Absolute Contraindications for Great Saphenous Vein Radiofrequency Ablation
The absolute contraindications for Great Saphenous Vein (GSV) radiofrequency ablation include active bacteremia or septicemia, acute deep vein thrombosis, major bleeding diathesis, lower extremity venous thrombosis if femoral vein cannulation is desired, and hemodynamic instability. 1
Absolute Contraindications
Active bacteremia or septicemia: Introducing a radiofrequency catheter during active infection could lead to seeding of the vascular system and potentially life-threatening complications 1
Acute deep vein thrombosis (DVT): Patients with acute DVT should not undergo GSV radiofrequency ablation due to increased risk of thrombus propagation and potential pulmonary embolism 1, 2
Major bleeding diathesis: Uncontrolled or severe bleeding disorders present an absolute contraindication due to the risk of uncontrollable hemorrhage during or after the procedure 1
Lower extremity venous thrombosis: If femoral vein cannulation is required for the procedure, the presence of venous thrombosis in the access path is an absolute contraindication 1
Hemodynamic instability: Patients who are hemodynamically unstable should not undergo GSV radiofrequency ablation as they may not tolerate the procedure 1
Relative Contraindications
Large GSV diameter: GSVs with very large diameters (>12mm) may have higher rates of post-procedural thrombotic events, though this is a relative rather than absolute contraindication 3, 2
History of superficial thrombophlebitis: Previous superficial thrombophlebitis is associated with higher rates of post-procedural thrombotic events 3
Inability to ambulate: Patients who cannot ambulate post-procedure may have increased risk of DVT 4
Severe peripheral arterial disease: Poor arterial circulation may compromise healing after the procedure 1
Pregnancy: While not an absolute contraindication, radiofrequency ablation during pregnancy should be approached with caution 1
Anatomical Considerations
Absent radial pulse (if using radial access approach): The absence of a radial pulse makes radial access impossible 1
Incomplete palmar arch or small/absent ulnar artery (if using radial access): These anatomical variations increase the risk of hand ischemia with radial access 1
Subclavian artery occlusion or stenosis (if using radial access): These conditions make it difficult or impossible to reach the target area 1
Severe aortic arch atheromatous disease (if using radial access): This increases the risk of stroke due to atheroembolization during catheter manipulation 1
Anticoagulation Considerations
Recent central nervous system bleeding: This represents a contraindication to anticoagulation, which may be needed during or after the procedure 1
Intracranial or spinal lesions at high risk for bleeding: These conditions contraindicate anticoagulation that might be required during the procedure 1
Recent spinal anesthesia/lumbar puncture: This presents a risk for spinal hematoma if anticoagulation is used 1
Important Clinical Insights
Recent research suggests that patients on therapeutic anticoagulation with warfarin can safely undergo GSV radiofrequency ablation with comparable efficacy and safety to non-anticoagulated patients 5
Post-procedural duplex ultrasound scanning is essential to detect potential complications such as endovenous heat-induced thrombosis (EHIT) or DVT 2, 6
The incidence of post-procedural thrombotic events appears to be higher with larger GSV diameters and in patients with a history of superficial thrombophlebitis 3
Technical factors such as catheter temperature and pullback rate may influence the risk of thrombotic complications 3, 7
By carefully screening patients for these contraindications, clinicians can minimize the risk of complications associated with GSV radiofrequency ablation while maximizing treatment benefits for appropriate candidates.