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Incidence, Risk Factors, Progression, and Treatment of Endovenous Heat-Induced Thrombosis Class 2 or Greater After Endovenous Radiofrequency Ablation

Sermsathanasawadi, Nuttawut, MD, PhD; Pitaksantayothin, Wacharaphong, MD; Puangpunngam, Nattawut, MD; Chinsakchai, Khamin, MD; Wongwanit, Chumpol, MD; Mutirangura, Pramook, MD; Ruangsetakit, Chanean, MD, MSc*

doi: 10.1097/DSS.0000000000001724
Original Article

BACKGROUND Endovenous heat-induced thrombosis (EHIT) is a thrombus that extends from an ablated saphenous vein into the common femoral vein after endovenous radiofrequency ablation (RFA).

OBJECTIVE To investigate the incidence, progression, treatment, and risk factors associated with EHIT-2 or greater after RFA.

MATERIALS AND METHODS This retrospective study included patients diagnosed with symptomatic superficial venous incompetence that were treated by RFA of the great saphenous vein or anterior accessory saphenous vein during the July 2012 to December 2016 study period. Duplex ultrasound scanning was performed at 1 week, 1 month, 3 months, and every year after RFA to detect EHIT.

RESULTS A total of 317 legs from 274 patients were included. The incidence of EHIT-2 or greater was 7.0%, including 5.4% EHIT-2, 1.3% EHIT-3, and 0.3% EHIT-4. No symptomatic pulmonary embolism was found. The independent risk factors for EHIT-2 or greater were vein diameter (p = .027) and concomitant sclerotherapy (p = .037).

CONCLUSION The risk factors found to be independently associated with EHIT-2 or greater were large vein size and concomitant sclerotherapy. Screening for EHIT should be performed in patients with one or both of these risk factors within 1 week after RFA and in patients with postoperative symptoms suggestive of venous thromboembolism.

*All authors are affiliated with the Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Address correspondence and reprint requests to: Nuttawut Sermsathanasawadi, MD, PhD, Division of Vascular Surgery, Department of Surgery Faculty of Medicine Siriraj Hospital, Mahidol University 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand, or e-mail:

Supported by a grant from the Siriraj Research Development Fund (managed by Routine to Research: R2R), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

The authors have indicated no significant interest with commercial supporters.

© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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