Incidence, Risk Factors, Progression, and Treatment of Endovenous Heat-Induced Thrombosis Class 2 or Greater After Endovenous Radiofrequency Ablation

Abstract

BACKGROUND Endovenous heat-induced thrombosis (EHIT) is a thrombus that extends from an ablated saphenous vein into the common femoral vein after endovenous radiofrequency ablation (RFA). OBJECTIVE To investigate the incidence, progression, treatment, and risk factors associated with EHIT-2 or greater after RFA. MATERIALS AND METHODS This retrospective study included patients diagnosed with symptomatic superficial venous incompetence that were treated by RFA of the great saphenous vein or anterior accessory saphenous vein during the July 2012 to December 2016 study period. Duplex ultrasound scanning was performed at 1 week, 1 month, 3 months, and every year after RFA to detect EHIT. RESULTS A total of 317 legs from 274 patients were included. The incidence of EHIT-2 or greater was 7.0%, including 5.4% EHIT-2, 1.3% EHIT-3, and 0.3% EHIT-4. No symptomatic pulmonary embolism was found. The independent risk factors for EHIT-2 or greater were vein diameter (p = .027) and concomitant sclerotherapy (p = .037). CONCLUSION The risk factors found to be independently associated with EHIT-2 or greater were large vein size and concomitant sclerotherapy. Screening for EHIT should be performed in patients with one or both of these risk factors within 1 week after RFA and in patients with postoperative symptoms suggestive of venous thromboembolism.

Comparison of Modified Above-Knee and Conventional Surgery with the Stripping of the Great Saphenous Vein of Varicose Veins of the Lower Extremities: A Retrospective Study

“…It was reported that a >6 mm GSV proximal diameter was an independent risk factor for endovenous laser recurrence and foam sclerotherapy after varicose veins of lower extremities. However, the recurrence incidence and venous thrombosis increased after radiofrequency ablation when the GSV proximal diameter was >8 mm [ 18 ]. Therefore, the definition of GSV proximal diameter was set as >8 mm in this study [ 19 , 20 ].…”

The Matter of Inflammatory Responses in Endovenous Radiofrequency Ablation and Conventional Venous Stripping

“…CRP has half life of 19 hours and gets peak level at 36-50 hours [42], whereas IL-6 has half life of 2-3 hours and gets peak level at 12-18 hours [43]. Because half life of CRP is longer than IL-6, 24-hr postoperative level of CRP increased less than IL-6.…”

Management of endothermal heat-induced thrombosis

“…With class I, both subgroups require no treatment and no further surveillance ultrasound scans are required unless to evaluate for research purposes. In a small proportion of patients with class II EHIT and above, small cohort studies have suggested that EHIT can progress to higher classes, 3 , 5 and therefore, surveillance is required, and treatment may be indicated. In class II, patients may be stratified into low and high risk for thrombus propagation.…”