FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2054297435> ?p ?o ?g. }

• W2054297435 endingPage "531" @default.
• W2054297435 startingPage "529" @default.
• W2054297435 abstract "We report a case of a 58-year-old male patient who underwent successful endovenous radiofrequency ablation of the left great saphenous vein for CEAP class 4a venous disease. On the third postoperative day, he had a duplex ultrasound scan for evaluation which showed successful occlusion of the great saphenous vein (GSV) with class 2 endovenous heat-induced thrombus (EHIT) that disappeared during the evaluation and caused a pulmonary embolism. To our knowledge, no case of pulmonary embolism has been reported to occur during postoperative follow-up duplex scanning. Relevant literature is reviewed and a possible mechanism for thrombus dislodgement is entertained. We report a case of a 58-year-old male patient who underwent successful endovenous radiofrequency ablation of the left great saphenous vein for CEAP class 4a venous disease. On the third postoperative day, he had a duplex ultrasound scan for evaluation which showed successful occlusion of the great saphenous vein (GSV) with class 2 endovenous heat-induced thrombus (EHIT) that disappeared during the evaluation and caused a pulmonary embolism. To our knowledge, no case of pulmonary embolism has been reported to occur during postoperative follow-up duplex scanning. Relevant literature is reviewed and a possible mechanism for thrombus dislodgement is entertained. Endovenous thermal ablation of the saphenous veins using radiofrequency ablation (RFA) or endovenous laser ablation has become the most common method of treatment for varicose veins and symptomatic venous reflux disease, and is getting wide acceptance.1Almeida J.I. Kaufman J. Göckeritz O. Copra P. Evans M.T. Hoheim D.F. et al.Radiofrequency endovenous Closure FAST versus laser ablation for the treatment of great saphenous reflux: a multicenter, single-blinded, randomized study (RECOVERY Study).J Vasc Interv Radiol. 2009; 20: 752-759Abstract Full Text Full Text PDF PubMed Scopus (211) Google Scholar, 2Lurie F. Creton D. Eklof B. Kabnick L.S. Kistner R.L. Pichot O. et al.Prospective randomised study of endovenous radiofrequency obliteration (closure) versus ligation and vein stripping (EVOLVeS): two-year follow-up.Eur J Vasc Endovasc Surg. 2005; 29: 67-73Abstract Full Text Full Text PDF PubMed Scopus (309) Google Scholar Minor complications such as skin bruising/hematoma, bleeding, transient paresthesias, and skin burns have been reported in 3% to 20% of patients.3Merchant R.F. Pichot O. Closure Study GroupLong-term outcomes of endovenous radiofrequency obliteration of saphenous reflux as a treatment for superficial venous insufficiency.J Vasc Surg. 2005; 42 (discussion 509): 502-509Abstract Full Text Full Text PDF PubMed Scopus (284) Google Scholar Major complications which include deep venous thrombosis (DVT) and pulmonary embolism (PE) are rare. Extension of thrombus from the saphenous to the femoral or popliteal veins have been reported to occur in 0% to 6% of patients.4Kabnick L.S. Complications of endovenous therapies: statistics and treatment.Vascular. 2006; 14: S31-S32Google Scholar The term endovenous heat-induced thrombus (EHIT) was introduced by Kabnick4Kabnick L.S. Complications of endovenous therapies: statistics and treatment.Vascular. 2006; 14: S31-S32Google Scholar who also classified the level of thrombus from 1 to 4 classes.4Kabnick L.S. Complications of endovenous therapies: statistics and treatment.Vascular. 2006; 14: S31-S32Google Scholar Hingorani et al5Hingorani A.P. Ascher E. Markevich N. Schutzer R.W. Kallakuri S. Hou A. et al.Deep venous thrombosis after radiofrequency ablation of greater saphenous vein: a word of caution.J Vasc Surg. 2004; 40: 500-504Abstract Full Text Full Text PDF PubMed Scopus (187) Google Scholar reported extension of thrombus in 16% of limbs treated with RFA, and raised caution about the procedure and recommended early postoperative duplex scan evaluation. Most of these thrombi retract or absorb, but they theoretically can also detach and cause a PE. A 58-year-old man was referred to our office by his primary physician with symptoms of left calf pain and progressive edema which had gradually gotten worse over the previous 3 months. The symptoms were more prominent at the end of the day. There