SUPPURATIVE THROMBOPHLEBITIS OF GREAT SAPHENOUS VEIN AFTER ENDOVENOUS LASER ABLATION  - CASE REPORT

SUPPURATIVE THROMBOPHLEBITIS OF GREAT SAPHENOUS VEIN AFTER ENDOVENOUS LASER ABLATION - CASE REPORT | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article SUPPURATIVE THROMBOPHLEBITIS OF GREAT SAPHENOUS VEIN AFTER ENDOVENOUS LASER ABLATION - CASE REPORT Predrag Matic, Aleksandar Babic, Slobodan Tanaskovic, Srdjan Babic, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3928247/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Endovenous laser ablation (EVLA) is a minimally invasive technique used to treat superficial venous reflux. The technique proved its safety and efficacy and became the standard of care for patients with chronic venous disease with lower rates of complications compared to open surgery. Case report We present a 68-year-old female with C5 stage of chronic vein insufficiency who underwent endovenous laser ablation of the great saphenous vein. On the fifth day, she developed fever and pain, tenderness, and redness on the medial side of the treated upper leg with fluctuations in some places. Urgent incisions and radical debridement with extensive drainage were made. After intensive daily local wound treatment and antibiotic therapy signs and symptoms resolved and she was fully ambulatory with satisfactory postoperative findings. Conclusion We want to point out that aggressive surgical treatment is the main goal in the treatment of patients with suppurative thrombophlebitis, and, antibiotic therapy results in complete healing and resolution of this rare, but life-treating complication. Suppurative thrombophlebitis EVLA case report Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 INTRODUCTION Endovenous laser ablation (EVLA) is a minimally invasive technique used to treat superficial venous reflux. Since its introduction by Carlos Bone in 1999, the technique proved its safety and efficacy and became the standard of care for patients with chronic venous disease[ 1 ]. Using a less invasive approach, compared to open surgery, lower rates of complications are described. According to Karimian et al., the most often complications following EVLA are ecchymosis (41,3%), pain (26,1%), bruising (24,2%), and induration (22,7%)[ 2 ]. Other complications include edema, thrombophlebitis, cellulitis, thermal injury, deep vein thrombosis, and pulmonary embolism[ 2 ]. We report a case of rarely described complication - suppurative thrombophlebitis developed after endovenous ablation of the great saphenous vein (GSV). CASE REPORT A 68-year-old female was admitted to our Institution for scheduled vein surgery. She had a history of hypertension and dyslipidemia. She has not any previous intervention. Also, she had easily detachable flakes on her lower leg (Fig. 1 ). Stadium of her chronic vein insufficiency was C5[ 3 ]. Ultrasonography showed insufficient left GSV with a diameter of vein 8 mm and reflux of 3 seconds. Under tumescent anesthesia and by ultrasonography guidance, fiber was introduced in GSV about 10 cm below the knee and placed to the groin, after carefully spraying the whole leg with Octenisept. The correct positioning of fiber was at the confluence of the superficial epigastric vein into GSV. The whole GSV was ablated with a wavelength of 1470 nm and a laser-emission energy of 10 W as the laser fiber catheter slowly withdrew at a speed of 2mm/s. EVLA was combined with stab avulsion mini-phlebectomy below and above the knee. After completion of the procedure compression bandage was placed from the foot to the groin of the treated leg. The patient was allowed to walk immediately after the intervention. Half an hour after the operation patient was discharged from the hospital with a prescription to receive low-molecular weight heparin next six days. There was no prescribed antibiotic therapy, as usual. On the fifth postoperative the patient presented to our outpatient department with fever and pain, tender and redness on the medial site of the treated upper leg with fluctuations in some places appeared. Urgent incisions and radical debridement with extensive drainage were made. We evacuated a large amount of purulent content (Fig. 2 ), took a swab, and started antibiotic therapy empirically with Ceftriaxone. After making incisions and intensive daily local wound treatment signs and symptoms resolved. On the fifth postoperative day, we sutured wounds (Fig. 3 , 4 ). Further course was uneventful and on the 17th day after EVLA, she was fully ambulatory with satisfactory postoperative