When varicose veins of the lower extremities progress to a certain extent, complications such as intravenous thrombosis, aseptic inflammation (phlebitis), hyperpigmentation, ulceration, bruising dermatitis, rupture and bleeding can occur. Therefore, early treatment with surgery is the main medical tool to prevent these consequences.
Varicose vein surgery was once mistakenly considered as a “minor surgery” in the past, but a large number of surgical complications were encountered clinically, which made many patients “cold to the knife” and delayed the disease. In recent years, the emergence of minimally invasive techniques and updated concepts, and the emergence of professional vascular surgeons, have significantly reduced the incidence of postoperative complications.
Even with the use of minimally invasive means such as laser, radiofrequency, electrocoagulation, and TRIVEX, various post-operative complications can still occur. For patients, it is important to choose doctors with adequate clinical experience, good level of competence and responsibility so that complications are less likely to occur or can be identified and managed early.
So what are the complications after varicose vein surgery?
1.Deep vein thrombosis of the lower limbs
Clinical symptoms: Significant swelling of lower limbs, shiny skin, deep pressure pain in calf gastrocnemius muscle. (Unilateral prevalence)
Early recognition: If there is bruising or hard nodules on the skin and the pressure pain or tenderness is on the skin surface, it is often a normal postoperative reaction. Pinch the calf belly bilaterally by hand for comparison, and if there is deep pressure pain on one side, check D2 aggregates and deep vein ultrasound at the hospital to confirm.
Prognosis: The prognosis is good for early detection.
Comment: Varicose vein surgery in the lower extremities does not directly cause DVT, but the hypercoagulable state caused by the surgery and prolonged postoperative bed rest may induce DVT.
Prevention points: choose minimally invasive surgery, walk down early, and choose experienced experts to shorten the operation time.
2.Saphenous nerve injury
Clinical symptoms: Dullness or absence of skin sensation in the area of the inner ankle or dorsal foot.
Early recognition: feeling the skin of the region with fingers, dull sensation.
Prognosis: no effect on function. Sensory recovery is slow, but without serious consequences.
Comment: The saphenous nerve, which innervates skin sensation, starts gradually below the knee with the saphenous vein and the two are almost adherent at the ankle. Some patients have to sacrifice part of the nerve in order to deal with the diseased vein here.
Prevention point: Experienced surgeons use a range of surgical techniques to reduce the incidence of nerve injury. Examples include selective management of the saphenous vein trunk, separation of the ankle trunk from the nerve, and stripping the vein from below to above. For appropriate patients, the CHIVA procedure is chosen to completely avoid such complications.
3.Superficial phlebitis
Clinical symptoms: long, cord-like hard lump on the inner thigh with darkened surface skin and sometimes pressure pain. There is a pulling sensation when walking.
Early recognition: as above. ultrasound can confirm.
Prognosis: good. Usually fades after a few weeks
Point: Superficial phlebitis often occurs with laser (EVLT), radiofrequency closure procedures that preserve the main trunk of the saphenous vein.
Points of prevention: Postoperative bandage compression should be kept tight and bandages should be extended appropriately. Currently only saphenous vein stripping or CHIVA surgery can completely avoid this complication.
4.Lymphangitis
Clinical manifestations: high fever, chills, redness and tenderness of a large area of skin on the lower leg, edema
Early recognition: light touching of the reddened skin by the fingers and sensation of pain. The blood routine suggests elevated white blood cells.
Prognosis: generally high fever in the calf after 1 to 2 days. Other symptoms subside in about two weeks.
Comment: Acute reticulolymphangitis, also known as “dermatophytosis”, is mainly caused by tinea pedis and diabetes. Severe varicose veins cause skin dystrophy, which can also cause lymphatic reflux obstruction, leading to inflammation. The main causative agents are Staphylococcus aureus and Streptococcus, so penicillin is very effective in treatment.
Prevention points: early surgery. Choose minimally invasive surgery. Pre-operative control of tinea pedis, blood sugar, etc. Keep the skin clean.
5.Subcutaneous hematoma
Clinical manifestations: flaky bruised skin (more common on inner thighs), may be painful.
Early recognition: as above
Prognosis: usually subsides in a few days or weeks with no sequelae.
Comments: Subcutaneous hematomas are often due to loose bandage wrapping, patient obesity, and other factors. Surgery is more common and has no adverse consequences
Prevention points: experienced surgeons will use certain techniques to stop bleeding during the operation, and the bandage should be tight after the operation.
6.Tension blisters
Clinical manifestations: blisters are found on the skin after removal of the bandage
Early recognition: the skin has strangulation marks from over-tightened bandages.
Prognosis: generally disinfected and bandaged, healed after a week
Comments: Generally occurs in obese patients with tight bandages. Some patients are allergic to antiseptic solution or excipients.
Prevention points: intraoperative hemostasis is complete, avoid bandages too tight.
7.Femoral artery injury
Clinical manifestations: massive bleeding, cold skin temperature and pale color of the lower extremity.
Early recognition: disappearance of dorsalis pedis artery, bright red bleeding in a jet
Prognosis: if not treated in time, the consequences are serious.
Point: Femoral artery injury is a serious medical malpractice, and the lack of vascular expertise and inexperience of doctors is the main reason
Prevention points: choose experienced vascular surgery experts to do the surgery.
8, femoral vein injury
Clinical manifestations: much bleeding and swelling of lower limbs.
Early recognition: severe lower limb swelling can appear after surgery. ultrasound can confirm.
Prognosis: severe deep vein thrombosis
Comment: Femoral vein injury is a medical accident. It occurs when the saphenous vein is ligated too high, or when the femoral vein is mistakenly ligated as the saphenous vein. This does not happen with experienced vascular surgeons.
Prevention point: choose an experienced vascular surgeon to do the surgery
9.Wound infection
Clinical manifestations: redness, swelling and pain of the incision and pus flowing after several days after surgery
Early recognition: as above. Only local redness is often a reaction of the incision tissue, which gradually subsides.
Prognosis: good prognosis with removal of stitches and drainage
Comment: Most varicose vein surgeries belong to the category of aseptic procedures, which do not require prophylactic antibiotics and have a very low rate of postoperative infection. Patients who present with skin dystrophy or ulcers are more likely to develop an infection in the incision at that site.
Prevention points: avoid incisions in areas of dystrophy or ulceration and use minimally invasive techniques to reduce the length and number of incisions.
Although varicose vein surgery may have these complications, most of them are not serious for professional vascular surgeons, as long as proper precautions are taken and treatment is timely. In contrast, delayed treatment may lead to more serious consequences such as venous thrombosis, ulceration, and bleeding.