Title: The Development of Reporting Standards for Ablation-Related Thrombus Extension (ARTE) 

Author: Tristan Bennett, BSA, Peter Lawrence, MD

Area of Concentration: Basic, Clinical, & Translational Research

Specialty: Vascular Surgery (Venous Disease)

Keywords: (Ablation-Related Thrombus Extension (ARTE), Endothermal Heat-Induced Thrombosis (EHIT))

Background & Objectives: Ablation-related thrombus extension (ARTE), previously called EHIT, is a known complication of endovenous vein ablation. AVF/SVS reporting standards were developed before nonthermal ablations were commonly used and only address the extent of thrombus in the deep system, without other critical variables. In addition, the reported risk of ARTE after nonthermal ablation is significantly greater than with thermal techniques. Since there are currently no requirements for reporting additional variables with ARTE, it is not possible to compare ARTE outcomes in research publications. This study queried venous ablation experts regarding key variables that should be included when reporting ARTE. 
Methods: A 22-item survey was developed using MESH terms [EHIT, ARTE] and other appropriate terms, after a systematic review of 159 research publications for variables that were reported with EHIT or ARTE. We then surveyed venous experts regarding the importance of each variable. The survey was distributed to investigators who had previously participated in varicose vein guidelines, venous ulcer guidelines, or EHIT reporting standards. Respondents rated patient demographics, risk factors, procedure details, vein characteristics, perioperative management, and antithrombotic medications. 
Results: Twenty-nine vein specialists rated the importance of clinical variables on a 10-point scale (see Table 1 and Table 2). The eight highest-rated variables (mean±SEM) were: ablation distance to the deep system (8.55±0.37), history of ipsilateral DVT or PE (7.76±0.47), vein diameter (7.52±0.52), anatomic vein site (7.07±0.51), PEM volume (6.90±0.51), BMI (6.72±0.51), commercial foam volume (6.71±0.51), and history of ipsilateral SVT (6.21±0.44).  
Conclusions: The high scores of the eight venous ablation variables support the requirement to use them in all research publications that include ARTE reporting standards, before a paper is accepted in a peer-reviewed journal.