstetrician are also recommended to ensure a healthy pregnancy [no direct evidence, but based on general medical knowledge].
Procedure Details
- Endovenous thermal ablation can be used for larger vessels, including the great saphenous vein, and is performed under ultrasound guidance with a local anesthetic [ 1 ].
- The procedure has a risk of surrounding nerve damage (approximately 7%) attributed to thermal injury, but most nerve damage is temporary [ 1 ].
From the Research
Pre-Procedural Considerations
- The patient's history of deep vein thrombosis (DVT) and great saphenous vein (GSV) diameter should be considered before the procedure, as these factors can increase the risk of proximal thrombus extension into the femoral vein 2.
- The patient's body mass index (BMI) and Clinical Etiologic Anatomic Pathophysiologic (CEAP) class may also influence the outcome of the procedure, with higher CEAP classes potentially affecting great saphenous vein diameter reduction and quality of life scores 3.
Procedure-Related Considerations
- The procedure should be performed using a minimally invasive approach, such as endoluminal radiofrequency thermal heating of the vein wall, to reduce the risk of adverse sequelae 4.
- The use of cyanoacrylate closure (CAC) has been shown to be effective in treating incompetent saphenous veins, with a low risk of complications 5, 6.
- The diameter of the saphenous vein and reflux time may affect the stump length after CAC, with larger vein diameters potentially resulting in longer stump lengths 6.
Post-Procedural Considerations
- Patients should be monitored for potential complications, such as deep vein thrombosis (DVT) and thrombus extension into the femoral vein, and treated accordingly 2.
- The patient's quality of life (QOL) scores and level of pain should be assessed after the procedure, with expected improvements in QOL scores and reductions in pain 3.
- Patients can typically return to normal daily activities and work within a few days after the procedure, with minimal downtime 3.