Complications

Modern minimally invasive venous treatments are safe. Safer than the more traditional surgery with knives, clips, hooks and strippers. Despite their inherent safety it is important to know that NO medical intervention is completely safe. The most concerning complication for endovenous therapy is deep vein thrombosis. It is rare, probably less than 1-2% of cases, made rarer by getting the patient up and walking within minutes of completing the procedure and encouraging mobility throughout the following 2-3 weeks.

This was highlighted to me recently after performing an ablation on a patient under general anaesthetic, at the patients request. All straightforward, as was the recovery. However, the tendency, after GA, is to spend time recovering in bed. Its a kind of tradition that is hard to culturally shake off. It makes people groggy for quite a period afterwards and subdues natural activity. Patients are dehydrated. All of this contributes to a pro coagulant state already present following surgery.

It was probably a combination of all these factors, and body habitus, an hot holiday weather in the weeks following that caused a DVT. Luckily, the patien has recovered well but it has delayed recovery for some months.

The lesson for me is to not try to please people all the time. Either it’s ambulatory surgery or it’s not, and if not then all the usual tools for thromboprophylaxis should be used. That said, I’ll refer you right to the top of the piece. There is nothing that one does in medicine that is completely safe.

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