Dislodged Endovascular Heat-induced Thrombus Resulting in Pulmonary Embolus Following Postoperative Ultrasound Compression

Abstract

Venous insufficiency and consequent varicose veins are common problems faced by many patients. Fortunately, there are many treatment options available including a minimally invasive method known as radiofrequency ablation (RFA). Radiofrequency ablation is not without complications; among those are endovascular heat-induced thrombosis (EHIT). This rare complication is typically managed conservatively; however, in rare occasions, the thrombus can detach and embolize causing further issues for patients. A 48-year-old male underwent an uneventful RFA procedure for a Clinical Etiologic Anatomic Pathophysiologic classification (CEAP) 4a venous insufficiency. On the postoperative ultrasound (US) venous duplex evaluation, the patient was found to have EHIT type 1 in the right greater saphenous vein extending to the sapheno-femoral junction. During compression and release of the US probe by the US technologist the thrombus detached from the venous wall and embolized to a right lung subsegmental branch. This case report focuses on the possibility of secondary sequela that may arise from EHIT affecting other organ systems from the RFA procedure, the classification system of EHIT, and management options.