In most cases, ablation of the saphenous vein (a superficial vein) by any method corrects associated deep vein reflux. Very rarely does it aggravate deep vein reflux, something a trained phlebologist would know. Serious deep vein reflux is a more challenging problem.

Published on Jul 11, 2012

Treating the superficial system can improve reflux in the deep system so it is not a contraindication.

Published on Jul 11, 2012

Most doctors would say no, because there wouldn't be a purpose in having those superficial veins treated, but it depends on your care provider and the severity of the reflux. If your provider thinks it would be to your benefit, then you can have the treatment done. However, with deep venous reflux, you will most likely not have any relief from the pain and discomfort.

Published on Jul 11, 2012

This is another great question! Combined deep and superficial reflux is a complicated problem. If your scan was performed in an upright position, or with table significantly tilted, then your diagnosis is likely accurate. If there is any question about the accuracy of the diagnosis, I would suggest seeking a second opinion. The reality is that you have miles of vein network in your lower extremities. If your deep system is without obstruction, there is a strong chance that your deep system will improve. When only a segment of the deep system of the thigh is involved, there is a 70 percent chance of normalizing flow in that segment following treatment. The likelihood of complete correction if the entire deep system is affected is very limited. If you have a successful ablation, the follow-up ultrasound studies will help determine whether you have persistent deep vein disease. If you do, you should make compression a routine part of your daily living to support your deep venous system. Again, this is a complex problem. I hope this has helped.

Published on Jul 11, 2012

Yes, the procedure can be done when there is both deep and superficial venous reflux disease. The VNUS closure procedure would only treat the superficial venous reflux and the deep venous reflux would just be treated with compression stockings alone. There currently is no intervention/treatment for venous reflux disease. The deep vein would continue to be dysfunctional . . . some blood will still flow out of the legs through the deep veins, they will just not be functioning at 100 percent. Compression stockings tend to improve the function of the blood flowing out of the deep veins.

Published on Jul 11, 2012

Clinically significant reflux in the saphenous veins can be treated very well with the VNUS Closure procedure. If treatment of the saphenous veins is indicated, the presence of deep vein reflux does not change the indication for treating the saphenous system. Occasionally, the deep vein reflux will improve after treating the saphenous vein. Most of the venous blood flow out of the leg is through the deep system whether reflux is present or not. The presence of deep vein reflux is an especially important reason for the patient to wear support hose for the long term as well as to lose weight if overweight.

Published on Jul 11, 2012

If you have deep and superficial insufficiency we can usually determine which is more severe. If the superficial system has the greatest amount of insufficiency, measured in seconds of reflux (>0.5 sec - 10 sec) and velocity of reflux with maximum valsalva maneuver. If the superficial system is equal to or greater than the deep system, then endovenous ablation may have significant benefit. If the deep system insufficiency is greater than the superficial, then I would be hesitant.

Published on Jul 11, 2012

There is no contraindication and, in fact, this happens quite often. Essentially treat the superficial reflux with closure and the deep reflux with support stockings. The deep reflux cannot be reversed. Blood will still flow through the deep system to the heart.

Published on Jul 11, 2012