Varicose Vein Excision Procedure Causes Severe Skin Necrosis

This 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.