Acute Thrombotic Complication Post-Endovenous Ablation With Mobile Thrombus: A Case Study

Endovenous ablation is a common procedure performed on the superficial veins of the lower extremities to treat symptoms of venous insufficiency and varicose veins. While endovenous ablation is a minimally invasive procedure, patients may develop thrombotic complications including endovenous heat-induced thrombosis. Endovenous heat-induced thrombosis is a rare complication of thrombus extension from the superficial vein into or near the deep system postprocedure. In this case report, a female with a history of recent endovenous ablation presented to the emergency department with symptoms of a pulmonary embolism. Sonographic evaluation of the right lower extremity revealed extension of thrombus from the ablated superficial vein into the common femoral vein. Thrombus was also noted in the left lower extremity extending from the ablated superficial vein to approximately the saphenofemoral junction. While the left lower extremity was being interrogated, the thrombus was documented, via a cine clip, liberating from the occluded great saphenous vein. Further assessment utilizing computed tomography revealed bilateral pulmonary emboli. This unique case emphasizes the importance of sonographic evaluation post-endovenous ablation.