What are the post-operative instructions for a patient after catheter ablation of the left calf lower superficial saphenous vein?

Post-Operative Instructions for Catheter Ablation of the Left Calf Lower Superficial Saphenous Vein

Patients should begin walking immediately after the procedure and continue regular ambulation to reduce thrombotic complications, while avoiding strenuous activities for 2 weeks. 1

Immediate Post-Procedure Care (First 24 Hours)

Compression and Ambulation

• Apply compression stockings immediately after the procedure and wear continuously for at least 7 days 1
• Walk for 10-15 minutes immediately after the procedure to promote venous return and reduce risk of deep vein thrombosis 1, 2
• Continue regular walking throughout the day, avoiding prolonged sitting or standing 1

Wound Care

• Keep the puncture site clean and dry for the first 24 hours 1
• Showering is permitted after 24 hours, but avoid tub baths, swimming, or soaking in water for 2 weeks 1
• Monitor the puncture site for signs of infection (increasing redness, warmth, purulent drainage) 3

Activity Restrictions (First 2 Weeks)

Permitted Activities

• Minor daily activities are not limited and should be continued 1
• Regular walking is encouraged and should be performed multiple times daily 1, 2
• Return to sedentary work is typically possible within 1-2 days 4

Activities to Avoid

• Strenuous exercise, heavy lifting, and vigorous physical activity should be avoided for 2 weeks 1
• Prolonged immobility (sitting >2 hours without movement) should be avoided 2
• High-impact activities including running, jumping, or contact sports should be deferred for 2 weeks 1

Compression Therapy Protocol

Duration and Compliance

• Wear medical-grade compression stockings (20-30 mmHg) continuously for at least 7 days post-procedure 1
• After the initial 7-day period, continue daytime compression for an additional 1-2 weeks based on symptom resolution 1
• Remove stockings only for showering after the first 24 hours 1

Rationale

• Compression reduces post-procedural pain, swelling, and risk of superficial thrombophlebitis 2
• External compression during the healing phase optimizes vein closure and reduces recanalization rates 4, 1

Monitoring for Complications

Warning Signs Requiring Immediate Medical Attention

• New onset chest pain, shortness of breath, or hemoptysis (possible pulmonary embolism, occurs in 0.1% of cases) 2
• Severe calf pain, swelling, or warmth extending beyond the treated vein (possible deep vein thrombosis, occurs in 0.3% of cases) 2
• Signs of infection at the puncture site including fever, increasing pain, or purulent drainage 3
• Sudden onset of numbness or tingling in the leg (possible nerve injury, occurs in approximately 7% of cases, usually temporary) 4

Expected Post-Procedure Symptoms

• Mild to moderate bruising along the treated vein is normal and resolves within 2-3 weeks 1
• Mild tenderness or tightness along the ablated vein is expected and typically resolves within 1-2 weeks 1
• Temporary skin discoloration (hyperpigmentation) may occur and usually fades over several months 5

Follow-Up Care

Scheduled Appointments

• Early post-operative duplex ultrasound at 2-7 days is mandatory to detect endovenous heat-induced thrombosis (EHIT) 5
• Clinical evaluation at 1 week to assess wound healing and symptom improvement 1
• Duplex ultrasound at 1 month, 6 months, and 1 year to confirm vein occlusion and assess for recanalization 1, 6

Management of EHIT

• If EHIT class III or higher is detected on early ultrasound, treatment with low-molecular weight heparin is required 1
• EHIT occurs when thrombus extends from the treated vein into the deep venous system and requires anticoagulation to prevent progression 1

Concomitant Procedures Considerations

If Sclerotherapy Was Performed

• Sclerotherapy of tributary veins is typically deferred at least 2 weeks after thermal ablation to allow initial healing 1
• If performed simultaneously, the same post-operative instructions apply with emphasis on compression therapy 5

If Phlebectomy Was Performed

• Additional small incision sites require the same wound care as the main puncture site 1
• Bruising may be more extensive but follows the same resolution timeline 1

Common Pitfalls to Avoid

• Do not discontinue compression stockings prematurely, as this increases risk of post-procedural pain and thrombophlebitis 1, 2
• Avoid non-steroidal anti-inflammatory drugs (NSAIDs) in the first 48 hours if significant bruising is present, as they may worsen bleeding 1
• Do not assume all leg pain is normal; persistent or worsening pain beyond 3-5 days warrants evaluation for DVT or EHIT 2
• Patients with pre-existing lower extremity ulcers have 2.4 times higher risk of DVT and require closer monitoring 2