hat are the causes of swelling and nerve problems after minimally invasive varicose vein treatments?
Dr. Salama: Swelling after endovenous laser therapy or segmental radiofrequency ablation can occur due to heat-induced inflammation of the vein and surrounding tissue. Such swellings regress after several weeks and are treated with compression, elevation and non-steroidal anti-inflammatory drugs. Cooling packs after showering and a 1% hydrocortisone or a gentle skin cream are also used. A so-called "frustrated venous abﬂuss" is a condition in which there is temporary mechanical swelling because the truncal veins have been intentionally occluded by the procedure. Once the body diverts the flow to the surrounding healthy, superﬂuous veins, this swelling recedes after several weeks, as mentioned.
What can be done about inflammation of a venous blood vessel?
Dr. Salama: Phlebitis or thrombophlebitis is not dangerous in itself because the clot is located in the oberﬂächlichen veins and is "enclosed." That is, there is no flow above or below the clot. Oberﬂächliche venous thrombosis is caused by clotted blood in the closed truncal vein or in the side branches of varicose veins. High-performance compression stockings for the legs can be particularly helpful against this. If phlebitis occurs in combination with non-clotted blood, this is suctioned off to reduce pain and empﬁndability and accelerate the subsiding of the inflammation and swelling.
Can muscle pump weakness lead to swelling?
Dr. Salama: When the calf muscle pump fails, patients with weakened muscles have difficulty transporting fluid from the legs back to the heart. As a result, fluid backs up in the legs. Treatment consists of strengthening affected muscles by means of toe-lifting exercises, pressing the feet against the resistance of a theraband, and walking.
And in the case of deep vein thrombosis? Dr. Salama: This extremely rare but urgent complication requires blood thinners. After vein ablation interventions, there may be extension of the superficial truncal veins into the deep system. Although this looks like deep vein thrombosis, it behaves like superﬂicial vein thrombosis because it resolves quickly. A trained ultrasound and vascular specialist can distinguish between these two conditions and guide treatment accordingly.
Can nerves be irritated?
Dr. Salama: Thermal vein ablation can irritate or injure a nerve in the thigh area (saphenous nerve) that attaches closely to the confluenceﬂuss of upperﬂurally located foot veins on the lower leg. Like a lamp that ﬂacks due to inadequate electrical insulation, the saphenous nerve may tingle or become numb due to heat-induced weakening of the waxy insulating myelin layer around the nerve. The 6- to 12-month recovery depends on how severe the injury is; the greater the initial injury, the slower and longer the recovery. The lighter the injury, the greater the chance it will heal completely. With compression stockings, make sure the top of the knee stocking is not too tight.
At the LBCL Surgery & Vein Practice at the Kindermann Center, we care for our patients with a comprehensive, speciﬁc 28-day treatment plan. We accompany them in their healing process and ensure that any disturbances that may occur in the postoperative phase are immediately remedied by a high level of training of our staff and a state-of-the-art technical, medical inventory and treatment model. We take care of the smallest details, such as making sure that compression stockings fit exactly and that the measurements are accurate. Furthermore, we advise every patient and every patient to have a follow-up examination after 3, 6, 12 and 18 months.