Endothermal Heat Induced Thrombosis

Abstract

Endothermal heat induced thrombosis (EHIT) is a post-procedural entity following endothermal superficial venous ablation that refers to the propagation of thrombus into the adjacent deep vein lumen. It is identified most commonly during the post-procedural surveillance venous duplex ultrasound. EHIT is recognized as a unique post-procedural entity, distinct in clinical behavior from a deep vein thrombosis. The definition, classification systems, pathophysiology, risk factors, treatment, and prevention are all discussed. The understanding of EHIT has advanced considerably, but additional data are required to understand its impact on quality of life and the cost-effectiveness of surveillance.

Zusammenfassung

Die endotherme hitzeinduzierte Thrombose (EHIT) ist eine postoperative Erscheinung nach der endothermen oberflächlichen Venenablation, die sich auf die Verschleppung eines Thrombus in das angrenzende tiefe Venenlumen bezieht. Sie wird meist beim Duplex-Ultraschall zur Kontrolle der Vene nach dem Verfahren erkannt. Die EHIT wird als eine einzigartige postoperative Erscheinung anerkannt, die sich im klinischen Verhalten von einer tiefen Venenthrombose unterscheidet. Definition, Klassifikationssysteme, Pathophysiologie, Risikofaktoren, Behandlung und Prävention werden in diesem Zusammenhang diskutiert. Das Verständnis der EHIT ist inzwischen weit fortgeschritten, aber es sind noch weitere Daten erforderlich, um ihre Auswirkungen auf die Lebensqualität und die Kosteneffizienz der Überwachung zu verstehen.

Key words

endothermal heat induced thrombosis (EHIT) - endothermal ablation - great saphenous vein - small saphenous vein

Schlüsselwörter

endotherme hitzeinduzierte Thrombose (EHIT) - endotherme Ablation - Vena saphena magna - Vena saphena parva