findings (Fig. 5 ). DISCUSSION Chronic vein insufficiency (CVI) is a very common condition with an incidence of 25–40% in women and about 10–20% in men[ 4 ]. New endovascular treatments for CVI slowly taking precedence over the surgical treatment due to lower incidence of complications, decreased postoperative pain, early ambulation, and return to activities of daily living and to work. Nesbitt et al. analyzed 13 randomized controlled trials with 3081 patients and concluded that neovascularisation and technical failure were both statistically reduced in the laser treatment group versus surgery[ 5 ]. In a large systematic review with 12320 patients success rates after three years of stripping and laser therapy were about 78% and 94%, respectively[ 6 ]. Wound complications such as infection, hematoma, and abscess after open surgery had a rate from 1,91–10%, compared to EVLA whose infection rate was 0,33%[ 7 , 8 , 9 ]. There was no significant difference in the incidence of postoperative phlebitis after EVLA and open surgery (6% vs. 3,7%; p = 0.06)[ 9 ]. All of the previously mentioned complications did not require surgical treatment. Puggioni et al. found a greater incidence of painful thrombophlebitis of GSV and cellulitis after EVLA compared to after RFA, which was attributed to incomplete vein emptying and intraluminal thrombus[ 10 ]. Otherwise, the incidence of thrombophlebitis after EVLA varies from 0–67%[ 11 , 12 ]. The most fearful complications such as deep vein thrombosis and consequent pulmonary embolism are rare- 1,55% and 0,07%, respectively[ 13 ]. Another rare, but potentially life-threatening complication is suppurative thrombophlebitis. Usually, it is a condition that occurs in critically ill patients during and after intravenous injection or catheter insertion[ 13 ]. Otherwise, even with meticulous preparation in the operation field, there is always the risk of infection with the introduction of a foreign body into the veins. In addition, in EVLA necrotic vein is left in the leg compared to open surgical removal of GSV, which is another risk factor for infection. Another factor that bears a potential risk for infection is that stab avulsion phlebectomy was performed at the same time as EVLA. In our patient, EVLA led to a serious life-threatening infection, which required urgent aggressive surgical treatment. In the literature, there are only two cases similar to ours[ 14 , 15 ]. Both mentioned cases had ulcers on the lower leg, opposite to our patient who had some easily detachable flakes on her lower leg. Namely, during the preparation of the operation field, we only sprayed the leg with antiseptic, not rubbing the flakes on, so maybe this may be the source of infection. Because of the rarity of this complication, it is not clear that skin changes tissue culture, swabs, and antibiotic prophylaxis should be considered. There is not a lot of data or any guidelines on how to treat suppurative thrombophlebitis after EVLA. In some cases, antibiotics are the only therapy for patients with this complication, but in this case, aggressive surgical treatment and quality wound care are the only possible curative methods. We don’t have the intention to doubt the method and its efficiency and safety, because we routinely perform a lot of this intervention with a small percentage of self-limited complications. We want to draw attention to the specific characteristics of the patient that may lead to differences in the outcome of this generally very safe method and alert the doctors that every invasive procedure can lead to infection requiring aggressive surgical treatment. CONCLUSION We believe that EVLA is the future, but also the present in the treatment of chronic vein insufficiency with excellent results. Even concomitant ulcers and skin flakes on the legs are not contraindications for EVLA, which increases the risk for the development of suppurative thrombophlebitis. Accordingly, we think that maybe total isolation of skin changes should be implemented in operative field preparation hoping to prevent potential infection. In addition, preoperative and postoperative antibiotics should be given to these patients. Of course, we want to point out that aggressive surgical treatment is the main goal in the treatment of these patients, and, antibiotic therapy results in complete healing and resolution of this rare, but life-treating complication. ABREVIATION EVLA - endovenous laser ablation GSV - great saphenous vein CVI - chronic vein insufficiency Declarations Conflicts of interest- The authors