Pulmonary Embolism following Endovenous Laser Ablation (EVLA) of the Great Saphenous Vein

Abstract

A 70yr old lady presented to accident and emergency with sudden onset pleuritic chest pain. A pulmonary embolus (PE) was diagnosed by CTPA. Ten days earlier she had bilateral EVLA for recurrent great saphenous vein disease. Confounding risk factors for pulmonary embolism included bilateral ligation and stripping of the great saphenous vein a year earlier, malignancy, EVLA and phlebitic tributary varices. EVLA has been shown to be an effective treatment for superficial venous insufficiency with low morbidity and high patient satisfaction. The investigation of confounding risk factors and possible causes should not compromise the initial treatment of PE.

Figure 1

EVLA under ultrasound control

Figure 2

Pre-operative CXR

Figure 3

CXR on presentation with PE

Figure 4

Coronal reformatted CTPA showing thrombus within an upper segmental branches of the right lower lobar pulmonary artery (white circle).

Figure 5

Transverse CTPA cut showing thrombus within an upper segmental branch of the right lower lobar pulmonary artery (white circle).

Figure 6

Ventilation Perfusion Scan 7months post diagnosis of PE, demonstrating small mismatches at the right lung apex and superior segment of the right lower lobe.