Thrombus Extension into the Common Femoral Vein after Endovenous Ablation of the Greater Saphenous Vein for the Treatment of Venous Insufficiency

Abstract

Increasingly, endovenous ablation of the greater saphenous vein (GSV) is used for the treatment of symptomatic varicose veins. The propagation of thrombus can result in a “tail of thrombus” within the common femoral vein (CFV). In two cases, patients were treated with low molecular weight heparin and re-imaged within 1 week. In both cases, complete resolution of the thrombus was confirmed, and anticoagulation was discontinued. Thrombus extension into the CFV after endovenous ablation may be safely treated with short-term anticoagulation and followed by duplex ultrasound. If unresolved, standard deep vein thrombosis anticoagulation is indicated.

EHIT after thermoablation

“…The incidence of EHIT reported in the literature varies widely between studies and ranges from 0-16 % (16)(17)(18). 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.…”

Guidelines of the First International Consensus Conference on Endovenous Thermal Ablation for Varicose Vein Disease – ETAV Consensus Meeting 2012

“…Synonymously the term endovenous heat induced thrombosis (EHIT) is used for this condition. 118,121 It is classified into four stages: PASTE (EHIT) type I involves thrombosis to the level of the superficial-deep junction, type II involves thrombus extension into the deep venous system with cross-sectional area 50%, type III involves thrombus extension into the deep venous system with cross-sectional area 50%, and type IV is total occlusion of the deep vein. 92 In a large series of 1000 RFA procedures with 35% patients undergoing concomitant phlebectomies (examined by ultrasound 24-72 h after the procedure) PASTE class II and III was found in 4.1% of the patients.…”