Fatal pulmonary embolism following ultrasound-guided foam sclerotherapy combined with multiple microphlebectomies

Phlebology
Cornelis Ma Bruijninckx

Abstract

Ambulatory ultrasound-guided foam sclerotherapy (UGFS) for refluxing saphenous veins is considered a safe therapy. Venous thromboembolic complications after UGFS as well as after all other ambulatory ablative venous interventions are rarely reported. This paper reports a fatal pulmonary embolism (PE) following UGFS in combination with an extended phlebectomy, and questions what measures should be taken to minimize the risk for thromboembolic complications after these procedures. In the reported case (unsuspected), extensive non-occluding atherosclerosis as well as obesity in combination with use of an oral contraceptive might have contributed to the development of the PE while the use of a β-blocker might have increased its fatal course considerably. Routine measurement of the ankle-brachial pressure index reduces the risk for undetected atherosclerosis. It appears that 'in the real world' of ambulatory phlebological treatments thromboembolic complications are more common (2.4-4.7%) and appear accompanied by post-procedural mortality. It is concluded therefore that pharmacological thromboprophylaxis appears warranted in selected cases, perhaps even routine application could be considered. Attention is drawn to the highly thromb...Continue Reading

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Citations

Jun 23, 2018·Jornal Vascular Brasileiro·Alexandre Faraco de Oliveira, Horácio de Oliveira
Mar 9, 2019·BMJ Case Reports·Maryam MukhtarWaqas Ullah
Oct 7, 2020·Phlebology·Eduardo T de AguiarDanielle D Carvalho

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