I had EVLT about 4 months ago. Why is the swelling is worse than it was before the procedure? (Photo)

Question

Feeling a tingling and mild pain in the areas on my ankles where the procedure was done, so I assume I had some nerve damage. My swelling is way worse than it was before the procedure. I am 37 years old, non-smoker, healthy eater, I exercise 4x/week. Kidney, liver functions and blood pressure are great. My doc says there are no blood clots and veins are closed, so it must be something else. Why is the swelling now so much worse than before? Can it be from inflammation from the damaged nerves?

Raymond Shaheen, MD, FACS · Answer

Swelling following saphenous ELVT (laser) or radiofrequency (RFA) vein ablation procedures may occur due to:Heat-induced inflammation of the vein and surrounding tissues - this type of swelling resolves over several weeks, and is treated with compression, elevation, NSAIDS (non-steroidal anti-inflammatory medcations). Ice/cool packs after showering, and topical 1% hydro-cortisone or Dermaka cream can be used as well. "Frustrated venous drainage" -  is a condition in which you have temporary mechanical swelling from your saphenous vein being intentionally closed by the procedure. Once your body re-routes the flow into surrounding healthy redundant veins, this type of swelling resolves over several weeks. You can expedite the resolution of this type of swelling with compression and an exercise walking program. Aggressive exercise will typically cause post-exercise worsening of swelling until the re-routing process has completed. High-performance exercise compression leg sleeves may dramatically help."Phlebitis" [Also known as Superficial Vein Thrombosis (SVT)] - is caused from some trapped clotted blood in the closed saphenous vein or side-branch varicose veins. This can be seen in combination with non-clotted blood, which can be aspirated (sucked out) to reduce pain, tenderness, and thus speed up the resolution of the inflammation and swelling. By itself, this is not dangerous given that the clot is in the superficial veins and is "land-locked"(i.e. no flow is going through above or below it).Calf muscle pump failure - just like how hear-failure patients develop fluid on their lungs, patients with weakened calf and foot muscles (i.e. from using a shuffling gait, cains, and walkers) have a hard time getting fluid out of the legs back to the heart; thus they get a back-up of fluid the legs. This can be treated by strengthening the involved muscles with toe-raise exercises, pushing your feet against the resistance of a therapy-band, and walking in general.DVT (deep venous thrombosis) - This is an exceedingly rare, but emergent complication that requires blood thinner. This would be essentially unheard of in a young, healthy, active patient. However, following vein ablation procedures, there can be superficial saphenous vein extension "cauliflowering" into the deep system called EHIT (endothermal heat induced thrombosis). EHIT looks like a DVT but behaves like a superficial vein thrombosis, in that it resolves quickly. A trained ultrasound and vascular specialist can differentiate between these two and guide a patient's treatment for these conditions.Nerve irritation - Thermal vein ablation (from EVLT or RFA) can irritate or injure the saphenous nerve which is densely adherent to the saphenous vein below the gastrocnemius muscle. Like a light that flickers due to inadequate electrical wire insulation, the saphenous nerve can tingle, or go numb from a heat-induced weakening of the waxy insulating myelin sheath layer around the nerve. Recovery from this takes a frustratingly long time (greater than 6-12 months). The speed of the recovery is typically related how dense the injury is; the greater the initial injury, the slower and longer the recovery. Also, the more mild the injury, the greater the chance that this will fully recover. Avoid excessively tight compression socks that dig into the ankle for protracted periods of time, as they can pinch the nerves by the ankle (i.e. "extrinsic nerve compression"), and can actually delay recovery. Also, make sure the top of the knee-high stocking is not creating a tight-band at the top, as this can extrinsically compress the peroneal nerve and can actually make your swelling worse from blocking the fluid and venous outflow for your calf.
In a young, active, and healthy patient like you, without having examined you, your symptoms are consistent with lingering inflammatory swelling and some "frustrated venous drainage" which will take time to resolve and re-route. Regarding your nerves, patience is a virtue, as you should expect slow but continued improvement or the next 6-12 months and beyond.

Thomas Wright, MD · Answer

Thank you for providing the photo. If your swelling is just in the leg of the procedure and occurred just after the procedure, it is likely from the EVLT procedure. If is possible you could have small DVT. It is more likely that you have suffered some lymphatic damage from your EVLT.  There are lymph ducts that follow the saphenous vein in the leg and it is possible that they were injured in your procedure. Please consult with venous and lymphatic specialist to for a diagnosis. If diagnosed please get proper treatment for lymphedema. This will include compression, Manual Lymph Drainage and possibly wraps and or a pump.  Wishing you the best of health!

Jawdat Abboud, MD · Answer

One of the common symptoms and sings of varicose veins is leg swelling, swelling usually improve after treatment of varicose veins (ablation of the dysfunctional veins), if you develop the swelling immediately after ablation of your veins, the doctor should look for the reason for that. It could be deep veins involvement distaly, wich could lead to this picture, diffntly you should at least follow up with the doctor who performed the procedure, if he could not solve the issue, seek second opinion.

Susan Fox, DO, RPVI · Answer

I would recheck an ultrasound to make sure that you did not develop a blood clot.  There can be some heat induced swelling and nerve injury post laser.  The swelling should not be severe.  I would walk, wear compression hose and elevate the legs.  If the swelling is severe and in the whole leg a clot could be located higher.  As well, lymphedema is a risk factor and can happen in rare circumstances.  If your swelling is worse and not improving, I would go back and see your doctor.

Rodolfo Farhy, MD · Answer

The burning and tingling comes from nerve damage. Unclear why the doctor did EVLT in the ankle. I'm highly suspicious that you have a deep vein thrombosis, else more veins were affected than what you needed. If your doctor cannot give an answer get a second opinion. That swelling is not right.

I had EVLT about 4 months ago. Why is the swelling is worse than it was before the procedure? (Photo)

Answers (5)

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I had EVLT about 4 months ago. Why is the swelling is worse than it was before the procedure? (Photo)

Answers (5)

Answer: Swelling post laser

Answer: Swelling post laser

Answer: Swelling after EVLT

Answer: Swelling after EVLT

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Everything you need to know about EVLT

Our mission is to create a world where every investment in modern beauty is Worth It.