Varicose Vein Excision Procedure Causes Severe Skin Necrosis

    Varicose vein excisionThis case involves a 54-year-old female patient that underwent a varicose vein excision procedure. The patient underwent a left great saphenous vein radio frequency ablation approach but the following morning she experienced several complications including a significant portion skin sloughing that came off her upper thigh. The patient was treated with silver sulfate cream on the wound and was referred to a plastic surgeon by the original treating surgeon. The surgeon that performed the procedure claimed that the catheter was defective and may have caused the complications.

    Question(s) For Expert Witness

    • 1. Is it plausible that a defective catheter may have caused this significant damage?
    • 2. Is skin sloughing a know complication of this procedure?

    Expert Witness Response E-001075

    There are several known complications to radiofrequency ablation (RFA) of the saphenous vein to treat venous insufficiency/symptomatic varicose veins. The most common include the development of discomfort, pain, paresthesia/numbness, hyperpigmentation. One of the most concerning is the development of thrombus extension leading to a deep venous thrombosis. It is possible to get “skin burn” but this is extremely rare. Rates are usually “zero.” I am uncertain how the catheter would have been defective to a point to cause the sloughing process. The generator is pre-set to deliver the proper amount of energy (Watts) to make the heating element exactly 120 degrees.

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