declare that there is no conflict of interest. Ethics approval- The Ethical Committee of Dedinje” Cardiovascular Institute approved this study and the approval number is 6487 of the date 24.10.2023. Consent to participate- We have a written form of patient consent confirmation for participation and publication. Consent for publication- We have a written form of patient consent confirmation for participation and publication. Funding- This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors' contributions- PM, AB, ST, SB, PG, SP and NI have substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; Also, PM, AB, ST, SB, PG, SP and NI drafted the article or revised it critically for important intellectual content and made final approval of the version to be published. Availability of data and material (data transparency)- Yes Code availability (software application or custom code)- Not applicable References Bone C. Tratamiento endoluminal de las varices con laser de diodo: estudio preliminary. Rev Patol Vasc. 1999;5:35–46. Karimian M, Tardeh S, Tardeh Z. Endovenous Laser Ablation for Varicos Vein Treatment: A Systematic Review and Meta-Analysis. Indian J Surg (2022). Lurie F, Passman M, Meisner M et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord. 2020;8(3):342–352. 10.1016/j.jvsv.2019.12.075 . Epub 2020 Feb 27. Erratum in: J Vasc Surg Venous Lymphat Disord. 2021;9(1):288. Al Shammeri O, AlHamdan N, Al-Hothaly B, et al. Chronic Venous Insufficiency: prevalence and effect of compression stockings. Int J Health Sci (Qassim). 2014;8(3):231–6. Nesbitt C, Bedenis R, Bhattacharya V et al. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus open surgery for great saphenous vein varices. Cochrane Database Syst Rev. 2014;(7):CD005624. Update in: Cochrane Database Syst Rev. 2021;8:CD005624. van den Bos R, Arends L, Kockaert M, et al. Endovenous therapies of lower extremity varicosities: a meta-analysis. J Vasc Surg. 2009;49(1):230–9. Critchley G, Handa A, Maw A, et al. Complications of varicose vein surgery. Ann R Coll Surg Engl. 1997;79(2):105–10. Perkins JM. Standard varicose vein surgery. Phlebology. 2009;24(Suppl 1):34–41. Pan Y, Zhao J, Mei J, et al. Comparison of endovenous laser ablation and high ligation and stripping for varicose vein treatment: a meta-analysis. Phlebology. 2014;29(2):109–19. Puggioni A, Kalra M, Carmo M, et al. Endovenous laser therapy and radiofrequency ablation of the great saphenous vein: analysis of early efficacy and complications. J Vasc Surg. 2005;42(3):488–93. Proebstle TM, Gül D, Lehr HA, et al. Infrequent early recanalization of greater saphenous vein after endovenous laser treatment. J Vasc Surg. 2003;38(3):511–6. Sadick NS, Wasser S. Combined endovascular laser with ambulatory phlebectomy for the treatment of superficial venous incompetence: a 2-year perspective. J Cosmet Laser Ther. 2004;6(1):44–9. Mazayshvili K, Akimov S. Early complications of endovenous laser ablation. Int Angiol. 2019;38(2):96–101. Grady Z, Aizpuru M, Farley KX, et al. Surgical resection for suppurative thrombophlebitis of the great saphenous vein after radiofrequency ablation. J Vasc Surg Cases Innov Tech. 2019;5(4):532–4. Dunst KM, Huemer GM, Wayand W, et al. Diffuse phlegmonous phlebitis after endovenous laser treatment of the greater saphenous vein. J Vasc Surg. 2006;43(5):1056–8. Supplementary Files CAREchecklist.pdf CoverLetter.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3928247","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":285490308,"identity":"f2842dec-75dc-4851-b08d-b3c3c1d64fe3","order_by":0,"name":"Predrag Matic","email":"","orcid":"","institution":"Institute for Cardiovascular Diseases Dedinje: Institut za kardiovaskularne bolesti Dedinje","correspondingAuthor":false,"prefix":"","firstName":"Predrag","middleName":"","lastName":"Matic","suffix":""},{"id":285490309,"identity":"aaa14c3d-1e65-4bdd-9791-fae53601995a","order_by":1,"name":"Aleksandar 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17:11:16","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":837567,"visible":true,"origin":"","legend":"\u003cp\u003eLeft leg, before the surgery, with easily detachable flakes\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-3928247/v1/25b68ff15419c55db6b9d3c2.png"},{"id":54037501,"identity":"d737be95-b5f9-4d04-b670-f27fe2cf822f","added_by":"auto","created_at":"2024-04-03 17:11:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":608082,"visible":true,"origin":"","legend":"\u003cp\u003eA large amount of pus was evacuated after the