was no family history of thrombophilia and his medical history was negative. He had no history of DVT and no history of smoking. He was taking no medications. On examination, his weight was 134 pounds, height was 5′6″, with a body mass index of 21.63. His blood pressure was 110 over 68, his pulse rate was 82/minute, and his respiratory rate was 16/minute. The general physical examination was essentially negative. The right leg had no evidence of varicose veins or stigmata of venous insufficiency. On the left leg, there was an area of skin hyperpigmentation in the distal medial calf. There were also obvious varicosities in the medial and posterior calf regions. His CEAP class was 4a and the Venous Clinical Severity Score was 6. The patient used compression stockings in the past for about 3 months without significant improvement. Duplex ultrasound scan evaluation was performed in our Intersocietal Commission for the Accreditation of Vascular Laboratories which showed reflux in the left great saphenous vein (GSV) with a maximum reflux of 3.5 seconds near the confluence of the saphenous vein. The maximum diameter of the GSV was 11 mm above the knee and 5 mm below the knee. The deep veins were all normal. The patient underwent RFA of the left GSV using ClosureFAST (VNUS MEDICAL Technologies Inc, San Jose, Calif) in a standard technique, with the head down position using tumescent anesthesia totaling 290 mL. The vein was accessed below the knee. The catheter tip was 2.8 cm from the saphenofemoral junction and 2.3 cm from the superficial epigastic vein. No prophylactic anticoagulation or aspirin was given to the patient. Postoperatively, the patient was active and walking, and used elastic stockings. The patient was re-evaluated 3 days later in our vascular laboratory, and the GSV was noted to be completely occluded. There was EHIT class 2 in the left saphenofemoral junction. The common femoral vein was compressible and had flow but there was thrombus protruding into the lumen filling <50% of the lumen (Fig 1) . There was no loose tail or floating thrombus. The evaluation was done in a routine fashion and no excessive compression was used. When the saphenofemoral region was re-evaluated after the compression test, the thrombus, which was protruding into the femoral vein, disappeared (Fig 2) . The patient was immediately referred to the hospital for PE workup. A computed tomography (CT) scan of the chest with contrast was obtained. This was positive for acute bilateral small segmental pulmonary emboli (Fig 3) . The patient had no symptoms of cough, chest pain, or shortness of breath. His vital signs were normal except for a heart rate of 116. The pulse oximetry was 100% on room air. He was admitted to the hospital and treated with enoxaparin sodium (lovenox) 1 mg/kg subcutaneously twice a day and then converted to warfarin. The admission was made necessary because he could not be treated as an outpatient over the weekend. The enoxaparin was continued until the international normalized ratio (INR) was therapeutic. He was discharged from the hospital after 3 days on 7.5 mg of warfarin daily by mouth and followed as an out-patient. Follow-up duplex scans done after 1 week, 1 month, 2 months, and 6 months showed no evidence of DVT and the GSV remained occluded. The oral anticoagulation was discontinued after 4 months. The Venous Clinical Severity Score improved from 6 to 4.Fig 2Duplex ultrasound scan of the saphenofemoral junction (SFJ) after compression, showing disappearance of thrombus from the common femoral vein (CFV) and distal great saphenous vein (GSV).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig 3Computed tomography (CT) of the chest showing acute bilateral small segmental pulmonary emboli.View Large Image Figure ViewerDownload Hi-res image Download (PPT) DVT and PE are rare complication of EHIT. Kabnick4Kabnick L.S. Complications of endovenous therapies: statistics and treatment.Vascular. 