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Is Ehit Bilateral?
Syed Ali Rizvi, DO1, Anil Hingorani, MD1, Pavel Kibrik, BS1, Ronak Patel, BS1, Jesse Victory, DO1, Dmitriy Rybitskiy, DO1, Eleanora Iadgarova, NP2, Justin Eisenberg, DO1, Enrico Ascher, MD1, Natalie Marks, MD1.
1NYU Lutheran Medical Center, Brooklyn, NY, USA, 2Total Vascular Care, Inc., Brooklyn, NY, USA.

Objective(s):
Endovenous ablation of the lower extremity veins is one of the mainstay treatments for symptomatic venous reflux disease. Endovenous heat induced thrombosis (EHIT) has been reported as a complications of these venous ablative procedures. Previously, we have described the incidence of this complication and the need for routine surveillance duplex post procedure. We have frequently noted that patients suffer bilaterally from EHIT. Our aim was to determine if prior history of EHIT predisposes to contralateral occurrence of EHIT.
Methods:
Retrospective analysis of data collected from January 2012 to December 2015 of 1,998 patients that underwent endovenous ablation for lower extremity venous reflux was performed. We reviewed charts of all patients that underwent radio frequency ablation or endovenous laser treatment during this time period. Post procedural venous duplex ultrasound was performed within one week to determine EHIT.
Results:
5,532 lower extremity endovenous ablation procedures were performed in 1,998 patients. 66.8% of patients were female. Procedures were performed almost equally in left and right lower extremity (50.1% vs 49.9%). CEAP classification of lower extremity limb venous disease showed 0.2%, 0.5%, 5.3%, 35.0%, 43.2%, 2.0% and 13.7% for C0 - C6, respectively. EHIT occurred after 164 of 5,532 (3.0 %) procedures. Average age of patients with EHIT versus those that did not have EHIT was 66.5 (range 33-93) years and 63.6 (range 17-99) years (p-value= 0.0219), respectively. Furthermore, a second EHIT event occurred in patients after 23 of 78 (29.4%) EHIT events on the left lower extremity and 24 of 86 (27.9%) EHIT events on the right lower extremity. The incidence of bilateral EHIT was 89/122 (72.9%). The relative risk of EHIT as a bilateral event versus a unilateral event was 1.46 (95% CI = 0.99 to 2.15) (p-value= 0.053). CEAP score, age and gender did not correlate with recurrence or occurrence of contralateral EHIT.
Conclusions:
These data suggest that second episode of EHIT may be a very common event after endovenous ablation. The data warrants further scrutiny to analyze for specific other risk factors for patients that develop EHIT.


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