incisions\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-3928247/v1/87b4b80304ebae0fd3558594.png"},{"id":54037437,"identity":"3842cb9d-c6ab-4d15-a060-49173a3f3b35","added_by":"auto","created_at":"2024-04-03 17:11:15","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1692410,"visible":true,"origin":"","legend":"\u003cp\u003eLeg at postoperative day 10\u003csup\u003eth\u003c/sup\u003e. Completely healing and resolution\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-3928247/v1/c00ef75252c2ec9ef69de494.png"},{"id":54037499,"identity":"4df9e194-3dc5-465d-8ba5-30412be8c9cd","added_by":"auto","created_at":"2024-04-03 17:11:16","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1353314,"visible":true,"origin":"","legend":"\u003cp\u003eSutured wounds\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-3928247/v1/f1d6268dcce4c7094de5c08f.png"},{"id":54037498,"identity":"a1b94184-c054-42ba-b513-ddc78b64d09a","added_by":"auto","created_at":"2024-04-03 17:11:16","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":2784002,"visible":true,"origin":"","legend":"\u003cp\u003eSatisfactory postoperative findings on day 17 (suture removal)\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-3928247/v1/01a6e7e2e2f2f923a7f78224.png"},{"id":56437360,"identity":"70d3eafd-254d-4aab-a736-1045f649ab0c","added_by":"auto","created_at":"2024-05-14 07:42:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3590084,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3928247/v1/13dc2c4d-60c8-4219-83db-c123d8f9d154.pdf"},{"id":54037502,"identity":"dbce8470-5884-45f6-9ce2-785a0d32b1c9","added_by":"auto","created_at":"2024-04-03 17:11:17","extension":"pdf","order_by":9,"title":"","display":"","copyAsset":false,"role":"supplement","size":812079,"visible":true,"origin":"","legend":"","description":"","filename":"CAREchecklist.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3928247/v1/70e127794b5da8dc7c67adfc.pdf"},{"id":54037503,"identity":"8b5c4431-a3c4-4b8b-899d-60d29ab6323b","added_by":"auto","created_at":"2024-04-03 17:11:17","extension":"docx","order_by":10,"title":"","display":"","copyAsset":false,"role":"supplement","size":15061,"visible":true,"origin":"","legend":"","description":"","filename":"CoverLetter.docx","url":"https://assets-eu.researchsquare.com/files/rs-3928247/v1/135325573406ccba2f56446e.docx"}],"financialInterests":"","formattedTitle":"SUPPURATIVE THROMBOPHLEBITIS OF GREAT SAPHENOUS VEIN AFTER ENDOVENOUS LASER ABLATION - CASE REPORT","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eEndovenous laser ablation (EVLA) is a minimally invasive technique used to treat superficial venous reflux. Since its introduction by Carlos Bone in 1999, the technique proved its safety and efficacy and became the standard of care for patients with chronic venous disease[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Using a less invasive approach, compared to open surgery, lower rates of complications are described.\u003c/p\u003e \u003cp\u003eAccording to Karimian et al., the most often complications following EVLA are ecchymosis (41,3%), pain (26,1%), bruising (24,2%), and induration (22,7%)[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Other complications include edema, thrombophlebitis, cellulitis, thermal injury, deep vein thrombosis, and pulmonary embolism[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. We report a case of rarely described complication - suppurative thrombophlebitis developed after endovenous ablation of the great saphenous vein (GSV).\u003c/p\u003e"},{"header":"CASE REPORT","content":"\u003cp\u003eA 68-year-old female was admitted to our Institution for scheduled vein surgery. She had a history of hypertension and dyslipidemia. She has not any previous intervention. Also, she had easily detachable flakes on her lower leg (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Stadium of her chronic vein insufficiency was C5[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Ultrasonography showed insufficient left GSV with a diameter of vein 8 mm and reflux of 3 seconds.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eUnder tumescent anesthesia and by ultrasonography guidance, fiber was introduced in GSV about 10 cm below the knee and placed to the groin, after carefully spraying the whole leg with Octenisept. The correct positioning of fiber was at the confluence of the superficial epigastric vein into GSV. The whole GSV was ablated with a wavelength of 1470 nm and a laser-emission energy of 10 W as the laser fiber catheter slowly withdrew at a speed of 2mm/s. EVLA was combined with stab avulsion mini-phlebectomy below and above the knee. After completion of the procedure compression bandage was placed from the foot to the groin of the treated leg.