Confused, not noticing improvement

I had minor reflux, but my reticular leg veins swell especially late in the day. I had 4 EVLTs, and the swelling is still there. The doc said I don't need sclero because the branches aren't open and don't need treatment. Why am I not seeing results?

Answers from doctors (7)


Vein Treatment Clinic

Published on Apr 23, 2018

Most patients after the vein treatment report improvement in their symptoms within one to two weeks following the procedure. However, it can take longer before full results are seen. See a vein specialist if you are concerned after the procedure for the sequence of ultrasound scans to mainly evaluate for lower extremity deep veins patency, superficial thrombophlebitis, and closure of the superficial vein that was treated. Vein specialist can help you with recommendations after the procedure to best manage your care and any discomfort once your ultrasound is completed.

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Answered by Vein Treatment Clinic

Most patients after the vein treatment report improvement in their symptoms within one to two weeks following the procedure. However, it can take longer before full results are seen. See a vein specialist if you are concerned after the procedure for the sequence of ultrasound scans to mainly evaluate for lower extremity deep veins patency, superficial thrombophlebitis, and closure of the superficial vein that was treated. Vein specialist can help you with recommendations after the procedure to best manage your care and any discomfort once your ultrasound is completed.

Published on Jul 11, 2012


Arizona Vein and Laser Institute

Published on Apr 21, 2011

4 procedures for minor reflux and the symptoms are still there means
that you should get evaluated by the surgeon or other vein clinic and
vascular surgeons. The larger spider veins should be treated if they
cause pain.

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Answered by Arizona Vein and Laser Institute

4 procedures for minor reflux and the symptoms are still there means
that you should get evaluated by the surgeon or other vein clinic and
vascular surgeons. The larger spider veins should be treated if they
cause pain.

Published on Jul 11, 2012


Vanish Vein and Laser Center

Published on Apr 21, 2011

If you had 4 EVLT procedures, it sounds like you had reflux of probably both greater and smaller saphenous veins. This is not minor reflux. Treating the reflux does not guarantee that the reticulars, spiders and varicose veins will resolve. In fact, most of the time these will require other treatments such as microphlebectomies or sclerotherapy. Think of your veins like a tree with a trunk and branches. The trunk is the saphenous system and the branches are everything else. Once the trunk is treated then the branches will usually require further therapy. It seems to me that you need further treatment of the branches. Also, if your problem is primarily swelling, then further evaluation of the cause of the swelling is required since the reflux may not have been the reason for the swelling.

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Answered by Vanish Vein and Laser Center

If you had 4 EVLT procedures, it sounds like you had reflux of probably both greater and smaller saphenous veins. This is not minor reflux. Treating the reflux does not guarantee that the reticulars, spiders and varicose veins will resolve. In fact, most of the time these will require other treatments such as microphlebectomies or sclerotherapy. Think of your veins like a tree with a trunk and branches. The trunk is the saphenous system and the branches are everything else. Once the trunk is treated then the branches will usually require further therapy. It seems to me that you need further treatment of the branches. Also, if your problem is primarily swelling, then further evaluation of the cause of the swelling is required since the reflux may not have been the reason for the swelling.

Published on Jul 11, 2012


VeinCare Centers of Tennessee

Published on Apr 20, 2011

There are many causes of leg swelling, some of which have little to do with veins. At other times, there may be a venous problem which is missed in the leg or abdomen. If you physician cannot answer your concern, seeking a second opinion may be worth considering.
Stephen F. Daugherty, MD, FACS, RVT, RPhS

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Answered by VeinCare Centers of Tennessee

There are many causes of leg swelling, some of which have little to do with veins. At other times, there may be a venous problem which is missed in the leg or abdomen. If you physician cannot answer your concern, seeking a second opinion may be worth considering.
Stephen F. Daugherty, MD, FACS, RVT, RPhS

Published on Jul 11, 2012


Vein Specialists

Published on Apr 20, 2011

This is a difficult issue to address in this forum. Leg swelling can be
from a number of different sources such as heart failure, kidney problems,
excess salt intake, lymphedema and lastly and most often overlooked, venous
insufficiency. When you say you had minor insufficiency, can you be more
specific? Technically speaking , anything more than 0.5 seconds is
considered abnormal, although in my practice we stratify insufficiency from
mild to severe based on the absolute number of seconds of insufficiency with
a range from 0 seconds to >10 seconds. Obviously the higher the number the
worse the insufficiency is and generally the better the response to
intervention. Four EVLTs in a single leg at different settings seems a bit
excessive on the surface. My recommendation would be to consider a second
opinion from a qualified vein specialist and confirm the ultrasound
technologist examines all five named veins: great saphenous, anterior
accessory, posterior accessory, small saphenous, and intersaphenous veins as
well as the deep system and the 3 different sets of perforators. Before you
consider anything else, take the time and get another opinion.

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Answered by Vein Specialists

This is a difficult issue to address in this forum. Leg swelling can be
from a number of different sources such as heart failure, kidney problems,
excess salt intake, lymphedema and lastly and most often overlooked, venous
insufficiency. When you say you had minor insufficiency, can you be more
specific? Technically speaking , anything more than 0.5 seconds is
considered abnormal, although in my practice we stratify insufficiency from
mild to severe based on the absolute number of seconds of insufficiency with
a range from 0 seconds to >10 seconds. Obviously the higher the number the
worse the insufficiency is and generally the better the response to
intervention. Four EVLTs in a single leg at different settings seems a bit
excessive on the surface. My recommendation would be to consider a second
opinion from a qualified vein specialist and confirm the ultrasound
technologist examines all five named veins: great saphenous, anterior
accessory, posterior accessory, small saphenous, and intersaphenous veins as
well as the deep system and the 3 different sets of perforators. Before you
consider anything else, take the time and get another opinion.

Published on Jul 11, 2012


General Vascular Surgery Group

Published on Apr 20, 2011

Swelling can be from many causes it may not be venous or from your deep veins.
Michael D. Ingegno MD

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Answered by General Vascular Surgery Group

Swelling can be from many causes it may not be venous or from your deep veins.
Michael D. Ingegno MD

Published on Jul 11, 2012


Angelo N. Makris MD

Published on Apr 20, 2011

I think you need an ultrasound/duplex exam to determine the source of reflux of the persistently "swelling" veins.

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Answered by Angelo N. Makris MD

I think you need an ultrasound/duplex exam to determine the source of reflux of the persistently "swelling" veins.

Published on Jul 11, 2012


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