King Saud University, College of Medicine, King Saud University Medical City, PO Box 242069, Riyadh 11322, Saudi Arabia.
King Saud University, College of Medicine, King Saud University Medical City, PO Box 242069, Riyadh 11322, Saudi Arabia.
Semin Vasc Surg. 2020 Mar;32(3-4):89-93. doi: 10.1053/j.semvascsurg.2019.06.001. Epub 2019 Jun 12.
Lower limb varicose veins are a common vascular disorder producing pain and disability when truncal vein reflux is present. Endovenous laser ablation (EVLA) of the great saphenous vein (GSV) is a safe and effective method for treating this condition. An unintended complication of this procedure is endothermal heat-induced thrombosis (EHIT) of common femoral vein. A retrospective outcomes analysis of patients who underwent EVLA of the GSV at King Khalid University Hospital from June 2006 to November 2018 was conducted to identify the risks factors and incidence of EHIT. Patients were assessed by clinical examination and duplex ultrasound imaging after the EVLA, and patient demographic characteristics and procedural factors predictive of EHIT were determined. Following EVLA, 11,070 duplex ultrasound examinations were performed for 1,230 limbs, and EHIT was detected in 65 (5.3%) limbs in 60 (6.8%) patients. Essentially all EHIT cases were detected in the first week (n = 63; 96.9%) and clot regression occurred over a period of 1-4 weeks. There were no significant differences in patient demographic characteristics or procedural factors between the EHIT and non-EHIT groups, except for the percentage of women (86% v 73%; P = .02), maximum GSV diameter (6.7 ± 2.7 mm v 6.0 ± 2.1 mm; P = .04), and percentage of patients with a competent saphenofemoral junction (41% v 37%; P < .001). EVLA is a safe treatment for great saphenous vein reflux, but EHIT can occur and was associated with female sex, large maximum GSV diameter, and competent saphenofemoral junction. Venous duplex imaging after EVLA is recommended because EHIT is asymptomatic in most patients.
下肢静脉曲张是一种常见的血管疾病，当主干静脉反流时会引起疼痛和残疾。大隐静脉（GSV）的静脉内激光消融（EVLA）是治疗这种疾病的一种安全有效的方法。该手术的一个意外并发症是股总静脉的热诱导血栓形成（EHIT）。对 2006 年 6 月至 2018 年 11 月在哈立德国王大学医院接受 GSV EVLA 的患者进行了回顾性结局分析，以确定 EHIT 的风险因素和发生率。患者在 EVLA 后通过临床检查和双功超声成像进行评估，并确定了预测 EHIT 的患者人口统计学特征和手术因素。在 EVLA 后，对 1230 条肢体进行了 11070 次双功超声检查，在 60 名（6.8%）患者的 65 条（5.3%）肢体中检测到 EHIT。EHIT 几乎全部在第一周内（n=63；96.9%）被发现，血栓消退发生在 1-4 周内。EHIT 组和非 EHIT 组患者的人口统计学特征或手术因素无显著差异，除了女性比例（86%比 73%；P=0.02）、GSV 最大直径（6.7±2.7mm 比 6.0±2.1mm；P=0.04）和有功能的隐股交界处的患者比例（41%比 37%；P<0.001）。EVLA 是治疗大隐静脉反流的安全方法，但 EHIT 可能发生，且与女性、GSV 最大直径大、有功能的隐股交界处有关。建议在 EVLA 后进行静脉双功超声检查，因为大多数患者的 EHIT 无症状。