\u003c/p\u003e \u003cp\u003eThe patient was allowed to walk immediately after the intervention. Half an hour after the operation patient was discharged from the hospital with a prescription to receive low-molecular weight heparin next six days. There was no prescribed antibiotic therapy, as usual.\u003c/p\u003e \u003cp\u003eOn the fifth postoperative the patient presented to our outpatient department with fever and pain, tender and redness on the medial site of the treated upper leg with fluctuations in some places appeared. Urgent incisions and radical debridement with extensive drainage were made. We evacuated a large amount of purulent content (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), took a swab, and started antibiotic therapy empirically with Ceftriaxone. After making incisions and intensive daily local wound treatment signs and symptoms resolved. On the fifth postoperative day, we sutured wounds (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e,\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Further course was uneventful and on the 17th day after EVLA, she was fully ambulatory with satisfactory postoperative findings (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eChronic vein insufficiency (CVI) is a very common condition with an incidence of 25\u0026ndash;40% in women and about 10\u0026ndash;20% in men[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. New endovascular treatments for CVI slowly taking precedence over the surgical treatment due to lower incidence of complications, decreased postoperative pain, early ambulation, and return to activities of daily living and to work. Nesbitt et al. analyzed 13 randomized controlled trials with 3081 patients and concluded that neovascularisation and technical failure were both statistically reduced in the laser treatment group versus surgery[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In a large systematic review with 12320 patients success rates after three years of stripping and laser therapy were about 78% and 94%, respectively[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Wound complications such as infection, hematoma, and abscess after open surgery had a rate from 1,91\u0026ndash;10%, compared to EVLA whose infection rate was 0,33%[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. There was no significant difference in the incidence of postoperative phlebitis after EVLA and open surgery (6% vs. 3,7%; p\u0026thinsp;=\u0026thinsp;0.06)[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. All of the previously mentioned complications did not require surgical treatment. Puggioni et al. found a greater incidence of painful thrombophlebitis of GSV and cellulitis after EVLA compared to after RFA, which was attributed to incomplete vein emptying and intraluminal thrombus[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Otherwise, the incidence of thrombophlebitis after EVLA varies from 0\u0026ndash;67%[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The most fearful complications such as deep vein thrombosis and consequent pulmonary embolism are rare- 1,55% and 0,07%, respectively[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Another rare, but potentially life-threatening complication is suppurative thrombophlebitis. Usually, it is a condition that occurs in critically ill patients during and after intravenous injection or catheter insertion[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Otherwise, even with meticulous preparation in the operation field, there is always the risk of infection with the introduction of a foreign body into the veins. In addition, in EVLA necrotic vein is left in the leg compared to open surgical removal of GSV, which is another risk factor for infection. Another factor that bears a potential risk for infection is that stab avulsion phlebectomy was performed at the same time as EVLA. In our patient, EVLA led to a serious life-threatening infection, which required urgent aggressive surgical treatment.\u003c/p\u003e \u003cp\u003eIn the literature, there are only two cases similar to ours[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Both mentioned cases had ulcers on the lower leg, opposite to our patient who had some easily detachable flakes on her lower leg. Namely, during the preparation of the operation field, we only sprayed the leg with antiseptic, not rubbing the flakes on, so maybe this may be the source of infection. Because of the rarity of this complication, it is not clear that skin changes tissue culture, swabs, and antibiotic prophylaxis should be considered.