UNASSIGNED: Ambulatory ultrasound-guided foam sclerotherapy (UGFS) for refluxing saphenous veins is considered a safe therapy. Venous @entity1031 after UGFS as well as after all other ambulatory ablative venous interventions are rarely reported. This paper reports a @entity1151 ( @entity1151 ) following UGFS in combination with an extended phlebectomy, and questions what measures should be taken to minimize the risk for @entity1031 after these procedures. In the reported case (unsuspected), extensive non-occluding @entity731 as well as @entity28 in combination with use of an oral contraceptive might have contributed to the development of the @entity1151 while the use of a b-blocker might have increased its fatal course considerably. Routine measurement of the ankle-brachial pressure index reduces the risk for undetected @entity731 . It appears that 'in the real world' of ambulatory phlebological treatments @entity1031 are more common (2.4-4.7%) and appear accompanied by post-procedural mortality. It is concluded therefore that pharmacological thromboprophylaxis appears warranted in selected cases, perhaps even routine application could be considered. Attention is drawn to the highly thrombogenic but not uncommon combination of overweight and use of oral contraceptive. Apart from applying some form of pharmacological thromboprophylaxis, technical adaptations that might prevent or reduce spill over of foam into the deep venous system should be considered. Firstly, next to adherence to the generally accepted maximum of 10   mL of foam per session, it seems prudent to maximize the injected volume of foam per site. Secondly, it seems best to inject the foam in an elevated leg without groin compression. The concentration of the sclerosant does not appear decisive in this respect, although higher concentrations appear more effective and therefore might be injected in lower volumes without compromising efficacy.

XXXX following ultrasound-guided foam sclerotherapy combined with multiple microphlebectomies.

@entity731 :: ('MESH:D050197', 'Disease') :: ['atherosclerosis'] @entity1031 :: ('MESH:D013923', 'Disease') :: ['thromboembolic complications'] @entity28 :: ('MESH:D009765', 'Disease') :: ['obesity'] @entity1151 :: ('MESH:D011655', 'Disease') :: ['fatal pulmonary embolism', 'PE']
@entity1151 :: (MESH:D011655,Disease) :: ['Fatal pulmonary embolism']
