Physician used the venaseal closure system to treat the patient's great saphenous vein (gsv).Local anaesthesia was used.The lumen was flushed prior to use.The procedure was completed per ifu.Both gsv's were treated.No challenges or deviation related to the location of the catheter tip prior to the initial delivery of adhesive.The catheter tip was 5 cm caudal to sfj.Compression was used.However, the adhesive was delivered every 4cm rather than 3cm due to the superficial nature of the gsv and the physician's medical judgement.The vein did close.It was reported that there was chronic venaseal extravasation/foreign body reaction along the course of the gsv.The patient's symptoms associated with this event also included pain and inflammation.The first symptoms occurred approximately 6 weeks post treatment of the right gsv (2.5 weeks post treatment of the left gsv) with erythematous rash reported below the knee along the course of the vein.Lot of pain were reported over the past few days.Patient was not compliant with benadryl or anti-inflammatory medication suggested.There was one spot on the skin, which appeared to have a little bit of excoriation, but there was no skin breach.Benadryl and aleve, or ibuprofen, were suggested round-the-clock for the next couple days.Four days post onset of symptoms, improvement was seen with benadryl and nsaids.Pain and skin problems resolved per patient, with cord along superficial vein still noted.Physician suggested to continue with benadryl and nsaids as needed for a few more days.14 days later patient again showed bead-like cord reaction along the course of the gsv bilaterally.A start of metoprolol succinate er tablet extended release 24-hour, 50 mg, 1 tablet, orally, once a day, so days, refills 3, low salt diet.Approximately one week later, patient calls the office and states that the veins are erupting/bursting and needs to be seen soon.Patient is seen in the office for swelling in the legs, vein bursting, and pus noted along areas of the gsv bilaterally.Patient was to start minocycline 100 mg, 1 capsule orally every 12 hours for 10 days and prednisone 200 mg, 1 tablet orally, once a day for five days.The patient was referred to an infectious disease expert physician and another physician for further consult and treatment plan.Approximately two weeks later, nodular areas along the vein seem to be drying out with medication and sterile dressings.Patient was scheduled for a biopsy; however, the patient missed the appointment due to the patient's thoughts that the wounds were healing with medications.However, after completion of the medications, a couple of the nodular areas began to emit puss-like drainage.The original physician, the physician for the biopsy, and the infectious disease expert physician continued care by prescribing batrim ds bid-10 days and encouraged the patient to have a biopsy done, even if the wounds appeared to be healing.Two bilateral sites in the medial thigh area, 3-4 cm above the knee, were cleaned and dressed in bioclusive dressings.10 days later, one open lesion with purulent was noted on the left thigh and multiple other granulomatous nodules were noted along the course of the bilateral gsv.Patient remains on the bactrim.No steroids prescribed at this time.Right mid-thigh and below knee biopsy sites healed well.Currently awaiting biopsy and discussion with the physician for the biopsy and the disease expert physician for further treatment plan.The issue is still present.No further patient injury reported.
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