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My husband had 2 knee replacements and gets frequent cellulitis in his leg that has poor circulation. Is the Edovenous Laser Ablation procedure safe in these circumstances? Will it help reduce getting cellulitis?
It might help reduce cellulitis. It may not be possible if the arterial circulation is very poor. The joint replacement is not an issue but the procedure should be deferred in the presence of infection.
If the cellulitis is really stasis dermatitis due to venous insufficiency, EVLA may be appropriate. If the cellulitis is non-venous, EVLA won't help.
It can be done, and may help these episodes. It depends on the cause of the cellilitis. See a vein MD for further evaluation.
If poor circulation means arterial insufficiency, he may not tolerate compression hosiery needed post EVLT.
If it means superficial venous insufficiency, this might contribute to the dermatitis if severe and improve after EVLT. If cellulitis related to the TKR surgery, ask the ortho his opinion also.
The procedure will be beneficial regardless of the cellulitis, but the cellulitis could potentially become better after the procedure. Make sure the procedure is done by an Interventional Radiologist.
Could be possible. Depends on exact nature of current circulation issues.
What is causing the celluitis? If due to an incompetent large varicose vein, an endovenous laser ablation may be very helpful. However, there is always a risk when performing any treatment while infection is present. Be sure to have a vein specialist evaluate his legs before making any decision. Cellulitis may be caused by an arterial insufficiency, and needs a complete evaluation by a vascular specialist.
I would wonder if his cellulitis is instead thrombophlebitis. EVLT is typically safe after knee replacements.
Cellulitis is not normally caused by saphenous reflux. It is advisable for your husband to be evaluated by a board certified surgeon to diagnose the underlying cause. Ablations should not be done in the presence of undiagnosed cellulits.
I'd recommend waiting on Endovenous Laser Ablation until your orthopedic surgeon gives the green light. Will it help reduce getting cellulitis? Difficult to predict without a thorough history and examination.
Lower extremity cellulitis can be due to many causes, but swelling in the soft tissues (edema) is a common cause of cellulitis. The swelling causes microscopic cracks in the skin which allow bacteria to enter the skin. The swelling also makes it more difficult for the body's defenses to fight infection. The most common causes of lower extremity edema in North America are venous insufficiency and obesity. If the lower extremity swelling is due to venous insufficiency, treatment of the venous insufficiency will reduce the risk of recurrent cellulitis. The appropriate procedure can only be determined by a knowledgeable physician after a physical exam and a thorough venous duplex ultrasound exam. We try to educate physicians and patients that the edema should be treated and controlled as much as possible BEFORE a knee replacement since a surgical wound will heal with fewer complications if the edema is controlled before surgery.
He needs an evaluation to determine how severe is his venous insufficiency. Certainly based on your description he will benefit by having the venous circulation improved. There is no contraindication to do EVLT after knee replacement.
I hope your husband is doing well from knee replacement surgeries. The first thing your husband needs is an appointment with an ultrasound to determine the cause of the cellulitis. Pending the results of the
ultrasound, a treatment plan will be determined.
If he has significant superficial venous insufficiency then by all means endovenous ablation may offer him significant relief from his swelling and recurrent bouts of redness or cellulitis. Often times the "cellulitis" is
actually stasis dermatitis which has flared up. Increased leg swelling after knee replacements is not infrequently encountered, and may be related to an exacerbation of venous insufficiency caused by decreased muscle contraction of the affected leg which is usually observed after replacement of a knee joint. Less activity, less muscle pumping, more pressure in the veins below the knee, and more liquid (water and albumin, serum) leaks out of the walled veins into the surrounding soft tissue. Get a reputable vein specialist to perform a thorough evaluation and assess your husband for deep and superficial insufficiency.
There is no contraindication to an ablation procedure in a leg that has had a TKR. Before an ablation, if your husband has poor circulation, he should have an arterial evaluation. If this is OK, then he can proceed with the ablation. There is no guarantee that an ablation will prevent cellulitis, but if he has underlying chronic venous insufficiency, most likely an ablation will improve the cellulitis.
EVLT is used to treat venous insufficiency, which can only be accurately diagnosed by sonography. It is not used to treat cellulitis.