Laser Ablation in the Treatment of Varicose Veins Revealing Deficit in Protein S: A Case Report

Abstract

A 70 years old female was admitted to Cardiovascular Surgery Department because of the aggravation of her left lower limb pruritis with eruptions and pigmentations. Her past medical history revealed deficit in protein S associated with pulmonary infarction, and had been pursued anticoagulation therapy. Ultrasound assessment of the vascular system revealed significant regurgitation in the varicose veins of small saphenous vein (SSV) without any sign of thrombosis at the deep vein in the lower limb (CEAP classification: C4a). Laser ablation was performed with 1470 nm ELVeS laser (ELVeS Radial 2ring). On the next day, ultrasound assessment detected endovenous heat induced thrombosis (EHIT) with class II to III at the junction of small saphenous vein and popliteal vein (SPJ). Laboratory study has shown PT-INR at 1.35. The reduction of the size of the thrombus within the small saphenous vein has been accomplished by the intensification of anticoagulation therapy. For patients with thrombophilia such as protein S deficiency, stable anticoagulation therapy may become one of the key factors to avoid thrombotic complications after laser ablation in the treatment of varicose veins.