Classification and Treatment of Endothermal Heat-Induced Thrombosis

Publication Date: September 29, 2020
Last Updated: March 14, 2022

Recommendations

Classification of endothermal heat-induced thrombosis (EHIT)

Classification system for EHIT

We suggest the use of a classification system to standardize the diagnosis, reporting, and treatment of EHIT. (G-U, )
679

Classification system based on duplex ultrasound

We suggest that venous duplex ultrasound with the patient in the upright position, performed within 1 week of the index procedure, forms the basis for the classification system. (G-U, )
679

Kabnick classification system

We suggest consideration of the Kabnick classification for reporting of EHIT at the saphenofemoral great saphenous vein [GSV]) or saphenopopliteal (small saphenous vein [SSV]) junction. (G-U, )
679

Lawrence classification system

We suggest consideration of the Lawrence classification for reporting of EHIT at the saphenofemoral (GSV) or saphenopopliteal (SSV) junction. (G-U, )
679

American Venous Forum EHIT classification system

We suggest preferential use of the unified American Venous Forum EHIT classification system to standardize ongoing reporting, given that it maintains the essence of the Kabnick and Lawrence classification systems, remains recognizable, and may be used for ongoing meta-analyses and systematic reviews. (BP) It is a four-tiered classification:
  • I = junction
  • II = <50% lumen
  • III = >50% lumen
  • IV = occlusive deep venous thrombosis
(G-U, )
679

Risk factors and prevention

Risk factors for EHIT

Some possible but inconsistent predictors or risk factors for EHIT include large GSV diameter, previous history of venous thromboembolic disease, and male sex. These may be considered in the preprocedure phase, but the evidence is inconsistent. (2 – WeakC)
679

Prevention of EHIT with mechanical prophylaxis

The use of mechanical prophylaxis for prevention of EHIT should be tailored to the patient after an assessment of the risks, benefits, and alternatives. (2 – WeakC)
679

Prevention of EHIT with chemical prophylaxis

The use of chemical prophylaxis for prevention of EHIT should be tailored to the patient after an assessment of the risks, benefits, and alternatives. (2 – WeakC)
679

Prevention of EHIT by increasing ablation distance

There is a trend toward decreased EHIT when ablation is initiated >2.5 cm from the saphenofemoral (GSV) or saphenopopliteal (SSV) junction. (2 – WeakC)
679

Treatment of EHIT

Classification system

We suggest the stratification of treatment based on an accepted EHIT classification system. (G-U)
679

Treatment for EHIT I

We suggest no treatment or surveillance for EHIT I. (2 – WeakC)
679

Treatment for EHIT II

We suggest no treatment of EHIT II but do suggest weekly surveillance until thrombus resolution. In high-risk patients, consideration may be given to antiplatelet therapy vs prophylactic or therapeutic anticoagulation with weekly surveillance. Treatment would cease after thrombus retraction or resolution to the saphenofemoral (GSV) or saphenopopliteal (SSV) junction. ( 2 – Weak , C)
679

Treatment for EHIT III

We suggest treatment with therapeutic anticoagulation for EHIT III, weekly surveillance, and cessation of treatment after thrombus retraction or resolution to the saphenofemoral (GSV) or saphenopopliteal (SSV) junction. (1 – StrongB)
679

Treatment for EHIT IV

We suggest that treatment should be individualized, taking into account the risks and benefits to the patient. Reference may be made to the Chest guidelines for the treatment of deep venous thrombosis. (1 – StrongA)
679

Management of SSV

Management of EHIT for the SSV

We suggest that management and treatment for EHIT as it relates to the SSV parallel those for the GSV. (2 – WeakC)
679

Recommendation Grading

Overview

Title

Classification and Treatment of Endothermal Heat-Induced Thrombosis

Authoring Organizations

American Venous Forum

Society for Vascular Surgery

Publication Month/Year

September 29, 2020

Last Updated Month/Year

April 1, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Intended Users

Nurse, nurse practitioner, physician, physician assistant