\u003c/p\u003e \u003cp\u003eThere is not a lot of data or any guidelines on how to treat suppurative thrombophlebitis after EVLA. In some cases, antibiotics are the only therapy for patients with this complication, but in this case, aggressive surgical treatment and quality wound care are the only possible curative methods.\u003c/p\u003e \u003cp\u003eWe don\u0026rsquo;t have the intention to doubt the method and its efficiency and safety, because we routinely perform a lot of this intervention with a small percentage of self-limited complications. We want to draw attention to the specific characteristics of the patient that may lead to differences in the outcome of this generally very safe method and alert the doctors that every invasive procedure can lead to infection requiring aggressive surgical treatment.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eWe believe that EVLA is the future, but also the present in the treatment of chronic vein insufficiency with excellent results. Even concomitant ulcers and skin flakes on the legs are not contraindications for EVLA, which increases the risk for the development of suppurative thrombophlebitis. Accordingly, we think that maybe total isolation of skin changes should be implemented in operative field preparation hoping to prevent potential infection. In addition, preoperative and postoperative antibiotics should be given to these patients.\u003c/p\u003e \u003cp\u003eOf course, we want to point out that aggressive surgical treatment is the main goal in the treatment of these patients, and, antibiotic therapy results in complete healing and resolution of this rare, but life-treating complication.\u003c/p\u003e"},{"header":"ABREVIATION","content":"\u003cp\u003e \u003cb\u003eEVLA\u003c/b\u003e- endovenous laser ablation\u003c/p\u003e \u003cp\u003e \u003cb\u003eGSV\u003c/b\u003e- great saphenous vein\u003c/p\u003e \u003cp\u003e \u003cb\u003eCVI\u003c/b\u003e- chronic vein insufficiency\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConflicts of interest-\u003c/h2\u003e \u003cp\u003eThe authors declare that there is no conflict of interest.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics approval-\u003c/strong\u003e \u003cp\u003eThe Ethical Committee of Dedinje\u0026rdquo; Cardiovascular Institute approved this study and the approval number is 6487 of the date 24.10.2023.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to participate-\u003c/strong\u003e \u003cp\u003eWe have a written form of patient consent confirmation for participation and publication.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication-\u003c/strong\u003e \u003cp\u003eWe have a written form of patient consent confirmation for participation and publication.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding-\u003c/h2\u003e \u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthors' contributions-\u003c/h2\u003e \u003cp\u003ePM, AB, ST, SB, PG, SP and NI have substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; Also, PM, AB, ST, SB, PG, SP and NI drafted the article or revised it critically for important intellectual content and made final approval of the version to be published.\u003c/p\u003e\u003ch2\u003eAvailability of data and material\u003c/h2\u003e \u003cp\u003e(data transparency)- Yes\u003c/p\u003e\u003ch2\u003eCode availability\u003c/h2\u003e \u003cp\u003e \u003cb\u003e(software application or custom code)-\u003c/b\u003e Not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBone C. Tratamiento endoluminal de las varices con laser de diodo: estudio preliminary. Rev Patol Vasc. 1999;5:35\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarimian M, Tardeh S, Tardeh Z. Endovenous Laser Ablation for Varicos Vein Treatment: A Systematic Review and Meta-Analysis. Indian J Surg (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLurie F, Passman M, Meisner M et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord. 2020;8(3):342\u0026ndash;352. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jvsv.2019.12.075\u003c/span\u003e\u003cspan address=\"10.1016/j.jvsv.2019.12.075\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2020 Feb 27. Erratum in: J Vasc Surg Venous Lymphat Disord. 2021;9(1):288.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl Shammeri O, AlHamdan N, Al-Hothaly B, et al. Chronic Venous Insufficiency: prevalence and effect of compression stockings. Int J Health Sci (Qassim). 