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What risks are involved in an endovenous laser treatment?

This question was asked in Gentry, Arkansas and has 9 answer(s) as of 06/04/2013.
I'm scheduled for endovenous laser treatment tomorrow for a large varicose vein. My primary doctor is against it. What should I do? The surgeon is a interventional radiologist who is specializing in vascular vein removal.


Doctors Answers (9)

It is unclear from your question what the objection is from your primary care doctor. The endovenous laser treatment is FDA approved as a minimally invasive office procedure that treats varicose veins by using a fiber-optic catheter inserted into the vein though a simple needle placed into the vein and monitored by ultrasound. It is a safe procedure using only a local anesthetic, that is both quick and highly effective. It is also safe for patients with other health problems including diabetes, well controlled hypertension, advanced age, and other controlled medical conditions.

Although Endovenous Laser Treatment is very a safe treatment, there is according to studies approximately 1/ 1000 to 1/10,000 risk of DVT or blood clot from the procedure.

You didn't mention if you have any other risk factors or medical conditions which may concern your primary care doctor. There are very few conditions which would affect the outcome of this procedure. I even treat patients who are on blood thinners without them having to stop for 5 days. If you have saphenous reflux (venous insufficiency) causing symptoms such as pain, heaviness, aching, swelling or skin changes to name a few, you are a good candidate for venous ablation. It will help alleviate these symptoms, give you more energy as your leg will feel "lighter". As a surgeon I would typically remove the large varicose vein at the same time using microphlebectomy (very small puncture through which the vein is removed). It may be that you won't need any other intervention later. Typically an Interventional Radiologist will only seal the saphenous vein which is refluxing and they will wait to see if the vein goes away or refer you to a surgeon for this later.

I would have a vascular surgeon with phlebology boards (vein specialist) to perform the procedure. The risks include reopening of the vein (especially if large) or deep vein thrombosis. Each risk is about 1 to 2%.

The endovenous laser is a very safe office based procedure that has been around for around 10 years. The biggest risk would be the risk of a blood clot which is quoted at less than one percent. Even if this did happen, in most cases you would just go on a blood thinner for a few months. Other than that the laser could break, could burn you, could irritate a nerve, could cause an inflammation of a superficial vein or some slight discoloration over the area. Just make sure that the doctor who is doing it has been well trained, does a lot of them, and will do sclerotherapy or phlebectomies as needed as well so that you are happy in the end.

I cannot answer this question without seeing you and looking at your veins and ultrasound results. However, venous disease is a very treatable health problem and it is the domain of Phlebology and vascular specialist. There is very little training or education provided to PCP's about venous disease.

The risks of endovenous laser ablation are minimal if performed by a vein specialist such as an interventional radiologist . These extremely uncommon risks include skin injury or blood clot formation in the deep vein system.

Serious complications of endovenous thermal ablation are very rare. Most patients will experience minor tenderness and bruising near the treated area. Some will have minor numbness in the inner aspect of the lower thigh or calf. This nearly always resolves with time. There are reports of burns to the skin from treating veins just under the skin. Skin burns almost always are avoidable. Sometimes a varicose vein that empties directly into the treated vein will clot over a short distance causing pain and tenderness. This is mostly annoying for a few days and is not dangerous. If you truly have significant symptoms from an incompetent saphenous vein, endovenous thermal ablation is the treatment of choice in the vast majority of cases. It is possible that your primary care physician thinks you do not have sufficient symptoms to warrant treatment or some other reason to oppose the treatment. if so, he should be able to tell you why. Unfortunately, many primary care physicians do not understand modern management of venous disorders and they discourage patients from evaluation and treatment which will improve their quality of life. You might want to be sure that your interventional radiologist truly specializes in vein treatment and that he can deal with any of your other vein needs such as sclerotherapy if you need sclerotherapy. Ask about credentials and experience treating varicose veins.

The risks for the procedure are extremely low. Interventional radiologists are highly specialized physicians who are very qualified to do such procedures. Potential risks for the laser treatment include bleeding, infection, skin burn, blood clot, nerve damage and darkening of the skin. These are all very rare. The last two complications are typically temporary.

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