I had endovenous laser ablation and sclerotherapy 5 mo ago. I have more pain and swelling in my ankles/feet than before treatment. I thought the treatments were supposed to help, but I feel like I am worse off. The doctor does not have answers for me. Is what I am experiencing normal? What should I do?
We advise you to make an appointment with your doctor to discuss, or to get a second opinion from a vascular surgeon.
Published on Jul 11, 2012
The discomfort that you are experiencing is not normal. Typically, by the 5 month mark, my patients are generally feeling really good. What we normally would do is re-ultrasound your leg(s) and see what is going on inside. Only then would we be able to see what might be causing your pain and swelling. If your doctor cannot provide you with answers, seek a second opinion from an accredited vein specialist who has years of experience, is skilled at performing a variety of modalities, and who has successfully performed those modalities on a wide range of patients.
Published on Jul 11, 2012
Your question is difficult to answer without further information and, perhaps, an examination. Do you have a deep vein thrombosis? Did you start any new medicines or increase the dose of medicines that might increase swelling such as Norvasc or Cardizwm? Did you stop any diuretics, or are you eating more salt in your diet?
Published on Jul 11, 2012
Try wearing compression stockings. If you find no relief, see a board-certified vein specialist.
Published on Jul 11, 2012
I have seen swelling post-ablation last up to 2 months. 5 months is much longer than expected. There are several things that you should do: First, redo the venous ultrasound to ensure that the veins are closed and to see if there are any other veins open. The physician should additionally look to see if the deep system has reflux, which would explain continued swelling. Also, wear compression hose and walk to use the calf muscle pump. It is important to note that a closure procedure may help swelling if there is associated reflux, but it may not help swelling at all.
Published on Jul 11, 2012
We recommend visiting a vein center to have another ultrasound to rule-out "dormant veins" flaring-up. Sometimes other veins may be diseased but due to the main vein (treated vein) being so symptomatic, the other veins don't show their true colors. After treating the main vein, other dormant veins that are diseased start to show symptoms. Hope this helps with your concerns.
Published on Jul 11, 2012
If the doctor currently treating you cannot answer your questions, it is time that you get a second opinion. See a different vein specialist, one that is board-certified and has tons of experience.
Published on Jul 11, 2012
Pain and swelling should not be present five months after ELA. You need to be evaluated by a board-certified vein specialist who is experienced and who can guide/manage your care appropriately.
Published on Jul 11, 2012
Not all pain and swelling is related to venous problems. An experienced vascular surgeon would evaluate your history and symptoms to determine if ablation is appropriate treatment in your case. Conservative therapy should be your first option, however. This includes quality compression hose, exercise, weight loss (only if overweight), leg elevation, and anti-inflammatory medication. If there is saphenous reflux present and you respond well to this, your symptoms MAY be relieved by ablation. You should seek a second opinion from an experienced vascular surgeon who specializes in venous disease.
Published on Jul 11, 2012
There may be other reasons for you pain and swelling, including a blockage in the veins in the pelvic area, heart failure, an issue with lymph drainage, and recurrence of your original vein problems.
Published on Jul 11, 2012
Did you have an ultrasound during those follow up appointments? That would've been a necessary step to determine if there are other veins that need to be treated. Sometimes, even if the venous insufficiency is treated, the corruption of the lymphatic system is permanent and will always be there. Venous insufficiency has been linked to insufficiency of the lymphatic system which can cause edema in the feet, ankles, and legs. One suggestion would be to make sure your physician is accredited by the American Board of Venous and Lymphatic medicine.
Published on Jul 11, 2012
I would get another MD to do an ultrasound and see what they think. Make sure that he/she is accredited and highly qualified.
Published on Jul 11, 2012
I would recommend a full ultrasound to map the veins again and make sure there are no perforator veins left behind. Continue wearing the compression stockings. Your doctor should also check for lymphatic system abnormalities and evaluate your heart, kidneys, and liver for problems as well.
Published on Jul 11, 2012