Pathergy following endovenous ablation for lower extremity venous disease: A case report of an unexpected complication

Purpose: In the past decade, less invasive endovenous ablation procedures have gained in popularity for the treatment of lower extremity varicosities. Recent improvements in clinical practice suggest that endovenous ablation surgery could reduce recurrence of ulcers and earlier healing time for treatment of chronic venous disease. Although pathergy is well documented being induced by surgery, there are only a few case reports highlighting pathergy after lower extremity endovenous ablation and none at the inicision site.

The purpose of this case report is to highlight a case of pathergy following endovascular ablation and to emphasize caution when treating venous disease with lower extremity endovenous ablation.

Case Study: A 64-year-old female presents with wounds to her left ankle. Although her soft tissue cultures, her arterial doppler and duplex studies were unremarkable, her venous reflux studies showed both right and left Small Saphenous Vein insufficiency. After 8 weeks of standard treatment, her wounds to the left ankle did not improve and she developed a wound to her right anterior leg. Her left ankle wound healed at the 8 month mark after initial presentation, while her right leg wound healed in 3 months.

Thereafter she underwent an endovenous ablation for her left Small Saphenous Vein, without apparent complications. 2 weeks after surgery, she developed an incision site scab that worsened and ulcerated. She went on to successfully heal the wound after 16 weeks of treatment after no debridement, application of topical steroids and multilayer compression. The case report highlights pathergy from the endovenous ablation for lower extremity venous disease.

Analysis & Discussions: This case showed a rare complication being pathergy after endovenous ablation for venous disease. We suspect this pathergy that occurred after the endovenous ablation was due to the patient’s underlying pyoderma gangrenosum. We believe that the differential diagnosis of pyoderma gangrenosum should have been recognized and acknowledged before the endovenous ablation procedure. Pathergy following endovenous ablation for venous disease is a serious complication that both surgeons and patients should be aware of. Endovenous ablation should be performed with caution in patients exhibiting wounds which may be associated with pathergy.