Why am I having pigmentation problems after RFA?

I had RFA (ClosureFast) for GSV in the right leg for varicose veins.
2 weeks later, I had superficial thrombophlebitis/phlebitis, which was painful/tender just below the knee on inside of leg (medial side of leg). The "line" was ~ 3 cm along treated GSV. This faded with Voltaren gel.
Since then, I have pigmentation only in this area. My concern is sometimes the pigmentation looks a bit "more" red, usually after exercise. No pain or swelling. What could this be? U/S showed successful closure.

Answers from doctors (3)


Hratch Karamanoukian, MD, FACS, RVT, RPVI, RPhS

Published on Feb 22, 2016

The clinical scenario described is "extension" of closure below the knee. Some vein specialists limit the ablation to the thigh because the great saphenous vein is within the saphenous sheath in this region and it is not likely for inflammation of the ablated segment to cause hyperpigmentation of the skin.

Below the knee, the saphenous segment is missing in most patients, and closure with either RF or endovenous laser can cause inflammation of the overlying skin and extravasation of hemosiderin and blood products, causing inflammation and ultimate hyperpigmentation, which can take up to a year to resolve.

The literature suggests that unless there is segmental reflux of the GSV below the knees, ablating 20 cm of saphenous vein in the thigh is more than enough length to relieve symptoms and also reduces the likelihood of causing hyperpigmentation of the skin as you describe above.

I recommend that you continue to use NSAIDs and also consider using a hydroquinone-based cream to help accelerate the clearing of this pigmentation.

Discuss these concerns with your vein specialist and always choose an ABVLM certified vein specialist.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/7743_1538076833.jpg
Answered by Hratch Karamanoukian, MD, FACS, RVT, RPVI, RPhS

The clinical scenario described is "extension" of closure below the knee. Some vein specialists limit the ablation to the thigh because the great saphenous vein is within the saphenous sheath in this region and it is not likely for inflammation of the ablated segment to cause hyperpigmentation of the skin.

Below the knee, the saphenous segment is missing in most patients, and closure with either RF or endovenous laser can cause inflammation of the overlying skin and extravasation of hemosiderin and blood products, causing inflammation and ultimate hyperpigmentation, which can take up to a year to resolve.

The literature suggests that unless there is segmental reflux of the GSV below the knees, ablating 20 cm of saphenous vein in the thigh is more than enough length to relieve symptoms and also reduces the likelihood of causing hyperpigmentation of the skin as you describe above.

I recommend that you continue to use NSAIDs and also consider using a hydroquinone-based cream to help accelerate the clearing of this pigmentation.

Discuss these concerns with your vein specialist and always choose an ABVLM certified vein specialist.

Published on Jul 11, 2012


More About Doctor Laser Vein Center

Published on Feb 22, 2016

It could be trapped blood in the vein leading to irritation and inflammation, or it could be matting. I recommend you check with your surgeon.

Answered by Laser Vein Center (View Profile)

It could be trapped blood in the vein leading to irritation and inflammation, or it could be matting. I recommend you check with your surgeon.

Published on Jul 11, 2012


The Sheen Vein Institute

Published on Feb 22, 2016

The hyperpigmentation is the result of blood that either got trapped in the treated vein or in one of the side branches. Probably when you got the phlebitis, one of your refluxing side branches clotted off as a result of the RF procedure. The result was the pain and tenderness, and this takes time to resolve. However, the blood that caused the phlebitis in the first place never left. The result is the hyperpigmentation that you are seeing. This is only one of many reasons why a single RF or laser procedure is an inadequate treatment for a person's vein issues. You have to keep in mind that vein disease is inherited and thus does not just affect one segment of vein. This is why proper treatment involves treating the entire leg from the inside all the way out to the skin. If you want the pigmentation to go away, you need to have the trapped blood taken out. Your doc should know this. If they do not, then you need to find a vein doc who knows what they are doing.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/1116_1499984661.jpg
Answered by The Sheen Vein Institute

The hyperpigmentation is the result of blood that either got trapped in the treated vein or in one of the side branches. Probably when you got the phlebitis, one of your refluxing side branches clotted off as a result of the RF procedure. The result was the pain and tenderness, and this takes time to resolve. However, the blood that caused the phlebitis in the first place never left. The result is the hyperpigmentation that you are seeing. This is only one of many reasons why a single RF or laser procedure is an inadequate treatment for a person's vein issues. You have to keep in mind that vein disease is inherited and thus does not just affect one segment of vein. This is why proper treatment involves treating the entire leg from the inside all the way out to the skin. If you want the pigmentation to go away, you need to have the trapped blood taken out. Your doc should know this. If they do not, then you need to find a vein doc who knows what they are doing.

Published on Jul 11, 2012


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