Leg Vein Ablation & the immaculate deception

[Protimenow]

A few days ago, I had a leg vein ablation that my cardiologist has been pushing me to do for a few years. It was supposed to reduce the pressure in my legs and improve my blood pressure by reducing the pressure in the useless veins in my legs.

It was a 'simple' procedure, and seemed to go well -- until a large hematoma developed. The doctor wrapped the cyst, presumably to stop it from growing - but it didn't stop.

I had continuous bleeding from a needle hole - it bled for two days - and may still start bleeding if I take the pad off (I finally got smart enough to tape it on so it wouldn't slide).

The next day, with the cyst seeming to grow, my doctor told me to go to the hospital, and have them tell him I was there. He actually meant to have them work me up, THEN call him. I told him that I may need Vitamin K (because this thing was bleeding) and maybe have the fluid sucked out. He thought this was a good idea.

In the E.R. they took blood. (Here's where the immaculate deception comes in) - the E.R. doctor told me my INR was 5. 5? I thought that maybe an anticoagulant was used during the ablation, and THIS made my INR climb (but according to my electrocardiologist who did the procedure, it was just saline and lidocaine).

I have a pill dispenser, with daily containers, morning and night. I only take what's in the day or night 'box' for each day. I'm very careful when I fill the box, and double check when I take the pills. I can't think of ANY way that I double dosed or made some other error that drove my INR up. Three days before the procedure, my INR was 2.7, right where I want it. So - how, four days later, was it 5.0?

So - now I have a cyst about the size of a golf ball in my upper thigh. The doctor who read the ultrasound in the hospital called it a 'Baker's Cyst' (Synovial Cyst). It's a pain. I'm seeing the rheumatologist who drained the Baker's Cysts that I had behind my knee a few years ago - maybe he'll be able to relieve some of the pressure.

The Vitamin K at the hospital made my INR drop to 2.9. I haven't taken warfarin since Saturday night. I've pulled the warfarin from my pill box for a few days. Maybe this will help some of the stuff in my cyst to tighten up. Maybe this will assure that my blood leak - which may have already resolved - stays closed.

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I thought that the procedure was so non-invasive that I didn't need to drop my INR. The scheduler who called me three days before the procedure said nothing about reducing my INR. I took my normal dose of warfarin, almost by accident, on the Wednesday and Thursday before the procedure - reflexively - open the lid of the night's dose, take a quick look, then pop them in my mouth - and didn't think about removing the warfarin before I swallowed them.

I told my doctor that I figured I didn't need to discontinue my warfarin because the scheduler didn't ask about INR or warfarin use. He told me that he'll talk to her.

One thing that doctors should do is TEST the INR of any patient on warfarin BEFORE they start a procedure. What does this take? A CoaguChek XS, some strips, and some one use lancets. And, of course, the doctors could probably charge a lot for giving the test and evaluating the results - and for some patients, this would prevent the kind of damage that I'm suffering from.

I really don't know WHY pre-op testing isn't done anyway - it keeps patients out of risk of bad outcomes, it assures the person doing the procedure that - no matter what the patient claims - the INR is low enough to safely do the procedure, and it makes the doctor some extra money for having a tech do a simple finger stick.

 

[Chuck C]

Bummer. I hope that this resolves soon for you.

I thought that the procedure was so non-invasive that I didn't need to drop my INR. The scheduler who called me three days before the procedure said nothing about reducing my INR

This is surprising to me. A family member had veinal ablation done and bleeding seemed to be the biggest risk factor. It seems pretty obvious that this would be a time to, at the very least, get ourselves to the low end of our range. I had a thyroid ablation about a year ago and, in consulation with my doctor, brought my INR down below my normal range to 1.4. My normal range is 2.0 to 3.0 and the plan was to be under 1.5 the day of the procedure. Not the same procedure as yours, but I would expect similar in terms of bleeding risk.

One thing that doctors should do is TEST the INR of any patient on warfarin BEFORE they start a procedure

Good point. But you are a long time self tester. I'm curious why you would not have self tested prior to the surgery? For my thyroid ablation, I tested the night before and the morning of my procedure.

 

[Protimenow]

Good question. In retrospect, I SHOULD have tested anyway - even if the scheduler made it sound like it wasn't necessary.

I usually check it and report it to my doctor. For some reason, I didn't. For what's probably a similar reason, I must have overdosed a day or two before the procedure - and I took warfarin a day or two BEFORE the procedure. Maybe I was hoping for a bad result????

