I'm a 25-year-old female who developed spider veins on thighs and blue reticular veins behind knee both legs 3 years ago. I had ultrasound and found out I have 0.3 to 0.5 sec reflux in GSV right leg. My doctor told me I have to do VNUS, but I don't have symptoms, so is the VNUS a good idea?
The veins you have at the surface are a result of the larger vein that has reflux. The vein will continue to cause additional spider and blue reticular veins on your leg if left untreated, resulting in more expensive treatment. You probably have symptoms but are unaware due to not recognizing what a healthy leg feels like. It's always best to speak with your doctor about long term prognosis without treatment.
Published on Jul 11, 2012
Spider veins and reticular veins in the legs are common signs of an underlying disease called venous reflux. Other common signs and symptoms of venous reflux are leg swelling, leg fatigue or heaviness, leg pain, leg night cramps, skin itching or burning, and leg ulcers or sores. The way venous blood flow normally moves in the legs is towards the heart. Unidirectional vein valves help the blood to keep moving up. When valves are not working properly, blood starts to pull in the legs causing signs and symptoms mentioned above. Factors that contribute to the vein valves issue include age, gender, family history, weightlifting, multiple pregnancies, and prolonged standing.
It is excellent that you saw a vein doctor that evaluated you using ultrasound to scan your leg(s) because results where able to confirm that you present venous reflux. It is a good idea to follow up with the vein specialist even if you decide not to do venous treatment of the GSV at this time, there are conservative management options to also consider that will help manage signs and future symptoms. Take in consideration that without treatment of venous insufficiency, those with the disease may experience progressive symptoms that can ultimately debilitate and impact the quality of life.
All the best,
Published on Jul 11, 2012
At this point, no. Significant reflux is defined as greater than 0.5 seconds in the GSV, and you do not reach that criteria at this time. You should, however, be followed both clinically and with periodic scans to monitor for disease progression. Also, are the superficial varicosities you are describing related to the SSV, and was this assessed adequately on your scan?
Published on Jul 11, 2012
If you don't have symptoms, then waiting til later is fine. 0.3-0.5 seconds of reflux is mild. Greater than 0.5 seconds is abnormal. However, it also depends on your symptoms. Venous reflux does not go away, but it is hard to estimate at when and how much it will progress. In our office, we go by patients' symptoms.
Published on Jul 11, 2012
I probably would not do it if you are not having symptoms. Sometimes treatment of cosmetic veins in that area may not be as successful, though I have treated spider veins in many patients with underlying reflux and still had good results.
Published on Jul 11, 2012
I would answer no! First of all 0.3-0.5 sec of reflux is minimal. We stratify all the way to > 10 seconds and rarely close a vein with less than 3 seconds. Secondly, just because you have reflux (0.5, 5 or >10 seconds)
does not mean you need a closure procedure. If you have no pain, swelling, achiness, or other symptoms, injection sclerotherapy is probably the best first line therapy for you. You must consider the possibility of failure of the injections in the veins behind your knees, but I do not believe the risk of DVT (albeit low at 1-2%) is justified without signs or symptoms of significant venous disease. Good job doing your homework.
Published on Jul 11, 2012
You have to meet certain criteria in order for your insurance to cover this procedure. First of all, you must be symptomatic. Also, you need to have at least .5 sec reflux. The only reason to have this done at this point in time would be to prevent the formation of any further spider veins or reticular veins. It it is cosmetic and you would need to pay out of pocket for this. If you're not in a hurry, wait.
Published on Jul 11, 2012
In the absence of symptoms or complications, VNUS is a good idea *only* if the veins you want eliminated are being fed by the abnormal saphenous vein. Your description of the visible veins makes that unlikely.
Published on Jul 11, 2012
Reflux up to .5 sec is normal so you do not have reflux and you have no symptoms. You do not need a VNUS closure procedure. Sclerotherapy would be the treatment of choice.
Published on Jul 11, 2012