Publication History

Article published online:
28 July 2021

• References

• 1 Gloviczki P, Comerota AJ, Dalsing MC. et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2011; 53 (Suppl. 05) 2S-48S
• 2 Hingorani AP, Ascher E, Markevich N. et al. Deep venous thrombosis after radiofrequency ablation of greater saphenous vein: a word of caution. J Vasc Surg 2004; 40: 500-504
• 3 Kabnick LS, Ombrellino M, Agis H. et al. Endovenous heat induced thrombosis (EHIT) at the superficial deep venous junction: a new post-treatment clinical entity, classification and potential treatment strategies. 18th Annual Meeting of the American Venous Forum. Miami, FL: 2006
• 4 Kabnick LS, Sadek M, Bjarnason H. et al. Classification and treatment of endothermal heat-induced thrombosis: Recommendations from the American Venous Forum and the Society for Vascular Surgery. J Vasc Surg Venous Lymphat Disord 2021; 9: 6-22 DOI: 10.1016/j.jvsv.2020.06.008.
• 5 Kabnick LS, Sadek M, Bjarnason H. et al. Classification and treatment of endothermal heat-induced thrombosis: Recommendations from the American Venous Forum and the Society for Vascular Surgery This Practice Guidelines document has been co-published in Phlebology [DOI: 10.1177/0268355520953759] and Journal of Vascular Surgery: Venous and Lymphatic Disorders [DOI: 10.1016/j.jvsv.2020.06.008]. The publications are identical except for minor stylistic and spelling differences in keeping with each journal’s style. The contribution has been published under a Attribution-Non Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0), (https://creativecommons.org/licenses/by-nc-nd/4.0/). Phlebology 2021; 36: 8-25 DOI: 10.1177/0268355520953759.
• 6 Lurie F, Kistner RL. Pretreatment elevated D-dimer levels without systemic inflammatory response are associated with thrombotic complications of thermal ablation of the great saphenous vein. J Vasc Surg Venous Lymphat Disord 2013; 1: 154-158
• 7 Santin BJ, Lohr JM, Panke TW. et al. Venous duplex and pathologic differences in thrombus characteristics between de novo deep vein thrombi andendovenous heat-induced thrombi. J Vasc Surg Venous Lymphat Disord 2015; 3: 184-189
• 8 Passariello F. Post ablation superficial thrombus extension (PASTE) as a consequence of endovenous ablation. An up-to-date review. Rev in Vasc Med 2014; 2: 62-66
• 9 Lawrence PF, Chandra A, Wu M. et al. Classification of proximal endovenous closure levels and treatment algorithm. J Vasc Surg 2010; 52: 388-893
• 10 Lin JC, Peterson EL, Rivera ML. et al. Vein mapping prior to endovenous catheter ablation of the great saphenous vein predicts risk of endovenousheat-induced thrombosis. Vasc Endovascular Surg 2012; 46: 378-383
• 11 Haqqani OP, Vasiliu C, O’Donnell TF. et al. Great saphenous vein patency and endovenous heat-induced thrombosis after endovenous thermal ablation with modified catheter tip positioning. J Vasc Surg 2011; 54 (Suppl. 06) 10S-17S
• 12 Knipp BS, Blackburn SA, Bloom JR. et al. Endovenous laser ablation: Venous outcomes and thrombotic complications are independent of the presence of deep venous insufficiency. J Vasc Surg 2008; 48: 1538-1545
• 13 Harlander-Locke M, Jimenez JC, Lawrence PF. et al. Endovenous ablation with concomitant phlebectomy is a safe and effective method of treatment for symptomatic patients with axial reflux and large incompetent tributaries. J Vasc Surg 2013; 58: 166-172
• 14 Chi YW, Ali L, Woods TC. Clinical risk factors to predict deep venous thrombosis post endovenous laser ablation of saphenous veins. Vascular Medicine 2011; 16: 235-236
• 15 Sermsathanasawadi N, Voravitvet TY, Chinsakchai K. et al. Risk factors for endovenous heat-induced thrombosis after endovenous radiofrequency ablation performed in Thailand. Phlebology/Venous Forum of the Royal Society of Medicine 2016; 31: 582-587
• 16 Rhee SJ, Cantelmo NL, Conrad MF. et al. Factors influencing the incidence of endovenous heat-induced thrombosis (EHIT). Vascular and endovascular surgery 2013; 47: 207-212
• 17 Jacobs CE, Pinzon MM, Orozco J. et al. Deep venous thrombosis after saphenous endovenous radiofrequency ablation: is it predictable?. Annals of vascular surgery 2014; 28: 679-685
• 18 Kane K, Fisher T, Bennett M. et al. The incidence and outcome of endothermal heat-induced thrombosis after endovenous laser ablation. Annals of vascular surgery 2014; 28: 1744-1750
• 19 Puggioni A, Marks N, Hingorani A. et al. The safety of radiofrequency ablation of the great saphenous vein in patients with previous venous thrombosis. J Vasc Surg 2009; 49: 1248-1255
• 20 Gibson KD, Ferris BL, Polissar N. et al. Endovenous laser treatment of the short saphenous vein: Efficacy and complications. Journal of Vascular Surgery 2007; 45: 795-803
• 21 Sufian S, Arnez A, Labropoulos N. et al. Endovenous heat-induced thrombosis after ablation with 1470nm laser: Incidence, progression, and risk factors. Phlebology 2015; 30: 325-330
• 22 Hicks CW, DiBrito SR, Magruder JT. et al. Radiofrequency ablation with concomitant stab phlebectomy increases risk of endovenous heat-induced thrombosis. J Vasc Surg Venous Lymphat Disord 2017; 5: 200-209
• 23 Sadek M, Kabnick LS, Rockman CB. et al. Increasing ablation distance peripheral to the saphenofemoral junction may result in a diminished rate of endothermal heat-induced thrombosis. Journal of Vascular Surgery: Venous and Lymphatic Disorders 2013; 1: 257-262
• 24 Mozes G, Kalra M, Carmo M. et al. Extension of saphenous thrombus into the femoral vein: a potential complication of new endovenous ablation techniques. J Vasc Surg 2005; 41: 130-135
• 25 Kearon C, Akl EA, Ornelas J. et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest 2016; 149: 315-352 DOI: 10.1016/j.chest.2015.11.026.
• 26 Zuniga JM, Hingorani A, Ascher E. et al. Short-term outcome analysis of radiofrequency ablation using ClosurePlus vs ClosureFast catheters in the treatment of incompetent great saphenous vein. J Vasc Surg 2012; 55: 1048-1051
• 27 Dexter D, Kabnick LS, Berland TL. et al. Complications of endovenous lasers. Phlebology 2012; 27 (Suppl. 01) 40-45
• 28 Marsh P, Price BA, Holdstock J. et al. Deep vein thrombosis (DVT) after venous thermoablation techniques: rates of endovenous heat-induced thrombosis (EHIT) and classical DVT after radiofrequency and endovenous laser ablation in a single centre. Eur J Vasc Endovasc Surg 2010; 40: 521-527
• 29 Knipp BS, Blackburn SA, Bloom JR. et al. Endovenous laser ablation: Venous outcomes and thrombotic complications are independent of the presence of deep venous insufficiency. J Vasc Surg 2008; 48: 1538-1545
• 30 Westin GG, Cayne NS, Lee V. et al. Radiofrequency and laser vein ablation for patients receiving warfarin anticoagulation is safe, effective, and durable. J Vasc Surg Venous Lymphat Disord 2020; 8: 610-616 DOI: 10.1016/j.jvsv.2019.11.013.