The Incidence and Outcome of Endothermal Heat-induced Thrombosis after Endovenous Laser Ablation

Kane, Katherine; Fisher, Tammy; Shutze, William P.; Hicks, Taylor D.; Grimsley, Brad; Gable, Dennis; Pearl, Greg; Smith, Bert

doi:10.1016/j.avsg.2014.05.005

Cited by 74 publications

(59 citation statements)

References 12 publications

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“…1,2 Initial studies described eHIT as a complication with low incidence rates, but subsequent clinical experience reported the actual incidence to be higher. 4 As a result, eHIT was studied more extensively, with risk factors demonstrated in the literature, and classification systems created to guide management ranging from observation with serial ultrasound to anticoagulation. 5 Similar to eHIT, the theoretical risk of a thrombus with glue extension in the deep venous system is the potential for embolus to the pulmonary system -a potentially fatal event.…”

Section: Discussionmentioning

confidence: 99%

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Thrombosis Following Endovenous Glue Ablation

Deen¹,

Bullen²

2020

Vascular and Endovascular Review

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Endovenous glue ablation for lower limb varicose veins is growing in popularity due to its safety and efficacy. Of significant concern is glue-associated thrombus extension into deep veins. We present a case of thrombus extending into the common femoral vein following endovenous glue ablation for varicose veins with the VenaSealTM closure system (VCS; Medtronic). A 63-year-old man who presented with symptomatic varicose veins had incompetence of the saphenofemoral junction. He underwent endovenous glue ablation using VCS closure. At 1 month, improvement in varicosities was mirrored by duplex ultrasound confirmation of successful long saphenous vein ablation, but ultrasound indicated thrombus extending into the common femoral vein. This was managed by surveillance duplex and serial clinical observation, with spontaneous resolution at 12 months. With increasing use of VCS for varicose veins, it is likely that thrombotic complications of the deep veins will be encountered more frequently. It is time for formulation of guideline-based management of this complication.

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Section: Discussionmentioning

confidence: 99%

“…There is a similar, well-researched complication, in TT techniques -endogenous heat-induced thrombosis (eHIT), for which classification systems and management guidelines exist. 4,5 In the case of endovenous glue ablation, further concerns are raised in patients who are high risk, as to whether the risk of embolisation may be similar to that of eHIT.…”

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confidence: 99%

Thrombosis Following Endovenous Glue Ablation

Deen¹,

Bullen²

2020

Vascular and Endovascular Review

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“…This mechanism of action can be regulated by physical parameters, such as wavelength, method of energy administration, and quantity of energy per surface area. 15,16 The level of energy absorbed is extremely important, since the vessel will only retract once it reaches a certain level and, if this is not achieved, the vein may remain open or recanalize. [17][18][19] Conversely, an excessive amount of energy could injure adjacent tissues, such as nerves and lymph vessels.…”

Section: Discussionmentioning

confidence: 99%

Influência da densidade de energia endovenosa linear no sucesso da termoablação endovenosa a laser como tratamento da insuficiência venosa crônica

Heineberg¹,

Brandão²,

Caron³

et al. 2019

J. vasc. bras.

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Resumo Contexto Mostra-se relevante a elucidação da influência da densidade de energia endovenosa linear (linear endovenous energy density, LEED) média no sucesso do tratamento da insuficiência venosa crônica por termoablação endovenosa a laser visando diminuir a morbidade desse método. Objetivos Avaliar a influência da LEED média na prevalência de fechamento das safenas após 30 dias do procedimento. Métodos Foram analisados 153 membros inferiores de 118 pacientes de um hospital referência, submetidos a termoablação com laser endovenoso 1470 nm sob anestesia local para o tratamento de insuficiência venosa crônica. Foi calculada a LEED média dos pacientes tratados para determinar se foi necessária uma energia maior que a média para o sucesso do tratamento. Resultados Dos 153 membros inferiores submetidos ao tratamento, houve diferença significativa (p = 0,021) no fechamento da junção safeno-femoral relacionada à LEED média utilizada acima do joelho. Por outro lado, no segmento de coxa não houve diferença significativa. Conclusões A LEED acima da média de 70,57 J/cm apresentou um índice maior de fechamento na junção safeno-femoral. Porém, no segmento de coxa, a densidade não influenciou o resultado, demonstrando que uma energia mais alta do que 70,57 J/cm tende a não ser necessária para o tratamento desse segmento.

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“…However, the extent to which these factors represent "risk factors" for the development of EHIT remains controversial. Factors related to the procedure include: the use of general or epidural anaesthesia, the incorrect positioning of the radiofrequency catheter or laser fibre at the saphenous femoral junction, and adjunctive phlebectomies of collaterals (8,(11)(12)(13)(14)(15).…”

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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The Incidence and Outcome of Endothermal Heat-induced Thrombosis after Endovenous Laser Ablation

Cited by 74 publications

References 12 publications

Thrombosis Following Endovenous Glue Ablation

Thrombosis Following Endovenous Glue Ablation

Influência da densidade de energia endovenosa linear no sucesso da termoablação endovenosa a laser como tratamento da insuficiência venosa crônica

EHIT after thermoablation

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