Endovenous laser treatment (EVLT) has become a gold standard varicose vein treatment. From the patient’s perspective, it is a relatively simple procedure. It’s only minimally invasive with little to no pain. It can be done as an out patient treatment in a vein clinic in about an hour. The patient is encouraged to walk right after the procedure to stimulate the blood flow to find a new pathway around the newly ablated vein. Then the patient goes home, or sometimes even back to work, wearing compression stockings.
Full recovery after EVLT varicose vein treatment takes about two weeks in most cases and there are seldom any complications. However, on rare occasions, there is one potentially serious complication that takes place. This is a thrombus (blood clot) in the saphenous vein. In some cases, this can cause inflammation of the vein where the vein becomes hot and tender, often appearing as a blotchy line of redness along the vein.
This condition is commonly referred to as “phlebitis.” If you break this word down into its Latin roots, it literally means “vein inflammation.” However, since the reaction is brought on by the clot, some doctors believe it would be better to call the condition, “superficial venous thrombosis” since this more accurately describes the condition. Unfortunately, if one goes to the emergency room with a case of phlebitis, or superficial venous thrombosis, emergency room doctors usually assume infection and will give intravenous antibiotics to treat the condition.
However, when phlebitis occurs in associated with a blood clot forming after EVLT varicose vein treatment, antibiotics are not the treatment that is needed. Instead, in most cases, a mild blood thinner, like aspirin, should be given to prevent any further formation of a blood clot and to help break up the blood clot. Graduated compression stockings would also be prescribed along with the aspirin. However, if the blood clot is located within five millimeters of a deep vein, the medical community has found there is a one percent chance it could break off, enter the bloodstream, and end up in the lungs causing a pulmonary embolism, which is a life threatening condition. In this case, the best treatment would be a much stronger blood thinner (anti-coagulant) like Warfarin, also known as coumadin.
Because of the extremely serious nature of a potential pulmonary embolism as a rare complication of an EVLT varicose vein treatment, it has been recognized since 2012 that phlebitis should be immediately diagnosed using a duplex ultrasound test. This is the only way to know the exact location and nature of the blood clot so it can be precisely mapped out and the proper treatment given. This is one reason that patients who have received EVLT varicose vein treatment should stay in close communication with their vein specialist at the vein clinic in which they had their procedure rather than, or at least in addition to, dashing off to the emergency room when signs of a complication arise.
It’s important to understand too that symptoms that seem like phlebitis may actually be something else. For example, what looks like phlebitis make actually be a deep vein thrombosis, or in rarer cases, actual infection of the veins due to the procedure. The only way to know for sure is to have a thorough duplex ultrasound test by a team of vein specialists who really know how to conduct and interpret these types of tests.
The information given in this article is not intended to scare anyone away from having a needed EVLT varicose vein treatment. While phlebitis, especially a case where it is five millimeters or less from a deep vein, is a very rare complication, it is still always better to be an informed patient so you know what to look for and you know exactly what to do if you have this rare complication. You should always ask your doctor what are the possible complications and then ask what you should do if these occur. A good vein specialist will be happy to answer these important questions.
The best way to lower your odds of a serious complication after EVLT varicose vein treatment, or really any other type of varicose vein treatment, is to have your procedure performed by a highly skilled vein specialist who has done literally hundreds, or even thousands, of similar procedures. You’ll find vein doctors with this type of skill and experience at Metro Vein Centers. If you suspect you may need varicose vein treatment, you can elect to have a free consultation at Metro Vein Centers and then go over the various treatment options with the doctor.