Post-Laser Varicose Vein Surgery: Addressing Hard Lumps and Complications

After undergoing laser treatment for varicose veins in the right leg, a lump has developed?

Hello, Dr.
Li.
I have had varicose veins in my right calf for about two years, and earlier this year I discovered that I also have varicose veins in my thigh.
There is no pain, and my daily life is not affected.
During a doctor's examination, it was determined that the condition had not progressed to the deep veins, so in mid-May of this year, I underwent laser treatment for varicose veins and was hospitalized for three days.
I was discharged and instructed to wear medical compression stockings for three months.

Currently, I have two issues:
1.
A few days after the surgery, I developed a large bruise on my right leg, which gradually disappeared after about three weeks.
However, near the surgical site on my thigh, a hard lump has formed.
Upon follow-up, the doctor performed an ultrasound and said that the lump is a calcified blood clot.
He advised that I should come back for an outpatient procedure to remove the lump after the pandemic.
He prescribed antibiotics for me.
However, the appearance of the lump was not mentioned as a potential postoperative symptom.

2.
I consulted a different doctor who performed an ultrasound and indicated that the blood vessels in my thigh were not adequately treated and that they are larger, measuring 0.8 mm, making them unsuitable for laser treatment.
To address the issue, traditional surgery to remove the veins is necessary.
He prescribed aspirin, stating that it would be effective for the lump in my thigh.
After taking it for three days, the lump has indeed decreased in size.

I would like to ask Dr.
Li about the two issues mentioned above: Is it common for blood clot calcification to occur after laser treatment for varicose veins? Or is it possible that the blood vessels are too large and were not adequately sealed, necessitating their removal? Currently, the only symptom I have after taking aspirin is related to the lump, which occasionally experiences slight throbbing pain.
Additionally, I would like to mention that the diagnosis certificate issued after the surgery states that both laser treatment and local vein stripping were performed, but I only have a few small surgical wounds on my leg.

Roy, 30~39 year old female. Ask Date: 2021/06/20

Dr. Li Zhonghuai reply Surgery

Hello! Both laser treatment and traditional surgery address great saphenous and small saphenous veins, with the main difference being that laser treatment does not require the removal of the veins.
The incisions are just a few small holes at the ends of the veins, and other local areas are also accessed through small incisions to tie off the veins.
Therefore, the wounds are inherently fewer and smaller.
As for postoperative hematomas and the effectiveness of compression, they are more related to the compression bandage.
Even with small incisions, there can still be bleeding from within, which relies on the compression bandage to help stop the bleeding.
Hematomas will gradually be absorbed by the body.
Each physician has different practices; if there are no symptoms, there is no need to worry.
If there are symptoms of compression, then further management is necessary.
Regarding whether the size at the junction of the great saphenous vein and the femoral vein affects the effectiveness of laser treatment, I cannot comment on that.
I suggest evaluating the situation after wearing compression stockings for a full three months.
Take care! Changhua Hospital cares about you!

Reply Date: 2021/06/20

More Info

Post-Laser Varicose Vein Surgery can sometimes lead to complications such as hard lumps and other issues, which can be concerning for patients. Based on your description, it seems you have experienced a couple of complications following your laser treatment for varicose veins, including the formation of a hard lump and the presence of a large bruise. Let's address your concerns in detail.

1. Formation of Hard Lumps: It is not uncommon for patients to develop hard lumps or areas of induration after laser treatment for varicose veins. These lumps can occur due to several reasons, including the formation of blood clots that may calcify over time. The ultrasound findings indicating that you have a calcified blood clot suggest that your body is responding to the trauma of the surgery. While this is not a typical symptom that is always discussed, it can happen, especially if there was significant manipulation of the veins during the procedure. The recommendation to perform a minor surgical procedure to remove the hard lump is a common approach to manage this complication. It is important to follow your physician's advice regarding this, as they will assess the best course of action based on your specific situation.

2. Inadequate Laser Treatment: The second issue you mentioned involves the assessment by a different physician who indicated that the laser treatment may not have adequately addressed the larger vein in your thigh. This can happen if the vein is too large or if the laser settings were not optimal for your specific anatomy. In some cases, traditional surgical methods may be more effective for larger veins, as they allow for complete removal of the affected vein. The prescription of aspirin is likely intended to help reduce the risk of further clot formation and to improve blood flow, which can assist in the resolution of the hard lump.

Regarding your questions about the frequency of these complications:
- Calcification of Blood Clots: While it is not the most common outcome, the calcification of blood clots can occur after any surgical procedure, including laser treatments for varicose veins. Factors such as the size of the vein, the technique used, and individual healing responses can all contribute to this complication.

- Inadequate Laser Treatment: If the vein is larger than 0.5 mm, it may not respond well to laser treatment alone, and traditional surgical methods may be more appropriate. This is particularly true if the vein is not fully sealed during the laser procedure, leading to persistent symptoms.

In terms of managing your symptoms, it is essential to continue following up with your healthcare providers. If you experience any new symptoms, such as increased pain, swelling, or changes in skin color, you should seek medical attention promptly. Additionally, wearing compression stockings as prescribed can help improve circulation and reduce swelling.

In summary, while complications such as hard lumps and inadequate treatment can occur after laser varicose vein surgery, they are manageable with appropriate medical intervention. Your healthcare team will guide you through the necessary steps to address these issues effectively. Always feel free to ask questions and express any concerns you may have during your follow-up appointments, as open communication is key to a successful recovery.

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