I had a laser ablation on my left leg and the follow-up ultrasound after 2-3 days of surgery which showed that the vein did not close. The doctor said she had never seen this before. Is this dangerous? Should I have the procedure again to close it?
This is not dangerous - apparently, your treatment was not successful after endovenous ablation (EVA). After re-evaluation, the vein can be re-treated - however, if laser ablation (EVLT - EndoVenous Laser Therapy ) was not successful, the vein can be treated by radiofrequency ablation (RFA - RadioFrequency Ablation). These are performed similarly but use a different source of energy (and heat) to treat the vein.
Published on Jul 11, 2012
A persistent (open) saphenous vein after *expert* laser ablation is very unusual. Re-treatment is certainly possible if the first ablation attempt did not make the vein too small, but it would be helpful to understand why the vein did not close the first time. Possibilities include defective equipment (laser generator or laser fiber) and operator error (e.g., inadequate fluency = the amount of energy delivered).
Published on Jul 11, 2012
Failure of vein closure after the initial attempt is not common but does
occur in <1% of patients. Obesity, coughing, bearing down, blood thinners
are all possible contributing factors to this finding. Very large veins may
also not close on the first try. Regardless, there is no danger and if you
had a good indication to close the vein the first time then I would suggest
you proceed with repeat try. Today I saw a patient back who had a failed
vein closure fact procedure 2 weeks ago (due to severe COPD and a huge vein)
and I repeated the closure with a laser and applied the laser energy for a
longer period of time and also ligated (tied off) the huge varicose vein
coming off the great saphenous vein in the middle thigh. Immediate post of
ultrasound showed the vein to be successfully closed off.
Published on Jul 11, 2012
Another laser would be necessary to close the vein. That is very rare for the laser treatment to not be effective. It is not dangerous, it just means it needs to be retreated.
Published on Jul 11, 2012
No, this is not dangerous. However, you should have the vein retreated.
Published on Jul 11, 2012
The vein can be treated again. In our office we use radiofrequency versus laser. Radiofrequency has a 95 percent closure rate and is less painful.
Published on Jul 11, 2012
It's not dangerous, your doctor just needs to do scanning to see what's going on and do the procedure again.
Published on Jul 11, 2012
You should have it redone at no charge.
Published on Jul 11, 2012
This problem is not dangerous. Most probably, it is due to some technical aspects of the procedure itself. It is not dangerous to do it again, and certainly that is what you should do. The doctor will need to know what aspects of the technique should be adjusted in order to prevent a new failure.
Published on Jul 11, 2012
There are several variables involved in this scenario. Most simply, not enough energy was delivered to the vein wall to close the vein. This could be from equipment failure, operator error, char accumulation on
the fiber tip, venous aneurysm, etc. I believe a repeat procedure following analysis of what went wrong should be done. You should wear the stocking until then. A slight increased risk of thrombosis should be addressed. A mapping of refluxing tributary and perforator veins by ultrasound is indicated.
Published on Jul 11, 2012
Give it about a month and then get another ultrasound. There is no danger.
Published on Jul 11, 2012
Most of the time, even if the vein stays open, symptoms improve significantly. The latest studies show 1-3 percent non-closure early after procedure. But the amount of leakiness of the valves and patients' symptoms improve usually. So, no big hurry to go back again right away.
Published on Jul 11, 2012
This is not dangerous and does occasionally happen for a multitude of reasons. Since it is only three days after the procedure, I would repeat the ultrasound in two weeks to see if the vein closes. Wear compression hose during this period. If the vein is still open, then, depending on the extent of the open vein, either repeat closure or ultrasonic sclerotherapy can be done.
Published on Jul 11, 2012
It can happen in a percentage of patients, despite proper performance of the procedure. It can be treated again either with laser or radiofrequency if you still have symptoms.
Published on Jul 11, 2012
Failure of endovenous thermal ablation is very uncommon, but it does occur on rare occasions even with the best of care. In most cases, the procedure should be repeated and nearly always is successful. Occasionally, there is a large incompetent perforating vein refluxing blood into the saphenous vein which is associated with a failure. In this case, treatment of the incompetent perforating vein before repeating the saphenous vein treatment makes sense.
Published on Jul 11, 2012
I have performed thousands of these procedures and not seen this. There could have been an issue with the fiber, laser function or some other technicality. If the laser had fired, there would still be inflammation and clot in the vein. If the fiber was not in the actual vein this could be a reason also. I would be interested to know if you have any discomfort or bruising after the procedure. If you are comfortable, have the procedure repeated. It should be safe. Discuss this with your surgeon or seek a second opinion from an experienced vascular surgeon who performs these procedures.
Published on Jul 11, 2012