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I almost thought the surgeon might have asked me about my INR, just for safety, before he started the procedure. What I would have told him may not have put him off enough that he wouldn't do the procedure - but at what may have been 2.7 may have been enough to cancel it that day.

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I've noticed a few positive results from this procedure:

My blood pressure has dropped -- so much so that when I see my cardiologist, I'll talk to him about reducing my medications (the HIGHEST I've recorded was 138/81, but it's been as low as 101/59 a few days ago, and a similar value when I went to a rheumatologist about my hematoma today).

I got my bark back. Okay, not every one would care about this one. I used to have a GREAT bark - it was good enough, when I misused it, to make people jump out of the way. I used it in stores when I needed to locate my kids or wife - through 'barklocation' (a form of echolocation) it always made it easy to find my kids - although shoppers would probably wonder where the hell the dog was and how it got into the store. It was good (and strong) enough to start the dogs in the neighborhood into an answer response loop.

Lately, I couldn't really get the bark to sound as real as it should - there's a spot in the throat that gives the bark its 'dogness' and I was rarely able to activate it. Now, it works without coaxing. I'm not sure if the reason is more strength (because my heart isn't fighting through the effects of blocked veins or I have better blood oxygenation), or other factors, but I'm really happy that I can bark like I used to - before this cardiac crap started.

My wife tells me that I'm looking better. Aside from this monstrous bruise on my left upper thigh, I AM doing better.

If I had known that the procedure would bring my bark back, I may have done it even earlier.

 

[Woodcutter]

My experience might be interesting so I will share. It was actually a leg vein ablation that put me on the "warfarin for life" plan. I ended up with a pulmonary embolism. A clot formed in my lower leg and migrated. Warfarin cleared it up! So I was already on warfarin when I developed AFIB a few years later, and then it was again a non-issue when the mechanical valve went in a few more years later.

I will add that I did have plenty of bruising and bleeding after the vein work (there were several aneurysms) and I was not yet on the warfarin, so I can easily envision that procedure on a high INR patient being challenging.

 

[Protimenow]

There are apparently a few methods of doing the leg vein ablation. I've seen ablations using lasers advertised. These apparently blast through the veins, zapping whatever is in the way. I suspect that this approach could possibly leave stuff behind that could float through your vascular system. (FWIW - if this caused a pulmonary embolism--as bad as it was--the floating stuff might have lodged in your brain, causing a stroke, or worse. You actually were a bit lucky.

The way that my ablation was done used lidocaine and water - done under ultrasound guidance. The doctor threaded a catheter in my blocked vein, then blasted (I think) the saline/lidocaine mixture through the vein and the blockage. Perhaps it was kind of what a pressure washer does. This might be a safer method - but in my case, with an unknown, extremely high, INR, the result in my upper inner thigh is a large, painful, hematoma that limits my mobility. (FWIW - my legs are otherwise fine, without incident, but this bruise is a real pain.

I'm glad that because you were already on warfarin, the Afib wasn't a big deal. And I'm glad that the fears of warfarin that many people experience when deciding on a valve was a non-issue for you.

Thanks for your response.

 

[Woodcutter]

Yes, the basic technique for mine was a thermal ablation with a radio-frequency catheter. Issue was several locations where the vein inside diameter was too large. In those locations the vein was surgically removed. I agree that I was quite fortunate!

Lest I leave a wrong impression, the Afib was definitely a big deal. I just did not have to deal with adding warfarin to my diet because I was already on it. Because I was pretty active and in good condition, my heart rate would easily exceed 200 under exertion. Candidly, the doctor was quite skeptical when I told him about that . . . . until I demonstrated on a treadmill and they shut down the stress test.

I did have a large hematoma in the groin area after mitral repair surgery. Size of a large grapefruit sliced in half. Recollection is it took 6-8 weeks to dissipate. ( I definitely was on warfarin at that time).

 

[Protimenow]

Half of a grapefruit? I've been describing mine alternatively as an empanada (a Mexican turnover), or a Golf Ball, but your 'grapefruit sliced in half' sounds like the most accurate.

I saw the Rheumatologist who drained my Baker's Cysts (cysts behind the kneecap) to see if he could drain the hematoma - he tried. It's almost all clots. It'll take a while (maybe the 6-8 weeks you mentioned) to dissipate. There's one side benefit, for what it's worth -- ultrasound in the hospital showed that I had another Baker's Cyst. It was small, I didn't really notice it (or maybe just lived with a slight bulge behind my knee) and the Rheumatologist drained a few ounces of blood from this cyst.

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Did they do some kind of ablation to stop the Afib? I'm not entirely familiar with how they deal with Afib.

I'm glad you're better.