Compared to the old way of “vein stripping” requiring hospitalization and general anesthesia with much higher risk and complications, modern vein procedures have drastically reduced risks and complications. Nevertheless, no procedure is completely risk free. Although much less common than previous major vein stripping, there are four risks of modern vein procedures to understand:
Bleeding. Excessive bleeding is rare. Why? First, we’re working on the veins with much lower pressure versus arteries. Second, the problem excessive pressure trunk or perforator vein is eliminated first via a small puncture through the skin. If micro-phlebectomy is needed, this is usually performed last. Typical blood loss is 5-10cc blood, and this amount of blood loss is made up by the body in less than 24 hours.
Infection. This is also very uncommon. Any time nicks are made through the skin, even when performed with surgical sterile technique, infection can occur. Since incisions through the skin are so small, infection risk is much less than major surgical procedures where skin disruption is much more extensive. The rare VSA patient who gets a local infection can be handled with oral antibiotic. No VSA patient has ever had major infection or needed IV antibiotics.
Nerve injury. There are two types of nerves in the lower extremities: sensory and motor. Sensory nerves provide sensation to the legs. Motor nerves send signals to make muscles move. For modern vein procedures, the small risk is damage to a sensory nerve. Rarely heat from the laser or inadvertently pulling on a nerve during micro-phlebectomy can irritate a nerve. In either case, the area of the skin the nerve supplies will be numb and perhaps even burning/stinging sensation. If it occurs, usually the numb area is very small, about the size of a quarter, but can be larger. This is a rare complication occuring in 1% or less of patients. When it occurs, the numbness usually resolves, but since nerves heal very slowly it may take weeks-months to recover, or even rarer the patient is left with a permanent numb area.
Deep Vein Thrombosis (DVT). DVT is a deep vein clot. DVTs usually occur in the leg, but sometimes occur in the veins of the pelvis. This is the most serious complication of modern vein procedures since DVT can be fatal. If a DVT occurs acutely it causes much pain and swelling in the affected leg, and may cause chronic swelling of the leg and require blood thinner. Fortunately, the risk of DVT with modern vein procedures is very low (1 in 1000 patients) compared to the risk of DVT with prior vein stripping and other major surgeries that require general anesthesia and post-operative inactivity/recovery (1 in 100 patients). The best prevention is early mobilization and we start that right after the procedure is over, with the patient walking out of the surgery center or office and continuing light activity at home.