Late pulmonary embolism after endovenous laser ablation (EVLA)

A female patient in her early 40s presented with bilateral great saphenous vein (GSV) incompetence, as identified on duplex ultrasound (DUS), and recurrent leg swelling. The patient underwent endovenous laser ablation for bilateral GSVs with concomitant phlebectomies. She was discharged on the same day without any reported complications and was prescribed prophylactic low-molecular-weight heparin for 1 week. Seven days later, although asymptomatic, the surveillance DUS confirmed bilateral GSV global occlusion.On postoperative day 27, the patient reported sudden-onset dyspnoea, chest pain and presyncope. CT angiography confirmed a pulmonary embolism associated with an area of pulmonary infarction. Further investigation with DUS identified an endothermal heat-induced thrombosis classified as type II.The patient was hospitalised for 3 days on therapeutic doses of anticoagulation. This treatment was maintained after discharge for 6 months and followed over 30 months, without residual symptoms, and additional testing for thrombophilia did not show positive results.