I had endovenous laser ablation (EVLA) done 6 months ago and I am still suffering in pain. I believe the vein failed to close completely, as I had a large amount of blood removed 3 months after my procedure. It still feels tight like a cord and I have pain in the same spot. If the specialist did in fact fail at the procedure, should it be fixed free of charge?
Every vein is different in terms of size, location, branches, leg size, amount of walking and compression post-procedure, ancillary follow up procedures such as phlebectomy or sclerotherapy. Not knowing all this information, it is difficult to comment on your question. Certainly, if the process failed, your doctor should have discussed this with you and formulated a strategy to achieve success, not just repeating the procedure, if you follow my thoughts. Of course, some endovenous procedures do need to be revised and are complicated by the possible presence of synechia (scar tissue) within the vein, requiring multiple insertions. Sometimes, if not too bad, just sclerofoam can achieve closure. As for the issue of failure, the success rate for the procedure varies, with an average success rate of 95%. Freebies for re-do procedures are between you and your doctor. There are significant fixed costs to do this procedure. What I'm saying is that a complete re-assessment needs to be done, not just a redo of one procedure in our toolbox.
Published on Jul 11, 2012
It depends on the arrangement you have with your treating physician. You should have an ultrasound to show whether the treated vein is closed or not so you both know where you stand. Removal of trapped blood is expected when a vein is closed, and a "tight, cord-like" sensation is also normal for some time following ablation. However, most patients are symptom-free one or two months after the procedure.
Published on Jul 11, 2012
I would say yes it should. That would be the right thing to do on the physician's side. That is what most, if not all, physicians do if a procedure does fail, especially since an EVLA procedure done properly has a less than 1% chance of failure, even with large veins.
Published on Jul 11, 2012
While an endovenous laser ablation procedure can fail, it is uncommon. The "cord-like" sensation can be helped with massage and some pressure over the area to soften scar tissue. There can be a lot of reasons for you pain. You may have scar tissue and some trapped nerves in the area of ablation. Again, try massage several times per day. Apply gentle, yet firm pressure. This may help with the pain also. Typically, if there is a failure to seal a vein, the issue can be brought to the attention of the insurance company. They may approve a new procedure. You should be thorough evaluated by an experienced vascular surgeon who is equipped to properly carry out vein procedures. If you are unsure about the job your doctor did, you can always seek a second opinion.
Published on Jul 11, 2012
There is an expression: "there are no guarantees in medicine". The failure rate for endovenous ablation is about 3%. Therefore, we know 3 of 100 patients will have a vein that recanulizes. Your body is fighting the process and trying to re-open the vein. Early on, the vein is only partially open and can often be closed with foam sclerotherapy, which is inexpensive.
Published on Jul 11, 2012
I am not sure what you mean by fixing the procedure. What you describe are things that can occur from endovenous laser ablation. Palpable cords can occur and sometimes need to be evacuated. The only way of knowing if the vein did not close is to repeat the venous ultrasound. If you did not have a post-ablation ultrasound, then you should. And if you did have one, then it should show whether or not the vein is closed. Certainly, pain 6 months later is not the norm and you should follow up with your treating physician or obtain a second opinion. By the way, no procedure carries a 100% success rate, and even venous closure has a 2 to 3% failure rate.
Published on Jul 11, 2012
Unfortunately, that is not how it works. All procedures have some risk of failure. You are not paying for results, rather the service. If you hire a lawyer to defend you and you are found to be guilty, you still must pay him. He has performed a service. The outcome may not be what you want, but the service was still provided. The same is true for a medical service or procedure.
Published on Jul 11, 2012
I'm not sure if it was private pay or covered by your insurance company. Almost all our vein patients do have insurance coverage and authorization, so we summit to them. I don't know how to answer your question
correctly because I don't know your agreement with the doctor who performed the procedure.
Published on Jul 11, 2012
It does not sound like the EVLA procedure failed. On occasion, the procedure may need to be repeated if the vein does not close, but a hard cord indicates the vein is probably closed. Discuss your concern with the treating MD or get a second opinion.
Published on Jul 11, 2012