Successful Treatment of Varicose Great Saphenous Vein Complicated with Acute Thrombosis by Balloon-Assisted Thrombectomy Combined with Radiofrequency Ablation: A Case Report

Abstract

Introduction:Great Saphenous Vein (GSV) varicosity is a common clinical vascular disease, frequently complicated by Superficial Venous Thrombosis (SVT). SVT may extend to the deep venous system, causing severe Venous Thromboembolism (VTE). The standard treatment for GSV varicosity with acute SVT—especially involving the Saphenofemoral Junction (SFJ)—remains controversial. Anticoagulation is the mainstream to reduce thromboembolic risk, while surgical treatment has drawbacks like significant trauma and excessive bleeding, failing to lower long-term thromboembolic incidence. This leaves gaps in optimal timing and combined regimens, with scarce evidence for alternative therapies without standard equipment. This case report describes a successful combined interventional therapy for a patient with 30-year untreated GSV varicosity and SVT, providing practical evidence.

Case Study:A 74-year-old male presented with right lower limb swelling and pain for 10 days, along with 30-year untreated varicosity. Physical examination showed tortuous and dilated GSV (earthworm-like protrusions), hard nodules, erythema, edema, and ankle pigmentation (CEAP class 4; Venous Clinical Severity Score [VCSS] = 12; Aberdeen Varicose Vein Questionnaire [AVVQ] = 22). Color Doppler ultrasound confirmed extensive GSV thrombosis (extending to SFJ) without deep venous thrombosis. After full risk disclosure of VTE, the patient opted for surgery (declined vena cava filter placement). Lacking a Fogarty catheter, the operator used a deep venous balloon catheter to occlude the SFJ, performed above-knee GSV thrombectomy with a superficial venous balloon, followed by endovenous radiofrequency ablation. Below-knee tributaries were treated with ultrasound-guided foam sclerotherapy combined with minimally invasive phlebectomy. Postoperative anticoagulation relieved symptoms; 10-month follow-up showed no thrombosis recurrence, vessel recanalization, or adverse events.

Conclusion:This case demonstrates the efficacy of combined therapy (deep venous balloon occlusion, alternative catheter-based thrombectomy, radiofrequency ablation, foam sclerotherapy/minimally invasive phlebectomy) for long-standing GSV varicosity with SVT. It confirms that deep venous balloon catheters can replace Fogarty catheters in resource-limited settings. The 10-month follow-up verifies long-term safety, offering a practical treatment paradigm for similar high-risk cases and supplementing evidence for individualized GSV varicosity therapy.