2006; 14: S31-S32Google Scholar introduced the term EHIT and noted that this is more benign than the spontaneously occurring thrombosis, in that it is stable and usually regresses or shows complete resolution. He also made the observation that EHIT displays a different sonographic echogenicity and becomes echogenic in <24 hours. The EHIT in our case does show increased echogenicity. He classified EHIT from class 1 to class 4. Another classification system was recently introduced by Lawrence et al6Lawrence P.F. Chandra A. Wu M. Rigberg D. DeRubertis B. Gelabert H. et al.Classification of proximal endovenous closure levels and treatment algorithm.J Vasc Surg. 2010; 52: 388-393Abstract Full Text Full Text PDF PubMed Scopus (85) Google Scholar from level 1 to 6. The International Endovascular Working Group registry shows that DVT/EHIT occurred in 0.27% (10 of 3696 cases) and PE occurred in 0.023% (1 of 3696) after endovenous laser ablation.4Kabnick L.S. Complications of endovenous therapies: statistics and treatment.Vascular. 2006; 14: S31-S32Google Scholar In a review of 11 articles, Mozes et al7Mozes G. Kalra M. Carmo M. Swenson L. Gloviczki P. Extension of saphenous thrombus into the femoral vein: a potential complication of new endovenous ablation techniques.J Vasc Surg. 2005; 41: 130-135Abstract Full Text Full Text PDF PubMed Scopus (185) Google Scholar reported 21 case of DVT and 2 cases of PE after the VNUS Closure (VNUS MEDICAL Technologies Inc) procedure.7Mozes G. Kalra M. Carmo M. Swenson L. Gloviczki P. Extension of saphenous thrombus into the femoral vein: a potential complication of new endovenous ablation techniques.J Vasc Surg. 2005; 41: 130-135Abstract Full Text Full Text PDF PubMed Scopus (185) Google Scholar At the Arizona Heart Institute, with >1000 cases of venous ablation, only 1 case of pulmonary embolism was reported.8Ravi R. Rodriguez-Lopez J. Ramaiah V. Diethrich E.B. Regarding “Extension of saphenous thrombus into the femoral vein: a potential complication of new endovenous ablation techniques.”.J Vasc Surg. 2005; 42 (author reply 182-3): 182Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar To decrease the risk of EHIT formation, several suggestions have been offered: the position of the catheter tip should be at least 2 cm from the saphenofemoral or saphenopopliteal junction, reduce the thrombus load by elevation of the leg during ablation, and also by using adequate tumescent anesthesia.7Mozes G. Kalra M. Carmo M. Swenson L. Gloviczki P. Extension of saphenous thrombus into the femoral vein: a potential complication of new endovenous ablation techniques.J Vasc Surg. 2005; 41: 130-135Abstract Full Text Full Text PDF PubMed Scopus (185) Google Scholar A recent article showed that a GSV diameter of >8 mm and history of DVT were associated with EHIT class 2 or greater.6Lawrence P.F. Chandra A. Wu M. Rigberg D. DeRubertis B. Gelabert H. et al.Classification of proximal endovenous closure levels and treatment algorithm.J Vasc Surg. 2010; 52: 388-393Abstract Full Text Full Text PDF PubMed Scopus (85) Google Scholar But another study which evaluated the influence of procedural factors concluded that there was no difference in catheter tip position or mean diameter of the treated vein between the EHIT and non-EHIT groups.9Rhee S.J. Stoughton J. Cantelmo N.L. Procedural factors influencing the incidence of endovenous heat induced thrombosis (EHIT).J Vasc Surg. 2011; 53: 555Abstract Full Text Full Text PDF Google Scholar There is no report on association of EHIT with hypercoagulable states. Our patient had no history of DVT or family history of thrombophilia, and the catheter tip was definitely identified at 2.8 cm from the saphenofemoral junction and 2.3 cm from the superficial epigastic vein. The diameter of his GSV was 11 mm, which may have contributed to the EHIT. We hypothesize that the standard technique of compression of the superficial and deep veins10Raghavendra B.N. Horii S.C. Hilton S. Subramanyam B.R. Rosen R.J. Lam S. Deep venous thrombosis: detection by probe compression of veins.J Ultrasound Med. 1986; 5: 89-95Crossref PubMed Scopus (97) Google Scholar used to evaluate for DVT at the saphenofemoral junction may have contributed to the dislodgement of the thrombus causing PE. To our knowledge, there has been no report of PE caused during ultrasound scan evaluation of EHIT. We recommend that when thrombus protrusion into the femoral or popliteal vein is observed after endovenous ablation, one should not use compression of the femoral vein, to avoid dislodgement and possible PE. Instead, a Valsalva maneuver should suffice. The treatment of asymptomatic PE after venous ablation is controversial, but it may not be necessary when the thrombus load is small. Further clinical study is needed to clarify this point." @default.
