EHIT after thermoablation

Summary

Aim: 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.

Zusammenfassung

Ziel: Nach 10-jähriger Erfahrung werteten wir die Inzidenz und das Management der Progression von Sapheno-Thrombosen im tiefen Venensystem nach endothermischer Behand-lung von Saphena-Venen-Reflux aus. Diese Komplikation wird als endotherme Hitze-induzierte Thrombose (EHIT) bezeichnet.

Methoden: Von 2006 bis 2016 wurden die Daten retrospektiv von 840 Patienten analysiert, die sich einer Saphena-Venenbehandlung durch Laser- und Hochfrequenztechnik unterzogen haben. Alle Patienten wurden durch TumeszenzLokalanästhesie und durch eine ambulante Einstellung behandelt, um ein schnelles Gehen zu fördern. Grad 2-Kompressionsstrümpfe und Heparin für fünf Folgetage wurde empfohlen.

Ergebnisse: EHIT wurde bei 15 Patienten und 992 Saphena-Venen (1,5 %) beobachtet. 14 Patienten, die mit EVLA behandelt wurden, zeigten EHIT 1, ein Patient unter RFA zeigte EHIT 2, kompliziert durch Lungenembolie. Alle EHIT-Patienten wurden mit niedermolekularem Heparin behandelt. 980 nm bare-tip Laser wurden bei EVLA-EHIT-Patienten verwendet. Es wurde kein EHIT bei Patienten gefunden, die mit 1470 nm Radialfaser-Lasern behandelt wurden.

Schlussfolgerungen: Die Technologie der neuesten Generation, ambulante Einstellung und lokale Anästhesie führten vermutlich zur niedrigen Inzidenz von EHIT. Weitere Studien sind notwendig, um eine bessere Kenntnis dieser Komplikationen und für die Entwick-lung spezifischer Richtlinien zu erlangen.

Keywords

EHIT - thrombosis - thermoablation - endovascular

Schlüsselwörter

EHIT - Thrombose - Thermoablation - endovaskulär

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