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Post microphlebectomy, what can I expect?

This question was asked in San Francisco, California and has 8 answer(s) as of 06/05/2013.
I had microphlebectomy done about a month ago and at first everything was fine but yesterday I noticed a red, swollen bump on my leg that feels hot. Should I worry about it? Is this a new problem? I'm worried that my varicose veins are going to come back now and I need to know what to do to stop it.


Doctors Answers (8)

A red swollen bump on the leg following a micro-phlebectomy is probably phlebitis or trapped blood in a closed segment of vein. It is best to return to the physician who did the procedure for a follow-up evaluation and possible draining of the bump. We routinely do a follow-up of all our patients following vein procedures (generally at no charge). Do not drain the bump yourself, trapped blood is a common occurrence in the larger treated veins and it is easy to drain in the office if needed. Walking is also beneficial following a micro-phlebectomy.

I am happy to take a look at you veins and make sure you are ok. There could be infection. It needs to be evaluated soon. Please call for appointment.

At one month after microphlebectomy, most patients will have smoothe skin with a slight firm feel at the incisions. The incisions usually are pink or slightly red at this point. Over time, the incisions usually will fade to a white color and the firmness in the tissues will resolve. Some patients will develop a number of firm areas about the size of small peas under the skin which develop due to blood or fluid collecting in the space formerly occupied by the veins which were removed. This almost always will resolve over a period of weeks to months. On rare occasions, it is necessary to apirate fluid from these collections with a syringe and needle. If you have concerns about your healing, do not be hesitant to contact your treating physician for a clinical evaluation.

It is impossible to tell without examining the area, but this is usually a benign condition. However, I strongly recommend that ALL questions should be directed at the physician who performed the procedure, preferably in person.

After an ambulatory microphlebectomy, you can resume normal daily activities such as walking, driving, and working. Most patients have no discomfort or minimal discomfort after the surgery. Occasionally there can be a small section of retained vein, or a side branch, which can develop a harmless but painful phlebitis. A superficial vein phlebitis, also called superficial thrombophlebitis, means inflammation and closing down of a vein section. It usually causes a tender, swollen, red area under the skin. The redness lasts about a week, the tenderness lasts several weeks, and the lumpiness can last several months. Ultimately it all resolves and rarely leads to a dangerous situation such as a deep vein thrombosis (DVT) or infection. Treatment of superficial vein thrombosis consists of taking anti-inflammatory medication such as ibuprofen (Advil), naproxen(Aleve), or aspirin, and placing cold compresses or warm compresses on the tender area. Just like a sprained ankle, I recommend cold compresses the first 24 hours after onset, then transitioning to warm compresses or heating pad for the next several days. A post-operative superficial phlebitis after a microphlebectomy does not mean the varicose veins will come back. Proper treatment of the deeper saphenous veins that feed the varicose veins is important in preventing new varicose veins from forming.

It is hard to tell without seeing it. Most likely this just represents mild inflammation of the residual vein or early wound infection. It should improve with antibiotics and/or warm soaks.

Most likely you have developed a clot in the remnant of vein that remained. Not to worry, that clot will not "travel" anywhere because it is sitting in the fat of the leg and not in the bloodstream. It should resolve in about a week and taking an anti-inflammatory will help. If the pain doesn't go away or it gets worse, occasionally it has to be drained. This can be done in the doctor's office and will take care of the problem for you.

This may be just a localized infection at one of the vein removal sites. Alternatively and possibly more likely this could be a small retained varicosity that has filled with a little bit of localized thrombus. This is not dangerous but it can cause inflammation that can be red and painful. It would be wise to followup with your physician to determine if you need antibiotics.

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