I had minor vein reflux. My veins stand out at the end of the day in several spots in front of thighs (look like cellulite but are not) After 4 EVLTs two months ago on both legs, the swelling is still there. What can cause them to swell other than reflux?
Swelling in the legs can be caused by many things ranging from heart issues to liver disease to kidney disease, etc. Assuming that all of those issues are not an issue, then the most likely reason you still have swelling is because you still have reflux in you veins. You have to keep in mind that you have hundreds of miles of vein structure in your body. Vein disease is considered an inherited disorder. So the likelihood that you only have 4 veins (the veins that you had layered) that are refluxing is highly unlikely. That said, your swelling is a result of the other 50+ yards of veins within each leg that were not treated. Vein disease is a circulation defect within your venous circulation. So unless you fix the entire leg and address most of your vein issues extending from your saphenous veins all the way out to the spider veins, you will not be able to adequately repair your venous circulation such that your swelling goes away. What I am saying is that your vein disease was not adequately fixed. Have the rest fixed and your swelling probably will go away.
Published on Jul 11, 2012
We have seen many people treated in other centers, having multiple procedures with no relief from swelling. I discuss with my patients that not all swelling is vein related and that, despite having vein reflux, may not be resolved with vein treatment. That said, unless the vein reflux is treated we won't know if they are related. I may refer patients to a lymphedema clinic to be assessed and treated if appropriate. I would definitely recommend continuing with compression hose to reduce the swelling. Perhaps a second opinion from a board certified vascular trained surgeon including ultrasound to rule out any other vein/arterial issues.
Published on Jul 11, 2012
Probably a source vein other than the ones teated, perhaps a perforating vein. Nevertheless, sometimes the veins buldge even if all sources are treated, and the cure is to remove those veins directly. See your provider for more advice.
Michael D. Ingegno, MD
Published on Jul 11, 2012
EVLT does not necessarily shrink the varicose veins. If they were there before the EVLT and have not resolved by 6 months later then you should have them removed by microphlebectomies. If they have worsened after the EVLT then a follow up venous ultrasound would be indicated.
Published on Jul 11, 2012
Commonly, there are varicose veins on the antererior or medial aspect of the thighs which are not solved with LASER ablations of the great saphenous veins. Sometimes, the problem is a refluxing anterior accessory saphenous vein or varicose veins that connect to the veins near the groin. Depending on the size, shape, and location of such veins, treatment might include LASER or radiofrequency ablation, microphlebectomy, foam sclerotherapy, or a combination of these techniques.
Stephen F. Daugherty, MD, FACS, RVT, RPhS
Published on Jul 11, 2012