Intraoperative Radial Fiber Cap Loss, a Rare Complication of Endoluminal Therapy

Abstract

Background In the past, surgical treatment of truncal varicosis consisted of high ligation, stripping procedures and if necessary phlebectomy in a minisurgical technique. In the last decade endoluminal technique and especially laser procedures have gained important. Complications after endoluminal laser techniques are rarely desribed.

Method We describe in a case report for the first time the intraoperative detachement of a laser probe tip during endonominal therapy of truncal varicosis. Direct imaging evidence of the detached probe tip was not possible by duplex sonography due to the applied TLA solution. CT diagnostics were also inconclusive.

Result On the day following the operation, the torn probe tip was easily identified by ultrasound. In order to prevent embolisation of detached glass particles we decided to openly surgically remove the probe tip and subsequently to perform high ligation.

Conclusion With a time delay (hours), it is possible to reliably locate the detached probe tip using ultrasound.Surgical intervention but also passive waiting are to be discussed.

Keywords

endoluminal therapy - laser therapy - laser probe complication - varicose vein surgery

Publication History

Article published online:
29 November 2022

• Literatur

• 1 Kheirelseid EAH, Crowe G, Sehgal R. et al. Systematic review and meta-analysis of randomized controlled trials long-term outcomes of endovenous management of lower extremity varicose veins. J Vasc Surg Venous Lymphat Disord 2018; 6: 256-270
• 2 Scholl S, Leitz N. Fallbericht zur Bergung von Katheteranteilen beim Radiofreqenzverfahren bei technischem Defekt. Phlebologie 2022; 51: 129-131
• 3 Spreafico G, Piccioli A, Bernardi E. et al. Endovenous laser ablation of great and small saphenous vein incompletence with a 1470 nm Laser and radial fiber. J Vasc Surg: Venous and Lym Dis 2014; 2: 403-410
• 4 Hartmann K, Stenger D, Hartmann M. et al. Endochirurgie versus offene Chirurgie. Hautarzt 2017; 68: 603-613
• 5 Stenger D, Hartmann M. Crossektomie und Strippingoperation Der Klassiker. Der Hautarzt 2013; 63: 616-621
• 6 Van den Bos RR, Neumann M, De Roos KP. et al. Endovenous laser ablation-induced complications: review of the literature and new cases. Dermatol Surg 2009; 35: 1206-1214
• 7 Lun Y, Shen S, Wu X. et al. Laser fiber migration into the pelvic cavity: A rare complication of endovenous laser ablation. Phlebology 2015; 30: 641-643
• 8 Bozoglan O, Mese B, Inci MF. et al. A rare complication of endovenous laser ablation: intravascular laser catheter breake. BMJ Case Rep 2013; 2013009012
• 9 Holdstock JM, Marsh P, Whiteley MS. et al. It ist possible to cause damage to a laser fiber during delivery of tumecent anaesthesia for endovenous laser ablation (ELVA). Eur J Vasc Endovasc Surg 2008; 36: 473-476
• 10 Proebstle TM, Lehr HA, Kargl A. et al. Endovenous treatment of the greater saphenous vein with a 940 nm diode laser: thrombotic occlusion after endoluminal thermal damage by laser-generated steam bubbles. J Vasc Surg 2002; 35: 729-736
• 11 Lekich C, Hannah P. Retained laser fibre: insights and management. Phlebology 2014; 29: 318-324