Part of the TeachMe Series

Consent: Endovenous Ablation

Not yet rated
based on ratings

Original Author(s): Ollie Jones
Last updated: February 14, 2019
Revisions: 6

Original Author(s): Ollie Jones
Last updated: February 14, 2019
Revisions: 6

format_list_bulletedContents add remove

This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent.

Overview of Procedure

Endovenous radiofrequency or laser ablation is the most common treatment for varicose veins, used for the long and short saphenous veins.

It involves an injection of local anaesthetic in the lower leg at the proposed site of venous puncture. The vein is cannulated and the ablation device passed to 2cm from the saphenofemoral or saphenopopliteal junction.

Injections of dilute local anaesthetic are then placed around the vein to prevent pain, act as a heat sink to prevent burns, and create pressure between the ablation device and the vein wall. The ablation device is then heated and withdrawn as per its instructions.

Intra-Operative

Complication Description of Complication Potential Ways to Reduce Risk
Haemorrhage This can occur due to damage to the vein, or inadvertent damage to an associated artery. Use of ultrasound guidance to identify the relevant neurovascular structures
Injury to surrounding structures Insufficient anaesthetic usage can cause burns to the surrounding structures or skin, or irritation to the nerves resulting in nerve pain. Use of ultrasound to assess the anaesthetic infiltration
Anaesthetic Risks This is a local anaesthetic procedure, however some individuals can react to the local anaesthetic.

Early

Complication Description of Complication Potential Ways to Reduce Risk
Pain The length of vein can become painful and tender post-operatively due to the inflammation. Use of topical NSAIDs.
Bleeding There is a small chance of bleeding and bruising at the cannulation site post-surgery.
Infection Superficial wound infection is possible, although are very rare. Peri-operative antibiotics will reduce the risk of wound infections
Skin Burns This can occur as the ablation device can get extremely hot and without due care and attention can burn the skin.
Venous Thrombosis, Nodularity, and Hyperpigmentation The treatment ablates the vein, causing it to become hard and lumpy. The haemosiderin will then break down leading to brown staining which can last for several months.
Blood Clots DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer and prolonged bed rest.

During this procedure if the ablation device is heated within the deep vein then this will cause a DVT.

The patient will be given anti-embolism stocking and low molecular weight heparin peri-operatively to minimise this risk as deemed appropriate.

Clear vision under ultrasound guidance of the superficial and deep venous junction, with a 2cm gap between the junction and the start of the ablation.

Death In an otherwise healthy individual this is 1 in 10000, however patients at higher risk of PE/DVT or other comorbidities then this will be increased.

Late

Complication Description of Complication Potential Ways to Reduce Risk
Reintervention Varicose veins have a tendency to reoccur over time, with new veins forming. Further intervention may therefore be required at a later date.