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.
