Is the advice my doctor is giving me valid?

One yr after saphenous vein ablation and phlebectomy below knee, an ultrasound shows areas of vein still open and many new small red veins at my knee. The Dr said leave alone and won't touch the other abnormal leg. Apparently, the veins are too wide for a catheter. Is his advice valid? Also, is Serrapeptase OK for the heart?

Answers from doctors (10)


Vein Specialties of St. Louis

Published on Aug 10, 2018

It is difficult to assess what your doctor is concerned with. However, we do at times see small areas of veins not sealed and/or associated perforator or communicator veins. These are often easily treated with sclerotherapy injections.
If you are concerned, I recommend a second opinion from a Board Certified vascular trained suregeon who specializes in treating vein problems. I have treated many patients who have a very large vessel. I do this with laser ablation. As for serapeptase supplements, I advise talking with your doctor before taking them. The claims are that they are a natural anti-inlammatory. I know of many doctors who have their patients take these pre and post operatively. I do not.

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Answered by Vein Specialties of St. Louis

It is difficult to assess what your doctor is concerned with. However, we do at times see small areas of veins not sealed and/or associated perforator or communicator veins. These are often easily treated with sclerotherapy injections.
If you are concerned, I recommend a second opinion from a Board Certified vascular trained suregeon who specializes in treating vein problems. I have treated many patients who have a very large vessel. I do this with laser ablation. As for serapeptase supplements, I advise talking with your doctor before taking them. The claims are that they are a natural anti-inlammatory. I know of many doctors who have their patients take these pre and post operatively. I do not.

Published on Jul 11, 2012


Artery and Vein Specialists of Idaho

Published on Mar 03, 2014

I have never heard of the veins being too wide for treatment. I am not familiar with Serrapeptase.

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Answered by Artery and Vein Specialists of Idaho

I have never heard of the veins being too wide for treatment. I am not familiar with Serrapeptase.

Published on Jul 11, 2012


Intermountain Vein Center

Published on Feb 04, 2014

The only thing with serrapeptase you may have to worry about is blood thinning. It can cause blood thinning so if you are taking aspirin or Rx blood thinners, then it might not be a good thing to take. That is the only contraindication I could find. To possibly answer the first question, I highly doubt the vein is too wide for a catheter. That is why the numbing liquid is a critical part in the ablation; it provides compression to the vein, squeezing it around the catheter so the treatment is effective. It also numbs your leg and protects the surrounding tissues.

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Answered by Intermountain Vein Center

The only thing with serrapeptase you may have to worry about is blood thinning. It can cause blood thinning so if you are taking aspirin or Rx blood thinners, then it might not be a good thing to take. That is the only contraindication I could find. To possibly answer the first question, I highly doubt the vein is too wide for a catheter. That is why the numbing liquid is a critical part in the ablation; it provides compression to the vein, squeezing it around the catheter so the treatment is effective. It also numbs your leg and protects the surrounding tissues.

Published on Jul 11, 2012


Vein Center of Orange County

Published on Jan 30, 2014

If a portion of the ablated vein remains open one year after treatment, the decision to perform further treatment depends on how much trouble it is causing. Veins are never too wide for a VNUS catheter; the problem comes when a vein is too narrow to insert and pass a catheter. However, if the untreated abnormal leg has no symptoms or visible varicosities, it may be safely left untreated in the absence of complications (thrombosis or ulceration).

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Answered by Vein Center of Orange County

If a portion of the ablated vein remains open one year after treatment, the decision to perform further treatment depends on how much trouble it is causing. Veins are never too wide for a VNUS catheter; the problem comes when a vein is too narrow to insert and pass a catheter. However, if the untreated abnormal leg has no symptoms or visible varicosities, it may be safely left untreated in the absence of complications (thrombosis or ulceration).

Published on Jul 11, 2012


Vein Care of New Mexico

Published on Jan 29, 2014

To adequately answer this question, a more precise description of the ultrasound findings is necessary.

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Answered by Vein Care of New Mexico

To adequately answer this question, a more precise description of the ultrasound findings is necessary.

Published on Jul 11, 2012


Cosmetic Vein Centers of Texas

Published on Jan 29, 2014

You need further ablation. I don't know what serrapeptase is, so I can't comment in that regards.



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Answered by Cosmetic Vein Centers of Texas

You need further ablation. I don't know what serrapeptase is, so I can't comment in that regards.



Published on Jul 11, 2012


The Sheen Vein Institute

Published on Jan 29, 2014

Based on what you are telling me, it appears that your original treatment a year ago was incomplete. Unfortunately, the majority of docs in the community only treat part of a person's vein issues. What should have happened was that they should have looked at all aspects of your vein structure in the legs and had any abnormal veins treated. Your doc probably only treated what they knew how to treat. The new veins that you are seeing are either left over from what you had untreated a year ago, or they could be new veins that have developed since your treatment. In either case, they sound like they are all abnormal.

