Management of endovenous heat-induced thrombus using a classification system and treatment algorithm following segmental thermal ablation of the small saphenous vein

Abstract

RFA of the SSV in symptomatic patients has a high success rate with a low risk of DVT. A classification system and treatment protocol based on the level of EHIT in relation to the saphenopopliteal junction is useful in managing patients. The approach to patients with thrombus flush with the popliteal vein or bulging has not been previously defined; our outcomes were excellent, using our treatment algorithm.

Pre-operative Color Doppler Ultrasonography Predicts Endovenous Heat Induced Thrombosis after Endovenous Radiofrequency Ablation

“…1). The closure level of the GSV was classified according to Harlander et al 10 : Level 1 represented closure with thrombus below the level of the SEV. Level 2 represented closure with thrombus extension flush with the orifice of the SEV.…”

Disease-specific guidelines for reporting adverse events for peripheral vascular medical devices

“…It is important to specify the severity of endovenous heateinduced injury by a standard classification system. 50,51 Last, air embolism can occur after sclerosing procedures, particularly after use of foam sclerotherapy. 52 Like all adverse events, failure of a procedure or device to achieve its therapeutic goals, in this case complete obliteration, is reported as a clinical failure of therapy rather than as an adverse event.…”

Venous duplex and pathologic differences in thrombus characteristics between de novo deep vein thrombi and endovenous heat-induced thrombi

“…Some authors suggest anticoagulation therapy for EHIT, whereas others have outlined various treatment algorithms based on the extent of thrombus extension into the deep femoral vein. 14,15 The clinical and treatment considerations for EHIT are not well defined in the literature despite the vast number of studies related to deep vein thrombi (DVT) that are not associated with endovenous ablation techniques. In spite of the few studies of the ultrasound differentiation between EHIT and DVT, there remains a paucity of literature regarding the evaluation of the ultrasound examination and the pathologic differentiation.…”

“…In spite of the few studies of the ultrasound differentiation between EHIT and DVT, there remains a paucity of literature regarding the evaluation of the ultrasound examination and the pathologic differentiation. [14][15][16][17] Although studies have evaluated the prevalence of EHIT and proposed treatment regimens, they have failed to verify and to validate the ultrasound characteristics of EHIT. [14][15][16] It would seem plausible that the pathologic inciting event for the development of a de novo DVT would potentially be different from that of an EHIT.…”

“…[14][15][16][17] Although studies have evaluated the prevalence of EHIT and proposed treatment regimens, they have failed to verify and to validate the ultrasound characteristics of EHIT. [14][15][16] It would seem plausible that the pathologic inciting event for the development of a de novo DVT would potentially be different from that of an EHIT. This could potentially create a dichotomy of treatment implications as well as future surveillance strategies.…”