I've had EVLT performed on both GSV's and both LSV's. How do you know if you need sclerotherapy foam on other veins and tributaries. Do these have to be incompetent to have this done? The EVLT was not performed on the lower portion of any of these veins.
Further procedures should be driven by how your legs are feeling. If you continue to have aching, swelling, itching, or heaviness you can consider further treatment. Also, if there is any skin ulceration or bleeding varices, you can consider further treatment.
Published on Jul 11, 2012
Proper vein treatment begins with an initial ultrasound to evaluate not just the saphenous veins but also any tributaries and branches that may be refluxing within the leg being treated. Whether foam sclerotherapy is required depends on whether there are any refluxing tributaries. You never want to treat normal veins if at all possible. That is when complications can occur. Your vein doc should know if there are any other refluxing veins deep inside your legs and should have addressed them or have plans to address them in the near future. Not treating them, from my perspective, constitutes incomplete treatment.
Published on Jul 11, 2012
I would discuss this with the treating physician as it varies from pt. to pt.
David A. Engleman M.D.
Published on Jul 11, 2012
Depends on many factors and ultrasound findings. Foam injections can be used however to treat residual veins, as can micro phlebectomies.
Michael D. Ingegno
Published on Jul 11, 2012
Typically the lower portion of either the long or short saphenous veins is not treated. They typically return to normal function when the pressure from above is relieved. I the very few cases where this doesn't occur I would recommend Ultrasound guided sclerotherapy to seal the GSV/SSV remnant. Additionally if there are any refluxing perforating veins which are causing symptomatic varicose veins, skin changes or ulceration, these would also be injected (USGS). Normal veins are best left alone.
Published on Jul 11, 2012
EVLT is the treatment for refluxing valves which feed the tributaries. It is not done on the lower portion of the grater and lesser saphenous veins to avoid nerve injury. These areas can be treated with foam. The tributaries will require further treatment usually with foam and do not need to be incompetent to be treated.
Published on Jul 11, 2012