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I had an endovenous laser treatment ( EVLT) a week ago and today the doctor found a clot in my saphenous vein. It is pretty close to the saphenofemoral junction. They prescribed baby aspirin and a follow-up scan. Should I be overly concerned that deep vein thrombosis or other complications will occur? Is it normal to form a clot in the saphenous vein after EVLT?
When a clot forms in the saphenous vein after endovenous laser treatment (EVLT), it is referred to as a HIT (Heat Induced Thrombosis). It resolves on its own and does not require treatment.
When properly performed, most patients do not develop clinically significant saphenous vein clots after EVLT. Minor clots near the sapheno-femoral junction usually resolve spontaneously.
It is not uncommon for a clot to form in the saphenous vein after EVLT. Follow your doctor's recommendations and get rescanned. It may take some time for the problem to resolve.
It is normal to form a clot in the greater saphenous vein (GSV) after endovenous thermal ablation. What is of concern is if the clot extends into the common femoral (deep) vein. Usually, these clots retract back into the the GSV, with normal clot retraction occurring after a week or two. It is essential to wear your compression hose and walk. Anticoagulation is optional, but can also be controversial in terms of its necessity.
Was the clot found in the same vein that was treated? Regarding the vein that was treated, did the doctor deem the procedure successful? Usually, superficial clots like this stay put and don't move to the deep system. With the laser ablation, the tip of the laser is placed between 1.3-2.0 cm from the junction, and sometimes blood may get trapped in that area after the procedure. Follow the physician's orders for taking the aspirin and continue to have follow up appointments as needed.
Yes, clots can form in the saphenous vein after EVLT.
That impression is what the vein looks like after EVLT.
A clot always forms in a saphenous vein after a EVLT, that is actually the goal of the treatment. What it sounds like you are describing is a clot that goes up to the saphenofemoral junction. If so, this occurs occasionally and may need additional treatment. A little concern is warranted, but I would not be overly concerned.
Clots can be associated with EVLT, but extension to the saphenofemoral junction is rare in the hands of an experienced surgeon. You should follow your doctor's instructions.
Anytime you do an EVLT procedure, the possibility of forming a blood clot always exists. There is nothing to be immediately concerned about given that the clot has not extended into you deep venous system. However, if you have any prior history of blood clots, this post-EVLT clot could suggest an underlying hypercoagulable state, which I would recommend working up. If there is no prior history of blood clotting, I would continue to follow up with your doctor and undergo treatment and clot monitoring as directed.
It is normal to have a clot in the saphenous vein after EVLT. It is a good idea to follow up closely to avoid progression to the femoral vein.
No, you should not be overly concerned. You are describing what is termed as endovenous heat-induced thrombosis (EHIT). This is rarely a serious problem. There are several articles on EHIT you can search for online. A small amount of clot in the saphenous vein is normal after EVLT.
Clots are a possible complication that can result after endovenous ablation of either the great, anterior or small saphenous veins, which is why treated veins should be investigated after every closure procedure. There is no consensus on any one treatment algorithm, but I prefer Plavix therapy when treating patients with filling defects close to the junction in the deep system. Additionally, I follow up with another duplex scan within a few weeks to make sure there has not been any progression. If there is filling defect encroaching on the popliteal vein or the femoral vein, I will step the treatment up to Lovenox and Coumadin therapy for one month and then repeat the duplex scan prior to discontinuing anticoagulant therapy to ensure thrombus resolution.
It is not normal to form a clot, but it can happen. The saphenous vein is normally clotted by the closure procedure. What is abnormal is when the clot extends beyond the saphenous vein into the saphenofemoral junction. This is called a heat induced thrombosis (HIT). This occurs in about 5% of people and usually is self-resolving. If the clot is large (>25% of the femoral vein), then it should be treated with anticoagulation. A follow-up ultrasound is usually done about one week later.
Sometimes the treatment of your vein extends beyond the intended point. When your saphenous vein is closed, most physicians will start the closure about 2 centimeters from your saphenofemoral junction. A small percentage of patients( ~5-7%) will experience an extension of clot beyond this point. This "clot" is not a true DVT and will likely be gone within the next week.