Delayed Presentation of Endovenous Heat-Induced Thrombosis Treated by Thrombolysis and Subsequent Open Thrombectomy

Kwak, JungHak; Kim, Song-Yi; Han, Ahram; Choi, Chanjoong; Ahn, Sanghyun; Ha, Jong‐Won; Min, Sang Il

doi:10.5758/vsi.2016.32.2.72

Cited by 10 publications

(10 citation statements)

References 10 publications

(15 reference statements)

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“…The reason for these contrasting data is not clear, probably some authors consider EHIT only when thrombus protruding into common femoral vein is present (EHIT class 2 [3,4]) and not EHIT-1, the most frequent, with the thrombus at saphenous femoral junction. Another potential reason is the lack of post-operative ultrasound surveillance that could be responsible for EHIT remaining under-recognized in asymptomatic patients (7,9).…”

Section: Discussionmentioning

confidence: 99%

EHIT after thermoablation

Mitri¹,

Leo²,

Romano³

2017

Phlebologie

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SummaryAim: After 10 years of experience, we evaluated the incidence and management of endothermal heat-induced-thrombosis (EHIT), i.e. saphenous vein thrombosis following endothermic treatment of saphenous vein re-flux.Methods: From 2006 to 2016 data were retrospectively collected on 840 patients undergoing saphenous vein treatment by laser and radiofrequency technique. All patients were treated with tumescent local anaesthesia in an ambulatory setting to promote early mobilization. Class II compression stockings and heparin were recommended for 5 days post-operatively.Results: EHIT was observed in 15 patients from a total of 992 saphenous veins which were evaluated (1,5 %). 14 patients treated by EVLA had EHIT 1, one patient by RFA had EHIT 2, complicated by pulmonary embolism. All EHIT patients were treated by low weight molecular heparin. 980 nm laser and bare-tip fibres had been used in EVLA-EHIT patients. EHIT was not observed in patients treated by 1470 nm laser and radial fibres.Conclusions: Latest generation technology, the ambulatory setting and local anaesthesia probably contributed to the low incidence of EHIT reported. Further studies are necessary for a better acquaintance of these complications and to facilitate the development of specific guidelines.

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Section: Discussionmentioning

confidence: 99%

EHIT after thermoablation

Mitri¹,

Leo²,

Romano³

2017

Phlebologie

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“…Hierbei werden vier Grade der EHIT unterschieden. Grad 4 repräsentiert den vollständigen Verschluss einer tiefen Beinvene -die tiefe Beinvenenthrombose [10]. Studien und Publikationen zu dem Risiko postoperativer tiefer Beinvenenthrombosen nach endovenösen thermischen Ablationen, beschreiben ein Thromboserisiko von ca.…”

Section: Postoperative Thromboseunclassified

Varizenchirurgie: Belastender als andere Verfahren?

Brunig¹,

Buhr²

2019

Phlebologie

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ZusammenfassungSämtliche in der Varizenchirurgie angewandten Verfahren beherbergen Risiken. Die Risiken der klassischen operativen Sanierung der Varikosis mittels Stripping sind in der Literatur sehr ausführlich beschrieben.Bei den neueren therapeutischen Optionen, wie z. B. den endovenösen Therapien oder der Schaumsklerosierung werden die möglichen Komplikationen erst in jüngerer Zeit systematisch ausgewertet. Dementsprechend liegen derzeit im Vergleich wenige Daten hierzu vor.Betrachtet man die Lebensqualität des Patienten in den neuesten Vergleichsstudien und Metaanalysen, zeigt sich, dass perioperativ kaum Unterschiede in der Mobilität, Mortalität und Lebensqualität des Patienten bei den unterschiedlichen Therapieverfahren bestehen [1].Insgesamt ist davon auszugehen, dass die klassische operative Sanierung der Varikosis mittels Crossektomie, Stripping und Miniphlebektomien im Vergleich zu den endovenösen Therapieverfahren sowohl mit einem erhöhten Blutungsrisiko, also auch mit einem erhöhten postoperativen Infektionsrisiko einhergeht. Grundsätzlich ist das Blutungsrisiko, als auch das Infektionsrisiko jedoch auch bei der Operation als niedrig einzuschätzen.Das perioperative Nervenverletzungsrisiko scheint bei beiden Verfahren ähnlich häufig zu sein, wobei repräsentative Daten aus Vergleichsstudien fehlen.Das postoperative Thromboserisiko mit ggf. konsekutiver Lungenarterienembolie ist unseres Erachtens nach bei den endovenösen Verfahren höher einzustufen als nach einer klassischen operativen Sanierung der Varikosis.Kosmetisch beeinträchtigende, postinflammatorische Hyperpigmentierungen im OP-Gebiet treten häufiger nach endovenösen Therapieverfahren und nach Sklerosierungstherapien auf.

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“…EVA is a minimally invasive procedure that utilizes radiofrequency or laser energy to purposely thrombose a vein by inducing endothelial injury to the superficial veins of the lower extremities. 3 Although EVA is a minimally invasive procedure, there is a risk of thrombotic complications, including EHIT, DVT, and a risk of subsequent PE. 4 EVA poses a unique risk of clinically induced thrombus propagating to or past the saphenofemoral or saphenopopliteal junction and into the deep system, termed EHIT.…”

Section: Endovenous Ablationmentioning

confidence: 99%

“…4,[13][14][15][16][17][18] Reported incidence of EHIT in literature widely ranges from 0% to 8% post-EVA. 3,5 The incidence of DVT and PE post-EVA has also been reported to range from 0.5% to 7.7% and 0.2% to 0.3%, respectively. 2,4 A study conducted by Ryer et al, 19 including 488 patients who underwent a RFA procedure, detected EHIT in approximately 2% post-RFA procedure.…”

Section: Endovenous Ablationmentioning

confidence: 99%

Acute Thrombotic Complication Post-Endovenous Ablation With Mobile Thrombus: A Case Study

O’Brien

Mohammad

2019

Journal of Diagnostic Medical Sonography

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Endovenous ablation is a common procedure performed on the superficial veins of the lower extremities to treat symptoms of venous insufficiency and varicose veins. While endovenous ablation is a minimally invasive procedure, patients may develop thrombotic complications including endovenous heat-induced thrombosis. Endovenous heat-induced thrombosis is a rare complication of thrombus extension from the superficial vein into or near the deep system postprocedure. In this case report, a female with a history of recent endovenous ablation presented to the emergency department with symptoms of a pulmonary embolism. Sonographic evaluation of the right lower extremity revealed extension of thrombus from the ablated superficial vein into the common femoral vein. Thrombus was also noted in the left lower extremity extending from the ablated superficial vein to approximately the saphenofemoral junction. While the left lower extremity was being interrogated, the thrombus was documented, via a cine clip, liberating from the occluded great saphenous vein. Further assessment utilizing computed tomography revealed bilateral pulmonary emboli. This unique case emphasizes the importance of sonographic evaluation post-endovenous ablation.

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Delayed Presentation of Endovenous Heat-Induced Thrombosis Treated by Thrombolysis and Subsequent Open Thrombectomy

Cited by 10 publications

References 10 publications

EHIT after thermoablation

EHIT after thermoablation

Varizenchirurgie: Belastender als andere Verfahren?

Acute Thrombotic Complication Post-Endovenous Ablation With Mobile Thrombus: A Case Study

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