Varicose Vein Treatment Risks

One of the most serious complications after any vein treatment is a blood clot in the deep veins of the leg (aka DVT or deep vein thrombosis), which could potentially break off and lead to a life threatening blood clot in the lung (AKA PE or pulmonary embolus). These events are collectively referred to as VTE. The risk of a VTE after EVLA reported in the literature is around 5/1,000.

Our VTE rates from 2012-2020 are as follows:
2012-2014 0/1000, 2015-2020: 1/1000.

Until June 2018, we had only had one case of pulmonary embolism. In 2019, we had one case. In 2020, there was a sudden jump to 7, which is almost certainly due to the prevalence of coronavirus increasing the risk of blood clots. One patient very sadly died, but to put this in context, it is the first death of a patient who has had treatment by us in the previous month in over 40,000 treatments.

Foam sclerotherapy in particular causes staining of the skin which looks like a bruise where the vein used to be. Many patients will experience some degree of staining which can last for several months or even over a year following treatment. Staining almost always resolves completely but we cannot guarantee that it will and permanent staining is possible.

Staining can also occur after other vein treatments but not so frequently.

Staining after foam sclerotherapy of large twisty vein on back of thigh

Similarly on front of thigh (different patient)

Staining after sclerotherapy to calf veins

Staining after Clarivein

Old blood which was aspirated 

Following aspiration, the staining resolved completely within a few weeks.

There have been a few cases where new thread veins appear over the area where EVLA has been performed. If this occurs, you will require microsclerotherapy injections or Veinwave to clear these up.

We have never seen any damage to a nerve that supplies muscles and therefore affects movement of the leg. This is exceedingly unlikely to happen. Nerves that transmit sensations from the skin can be damaged especially with EVLA below the knee and this can lead to numbness or tingling on the inside of the lower leg. This usually gets better in 3-4 months and is not disabling.

We have seen two cases of skin burns (see image below); however, these were both over 10 years ago in the early days of our practice and occurred after VNUS RF ablation. We have never seen any burns after EVLA laser treatment, but it is theoretically possible.

Skin burn after VNUS RF

Reactions to the stocking tops are quite common. About 10% of patients get some discomfort. We have tried all the quality stockings on the market and have found Sigvaris to be the most comfortable and least problematic.

This is an inflammation of the vein and almost inevitably accompanies any form of vein ablation. It is a natural reaction to the heat, chemical or mechanical trauma which is required to kill the vein. Most patients therefore will experience some symptoms of phlebitis, i.e. discomfort, swelling and maybe some redness.

This is usually shortlived, but if it persists, especially after foam sclerotherapy, it may be helpful to aspirate some of the old blood that accumulates. This can also help reduce the amount of skin staining.

Phlebitis after Endovenous Ablation is virtually never infected, so you should not require antibiotics.

Following foam sclerotherapy, we have a few patients who developed a temporary visual disturbance, like one gets with migraines. This lasted about 10 minutes for each patient, and was totally and permanently resolved in all cases.

These are likely caused by tiny bubbles of sclerosant entering the blood supply to the brain. This sounds frightening, but we have never seen any permanent visual sequelae. The likelihood of these reactions increases in those with a history of migraine, who may have a small hole in the heart, which allows passage of bubbles from the legs to the brain.

This is not uncommon, particularly when having the ultrasound examination whilst standing on a stool. No-one has come to any harm, and all patients recovered quickly with simple measures like lying down and raising their legs. Very occasionally, it can be more serious, but we are well equipped to deal with it.

We have seen three serious allergic reactions: two to the sclerosant chemical and one to the anti-inflammatory drug that was given after EVLA (Diclofenac). One of these required hospital admission for observation overnight. We have all necessary equipment and drugs to deal with any emergency of this nature.

The incisions involved in Endovenous Ablation are so small, meaning the risk of bleeding occurring is very low. It can occasionally occur after Avulsions.

As we are not making incisions in most cases, just needle punctures, the risk of infection is very low. We have seen one serious case that required antibiotics and hospital admission.

• Breakage of laser fibre or catheter
• Anaphylaxis (Severe life threatening allergic reaction)
• Heart attack
• Tissue necrosis (gangrene or death of skin/ muscle)
• Stroke
• TIA (minor stroke)
• Death

Whenever an instrument is placed inside the body, there is a small risk for retention of all or a part of it. If this occurs, a small incision is likely to be required to remove the instrument. Transfer to hospital may be necessary. There is a very low risk of this happening.

There have been three cases of the laser fibre breaking. They were the result of a manufacturing fault and consequently the manufacturer has redesigned the fibre to minimise this risk. Two of these necessitated a small incision to remove the fragment. In the third case, it was safe to leave the fragment in place, as there was no risk of it moving and causing any problems.

Various other rare minor problems can arise. We have seen one lady lose her thumb nail by pulling up her stocking. Ouch!