Validation of Caprini’s Saphenous Ablation Scores

Laser Ablation of Varicose vein is among the most performed procedures worldwide, Venous Thromboembolism (VTE), either as Deep Venous Thrombosis (DVT) or a potentially fatal Pulmonary Embolus (PE), is the most serious complication in all of these procedures after treatment of varicose veins [1-3]. Hilly, et al. pointed out that there is no consensus of the perioperative thrombosis prophylaxis after varicose veins laser ablation [4]. Clinical guidelines by the American ACCP, Scottish SIGN and Dutch CBO all recommend risk stratification after which only patients with risk factors for thrombosis are to be treated with prophylaxis. The most important risk factors are obesity and a history of VTE [5].

Comparison of the use of Caprini's Saphenous Ablation Scores versus Standard Caprini’s Score for the prophylaxis of VTE in EVLA.

60 patients admitted to Royal Vascular Center, Alexandria - Egypt. From Jan. 1st 2021 to June 30th 2021 divided in 3 groups. - Group A) Treated by ablation of Great saphenous vein and received VTE prophylaxis according to Caprini’s Saphenous Ablation Scores Figure 1 A &B -Group B) Treated by ablation of Great saphenous vein and received VTE prophylaxis according to Standard Caprini’s Risk Assessment Score for VTE Figure 2 C) Treated by ablation of Great saphenous vein without VTE prophylaxis Patients signed an informed consent [6,7]. The pre-operative assessment by venous Duplex Ultrasound to assess the incompetence of SFJ and DVT detection prior to intervention. Ablation was done using radial 1470 YAG laser fibers and Post-operative Duplex was done one day and one month. 

Figure 1: A & B) Caprini’s Saphenous Ablation. 

Figure 2: Standard Caprini's Risk Assessment.

Patients with primary varicose veins with saphenofemoral junction incompetence with CEAP classification 2-6.

• Patients with history of DVT
• Patients with recurrent varicose veins
• Patients who are unable to provide an informed consent
• Pregnant patients at the time of the examination

Age: 35.6+0.2, 34.3+0.5 and 37.6+0.09 years in the 3 groups M/F: 6/14, 8/12 and 7/13. In group A) all patients showed absent reflux post operatively and in all follow up visits .Dilated veins was noticed on the left side in 12 patients 60%, 2 patient on right and on 6 patients 30 % in Group (A), 14 patients 70%,one patient 5% and 5 patients 25% in Group (B) and 13 patients 65%,2 patients 10% and 5 patients 25% in Group (C), Table 1. 

Table 1: Side of varicose veins in the groups. 

Clinical presentation according to CEAP Classification showed that:(2,8,9,0,1 patents) were C2,3,4,5,and 6 in Group A , ( 2,7,9,1,1 patents) were C2,3,4,5,and 6 in Group B and( 3,6,10,0,1 patents) were C2,3,4,5,and 6 in Group C. Duplex examination revealed significant reflux in the great saphenous veins in all patients and ranged from 0.7:0.9 Sec. and mean duration 0.7+0.09 Sec. Vein diameter ranged from (0.6: 0.9,X+0.76 CM.) in group A), (0.6: 0.8,X+0.7 CM.) in group B) , (0.5: 0.8,X+0.65 CM.) in group C) Table 2. 

Table 2: Preoperative Duplex. 

According to Caprini’s saphenous score 14 patients 70% were classified as low risk who used compression stockings only , 4 patients 20% were of moderate risk who received 40mg Enoxaparin /day for one week in addition to the stockings and 2 patients 10% of high-risk who received 40mg Enoxaparin /day for 28 days in addition to the stockings in Group A, while applying standard Caprini’s Score in group B patients revealed : 6 patients 30% were of moderate risk and 14 patients 70% of high risk in Group B ) Table 3. 

Table 3: Risk assessment in Group A &B patients according to both risk assessment scores. 

So, 14 patients 70% received Enoxaparin 40 mg / day for 7 days in group B patients, only 4 patients 20% received the same dose and duration ,with 2 patients 10% received the same dose for 28 days in group A patients. No VTE events were shown in both A&B, while 3 patients developed superficial thrombophlebitis 15% and one patient 5% developed left calf DVT in Group C, and the estimated Saphenous score was 11 and the standard score was 7 for these patients. Significant drop in VCSS in patients in the three groups, it dropped from 10.9 to 8.1, from 10.7 to 7.9 and 10.6 to 7.7 in group A, B and C. The time needed to complete total ablation of GSV ranged from 40:51.5, with a mean time 43.6+0.3, 44.3+0.9, 43.7 + 0.75 minutes the 3 groups. 

So, 14 patients 70% received Enoxaparin 40 mg / day for 7 days in group B patients, only 4 patients 20% received the same dose and duration ,with 2 patients 10% received the same dose for 28 days in group A patients. No VTE events were shown in both A&B, while 3 patients developed superficial thrombophlebitis 15% and one patient 5% developed left calf DVT in Group C, and the estimated Saphenous score was 11 and the standard score was 7 for these patients. Significant drop in VCSS in patients in the three groups, it dropped from 10.9 to 8.1, from 10.7 to 7.9 and 10.6 to 7.7 in group A, B and C. The time needed to complete total ablation of GSV ranged from 40:51.5, with a mean time 43.6+0.3, 44.3+0.9, 43.7 + 0.75 minutes the 3 groups [8-10].

Risk assessment of patients undergoing varicose veins ablation should be done and applying Caprini’s saphenous score as a better alternative to Standard Caprini’s score for VTE prophylaxis and is considered a safe and cost-effective tool in VTE prevention in these patients.

The authors have no conflict of interest to declare.

The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

The authors report no involvement in the research by the sponsor that could had influenced the outcome of this work.

The authors acknowledge doctors and nursing staff in vascular surgery department of Alexandria Armed Forces hospital for proofreading activity.

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