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Abstract

Varicose veins of the lower limbs are a common clinical condition caused by CVI (Chronic Venous Insufficiency). EVLA (Endovenous Laser Ablation) is a widely practiced, minimally invasive treatment modality for managing superficial venous insufficiency and varicosities. Although complications are infrequent, some device-related issues warrant attention due to their potential consequences.


We report a rare case of intravascular fragmentation of the laser fiber tip during EVLA. A 62-year-old male with a 30-year history of bilateral varicose veins presented with left lower limb pain and pigmentation. Clinical examination and venous Doppler revealed SFJ (Saphenofemoral Junction) incompetence and multiple perforator insufficiencies. EVLA of the left GSV (Great Saphenous Vein) was performed. During the procedure, loss of resistance during fiber retraction prompted inspection, which revealed that the laser fiber tip had broken intravascularly. The fragment was localized radiologically and surgically retrieved via targeted wound exploration. The patient had an uneventful postoperative recovery.


Intravascular fragmentation of the laser fiber tip is a rare but recognized device-related complication of EVLA. Adherence to procedural protocols, including fiber inspection before and after ablation, careful energy settings, and continuous intraoperative monitoring, is essential for prevention. This case underscores the importance of prompt recognition and appropriate management to prevent further complications.


Varicose veins of the lower limbs are a prevalent vascular disorder resulting from CVI. This condition arises due to valvular incompetence within the superficial venous system, leading to venous reflux, increased venous pressure, and subsequent vein dilation. It significantly impacts patients’ quality of life by causing symptoms such as pain, heaviness, leg swelling, skin changes, and ulceration, in addition to posing socioeconomic burdens due to reduced productivity and healthcare costs.[1,2]


Historically, the mainstay of treatment for superficial venous insufficiency was surgical—specifically, high ligation and stripping of the great saphenous vein. In recent years, however, the management landscape has shifted toward minimally invasive endovenous techniques, including EVLA, RFA (Radio-Frequency Ablation), foam sclerotherapy, and cyanoacrylate glue closure. These techniques offer high efficacy, lower morbidity, shorter recovery time, and improved cosmetic outcomes.[3]


Among these, EVLA has emerged as one of the most commonly performed procedures due to its high vein closure rates and low recurrence and complication profiles. Although EVLA is typically considered safe, there are some rare instances where complications may arise. These include bruising, thrombophlebitis, DVT, skin burns, nerve injury, pigmentation, and more rarely, device-related issues such as laser fiber tip fragmentation.[4,5]


The case presented in this report is significant because it illustrates a rare but important device-related complication: intravascular fragmentation of the laser fiber tip during EVLA. This type of complication, if not promptly recognized and appropriately managed, can lead to serious outcomes such as thrombosis, embolism, or infection. The case underscores the need for strict procedural protocols, intraoperative vigilance, and post-procedural fiber inspection to ensure patient safety and optimal outcomes.


By documenting this event, the case adds to the limited existing literature on fiber tip fragmentation during EVLA and serves as a practical reminder for vascular surgeons and interventional radiologists to remain alert to this preventable complication during what is otherwise a safe and routine procedure.

Article Details

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How to Cite
Prajwal Chandrashekhara, Yajnesh Chandrashanker Shetty, & Caren D’Souza. (2025). Intravascular Laser Fiber Tip Breakage during Endovenous Laser Ablation - A Rare Procedural Complication. Journal of Evolution of Medical and Dental Sciences, 14(4), 92–94. https://doi.org/10.14260/jemds.v14i4.774
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