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Answered by The Sheen Vein Institute

Based on what you are telling me, it appears that your original treatment a year ago was incomplete. Unfortunately, the majority of docs in the community only treat part of a person's vein issues. What should have happened was that they should have looked at all aspects of your vein structure in the legs and had any abnormal veins treated. Your doc probably only treated what they knew how to treat. The new veins that you are seeing are either left over from what you had untreated a year ago, or they could be new veins that have developed since your treatment. In either case, they sound like they are all abnormal.

Published on Jul 11, 2012


Vanish Vein and Laser Center

Published on Jan 29, 2014

The basic philosophy in treating veins is to close all refluxing valves. If you have a recurrence of veins and still have refluxing valves, then these should be closed. There are alternatives to closing valves, including laser, RF, mechanochemical ablation and ultrasound-guided sclerotherapy. Large veins can be treated usually without any problems. There are techniques used to reduce the size of the veins. I would recommend a second opinion. In addition, there is no reason not to treat your other leg if there is a problem. Serrapeptase is a supplement, and I would ask your cardiologist before using it.

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Answered by Vanish Vein and Laser Center

The basic philosophy in treating veins is to close all refluxing valves. If you have a recurrence of veins and still have refluxing valves, then these should be closed. There are alternatives to closing valves, including laser, RF, mechanochemical ablation and ultrasound-guided sclerotherapy. Large veins can be treated usually without any problems. There are techniques used to reduce the size of the veins. I would recommend a second opinion. In addition, there is no reason not to treat your other leg if there is a problem. Serrapeptase is a supplement, and I would ask your cardiologist before using it.

Published on Jul 11, 2012


Aluna Vein Centers

Published on Jan 28, 2014

I think some information is lost in translation. If you have symptoms and your veins are enlarged more than a certain size and have reflux, then you are a good candidate for vein treatment. The only time you wouldn't be a candidate for vein treatment is if you have contraindications like severe peripheral arterial disease. The treatment choices depend on the size of abnormal vein and whether it is straight or not.

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Answered by Aluna Vein Centers

I think some information is lost in translation. If you have symptoms and your veins are enlarged more than a certain size and have reflux, then you are a good candidate for vein treatment. The only time you wouldn't be a candidate for vein treatment is if you have contraindications like severe peripheral arterial disease. The treatment choices depend on the size of abnormal vein and whether it is straight or not.

Published on Jul 11, 2012


Lone Star Vein Center

Published on Jan 28, 2014

Open segments of unclosed vein are not uncommon, but are sub-optimal. If there is significant reflux (blood running backwards) in the unclosed segment(s), then you may have ongoing venous hypertension, reflux and stasis, which will lead to more varicose veins. If the small red veins are spiders, then this may not represent ongoing high pressure. If they are the larger varicose veins, then you can expect them to get worse over time. Unclosed segments can easily be corrected by a skilled/experienced vein specialist. This is done using a laser fiber, or an RFA stylet. Longer 60, or 100 cm,
RFA catheters are just too long for most unclosed segments. Occasionally they can be addressed with a 3cm RFA catheter, but the tip of a laser or stylet work every time. Frequently the issue is getting an insurance company to pay for it!

We routinely close veins in excess of 6 cm using either RFA or laser
ablations. RFA catheters only have an approved FDA indication for veins up to 2 cm, but most drugs and devices used are done so in "off label" way, and it works very well and is safe and effective in my practice. I hope this helps,

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Answered by Lone Star Vein Center

Open segments of unclosed vein are not uncommon, but are sub-optimal. If there is significant reflux (blood running backwards) in the unclosed segment(s), then you may have ongoing venous hypertension, reflux and stasis, which will lead to more varicose veins. If the small red veins are spiders, then this may not represent ongoing high pressure. If they are the larger varicose veins, then you can expect them to get worse over time. Unclosed segments can easily be corrected by a skilled/experienced vein specialist. This is done using a laser fiber, or an RFA stylet. Longer 60, or 100 cm,
RFA catheters are just too long for most unclosed segments. Occasionally they can be addressed with a 3cm RFA catheter, but the tip of a laser or stylet work every time. Frequently the issue is getting an insurance company to pay for it!

We routinely close veins in excess of 6 cm using either RFA or laser
ablations. RFA catheters only have an approved FDA indication for veins up to 2 cm, but most drugs and devices used are done so in "off label" way, and it works very well and is safe and effective in my practice. I hope this helps,

Published on Jul 11, 2012


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