• W2054297435 created "2016-06-24" @default.
• W2054297435 creator A5016253719 @default.
• W2054297435 creator A5067378107 @default.
• W2054297435 creator A5089248774 @default.
• W2054297435 date "2012-02-01" @default.
• W2054297435 modified "2023-10-14" @default.
• W2054297435 title "Case of the disappearing heat-induced thrombus causing pulmonary embolism during ultrasound evaluation" @default.
• W2054297435 cites W1985676329 @default.
• W2054297435 cites W1995036178 @default.
• W2054297435 cites W2008283648 @default.
• W2054297435 cites W2070236491 @default.
• W2054297435 cites W2096120269 @default.
• W2054297435 cites W2137792716 @default.
• W2054297435 cites W2144965330 @default.
• W2054297435 cites W2167096084 @default.
• W2054297435 cites W2257909428 @default.
• W2054297435 doi "https://doi.org/10.1016/j.jvs.2011.07.070" @default.
• W2054297435 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/21958568" @default.
• W2054297435 hasPublicationYear "2012" @default.
• W2054297435 type Work @default.
• W2054297435 sameAs 2054297435 @default.
• W2054297435 citedByCount "17" @default.
• W2054297435 countsByYear W20542974352013 @default.
• W2054297435 countsByYear W20542974352014 @default.
• W2054297435 countsByYear W20542974352015 @default.
• W2054297435 countsByYear W20542974352017 @default.
• W2054297435 countsByYear W20542974352018 @default.
• W2054297435 countsByYear W20542974352019 @default.
• W2054297435 countsByYear W20542974352020 @default.
• W2054297435 countsByYear W20542974352021 @default.
• W2054297435 countsByYear W20542974352023 @default.
• W2054297435 crossrefType "journal-article" @default.
• W2054297435 hasAuthorship W2054297435A5016253719 @default.
• W2054297435 hasAuthorship W2054297435A5067378107 @default.
• W2054297435 hasAuthorship W2054297435A5089248774 @default.
• W2054297435 hasBestOaLocation W20542974351 @default.
• W2054297435 hasConcept C126838900 @default.
• W2054297435 hasConcept C143753070 @default.
• W2054297435 hasConcept C164705383 @default.
• W2054297435 hasConcept C2776265017 @default.
• W2054297435 hasConcept C2781362458 @default.
• W2054297435 hasConcept C71924100 @default.
• W2054297435 hasConceptScore W2054297435C126838900 @default.
• W2054297435 hasConceptScore W2054297435C143753070 @default.
• W2054297435 hasConceptScore W2054297435C164705383 @default.
• W2054297435 hasConceptScore W2054297435C2776265017 @default.
• W2054297435 hasConceptScore W2054297435C2781362458 @default.
• W2054297435 hasConceptScore W2054297435C71924100 @default.
• W2054297435 hasIssue "2" @default.
• W2054297435 hasLocation W20542974351 @default.
• W2054297435 hasLocation W20542974352 @default.
• W2054297435 hasOpenAccess W2054297435 @default.
• W2054297435 hasPrimaryLocation W20542974351 @default.
• W2054297435 hasRelatedWork W1531601525 @default.
• W2054297435 hasRelatedWork W2029967375 @default.
• W2054297435 hasRelatedWork W2167167265 @default.
• W2054297435 hasRelatedWork W2357989941 @default.
• W2054297435 hasRelatedWork W2388061019 @default.
• W2054297435 hasRelatedWork W2403684205 @default.
• W2054297435 hasRelatedWork W3173606202 @default.
• W2054297435 hasRelatedWork W3183948672 @default.
• W2054297435 hasRelatedWork W4200563007 @default.
• W2054297435 hasRelatedWork W3110381201 @default.
• W2054297435 hasVolume "55" @default.
• W2054297435 isParatext "false" @default.
• W2054297435 isRetracted "false" @default.
• W2054297435 magId "2054297435" @default.
• W2054297435 workType "article" @default.