2014;8(3):231\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNesbitt C, Bedenis R, Bhattacharya V et al. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus open surgery for great saphenous vein varices. Cochrane Database Syst Rev. 2014;(7):CD005624. Update in: Cochrane Database Syst Rev. 2021;8:CD005624.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan den Bos R, Arends L, Kockaert M, et al. Endovenous therapies of lower extremity varicosities: a meta-analysis. J Vasc Surg. 2009;49(1):230\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCritchley G, Handa A, Maw A, et al. Complications of varicose vein surgery. Ann R Coll Surg Engl. 1997;79(2):105\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePerkins JM. Standard varicose vein surgery. Phlebology. 2009;24(Suppl 1):34\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePan Y, Zhao J, Mei J, et al. Comparison of endovenous laser ablation and high ligation and stripping for varicose vein treatment: a meta-analysis. Phlebology. 2014;29(2):109\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePuggioni A, Kalra M, Carmo M, et al. Endovenous laser therapy and radiofrequency ablation of the great saphenous vein: analysis of early efficacy and complications. J Vasc Surg. 2005;42(3):488\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eProebstle TM, G\u0026uuml;l D, Lehr HA, et al. Infrequent early recanalization of greater saphenous vein after endovenous laser treatment. J Vasc Surg. 2003;38(3):511\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSadick NS, Wasser S. Combined endovascular laser with ambulatory phlebectomy for the treatment of superficial venous incompetence: a 2-year perspective. J Cosmet Laser Ther. 2004;6(1):44\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMazayshvili K, Akimov S. Early complications of endovenous laser ablation. Int Angiol. 2019;38(2):96\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrady Z, Aizpuru M, Farley KX, et al. Surgical resection for suppurative thrombophlebitis of the great saphenous vein after radiofrequency ablation. J Vasc Surg Cases Innov Tech. 2019;5(4):532\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDunst KM, Huemer GM, Wayand W, et al. Diffuse phlegmonous phlebitis after endovenous laser treatment of the greater saphenous vein. J Vasc Surg. 2006;43(5):1056\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Suppurative thrombophlebitis, EVLA, case report","lastPublishedDoi":"10.21203/rs.3.rs-3928247/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3928247/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEndovenous laser ablation (EVLA) is a minimally invasive technique used to treat superficial venous reflux. The technique proved its safety and efficacy and became the standard of care for patients with chronic venous disease with lower rates of complications compared to open surgery.\u003c/p\u003e\u003ch2\u003eCase report\u003c/h2\u003e \u003cp\u003eWe present a 68-year-old female with C5 stage of chronic vein insufficiency who underwent endovenous laser ablation of the great saphenous vein. On the fifth day, she developed fever and pain, tenderness, and redness on the medial side of the treated upper leg with fluctuations in some places. Urgent incisions and radical debridement with extensive drainage were made. After intensive daily local wound treatment and antibiotic therapy signs and symptoms resolved and she was fully ambulatory with satisfactory postoperative findings.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eWe want to point out that aggressive surgical treatment is the main goal in the treatment of patients with suppurative thrombophlebitis, and, antibiotic therapy results in complete healing and resolution of this rare, but life-treating complication.\u003c/p\u003e","manuscriptTitle":"SUPPURATIVE THROMBOPHLEBITIS OF GREAT SAPHENOUS VEIN AFTER ENDOVENOUS LASER ABLATION - CASE REPORT","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-03 17:11:00","doi":"10.21203/rs.3.rs-3928247/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e0381e82-534e-4ab3-b811-f85f74ef914f","owner":[],"postedDate":"April 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-05-14T07:33:59+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-03 17:11:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3928247","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3928247","identity":"rs-3928247","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}