The Risks of the Latest Minimally Invasive Ablation Procedures for Varicose Veins
Written by Dallas Vein Specialists on January 6, 2011
The modern era of varicose vein surgery has not only brought minimally invasive techniques that reduce patient suffering and increase the rapidity of patients return to usual activities including minimal work time loss but has also dramatically reduced the surgical risks of having varicose vein operations. Comparisons of risks and complication rates between the old vein stripping operation and the modern ablation procedure using radiofrequency or laser energy are striking and unquestionably come down on the side of the ablation procedure.
The risks of endovenous laser ablation include infection, skin burns, nerve injury, and deep vein thrombosis. I will take each risk and discuss it, as I do with every varicose vein patient who comes to me at Dallas Vein Specialists.
Infection is rare in these procedures. Every attempt is made to prevent infection by providing antiseptic preparation of the surgical site, i. e. the leg, and by preventing contamination by maintaining a sterile operative field at all times during the operation. To date I have not seen a leg infection from an ablation procedure.
This is a rare complication, and again I have not seen this complication in any of the many ablation procedures I have done. When it occurs, a burn of the skin is the result of the heat energy generated by the radiofrequency or laser that damages the overlying skin. Special consideration and care is necessary in patients with minimal fatty tissue over the vein to be treated. This complication, a skin burn, should not occur with careful planning of the procedure.
Here I am talking about a sensory nerve injury and not a motor nerve. That is to say numbness of the skin and not muscular impairment or paralysis. There are areas where sensory nerves travel quite close to superficial veins. These areas are in the lower leg below the mid calf. Abnormal veins in these areas are usually not treated with the ablation technique, and thus a heat-induced injury can be avoided. Small areas of partial numbness may occur after endovenous laser or radiofrequency ablation treatments, but these almost always resolve within the first 3 months postoperatively.
DEEP VEIN THROMBOSIS
Deep vein thrombosis (DVT) is a serious complication and may lead to life threatening complications. Fortunately the risk of this complication is quite low in patients undergoing an endovenous radiofrequency or laser ablation operation.
Any thrombus or clot that develops within the inside of a vein that is located deep to the outer lining of the muscle should be closely followed. If the clot is in the large deep veins of the knee or thigh or involves the veins of the pelvis and abdomen, the patient should be treated emergently. Patients treated early with anticoagulation usually do well and the clot resolves uneventfully.
Patients may develop DVT with no symptoms or signs. For this reason I ask patients to come in for a quick look, using ultrasound, at the deep veins within a few days after the ablation procedure. This check is almost always clear with no DVT found. This is no surprise, as I take care during the procedure to avoid any contact or manipulation of any deep vein structure.
In summary the modern minimally invasive procedures for varicose veins are highly successful and allow a rapid recovery. The risks are quite low and acceptable such that no one should suffer the pain, discomfort, or unhealthy skin changes that accompany varicose veins .