I had endovenous laser treatment on my saphenous vein. The doctor said he only treated it from the groin to knee, not to ankle. He said that should be enough to stop the blood flow. Is this OK, or should he have treated the entire vein?
Not necessary
Most parents this is enough
However it's preference of treating physicians
My preference is to treat whole leg
Published on Jul 11, 2012
With EVLT, treatment from the knee to the groin is usually adequate. We only typically treat below the knee for patients with nonhealing ulcers or perforating veins that persist. Treating below the knee increases one's risk for nerve injury which can lead to burning and pain along the area treated. If the EVLT was performed for swelling and fatigue as well as cramping, and above knee approach should work!
Published on Jul 11, 2012
It depends on the initial ultrasound findings. Make sure your ultrasound tech is RVT certified and has had experience in CVI screening.
Published on Jul 11, 2012
Not necessarily. It all depends on the vein mapping performed prior to your EVLT.
Published on Jul 11, 2012
It just depends on where a good access point is for that vein. Sometimes the vein below the knee can be really small or have a little curve to it, making it difficult to access. We see that all the time. You would never get access down by the ankle, but typically mid-calf is a good access point. That said, it varies with everyone. Yes, it is sufficient to shut down that vein. Make sure you are scheduled for a follow-up ultrasound within a week or two to make sure.
Published on Jul 11, 2012
It depends on your specific problem. Duplex ultrasound would show how far down the leg thermal ablation should be done. Sometimes doctors avoid thermal ablation below the knee to prevent nerve damage because the saphenous nerve runs close to the saphenous vein below the knee, and instead use supplemental sclerotherapy below the knee. If your symptoms and/or veins remain or recur quickly, you will know the answer to your question all too soon.
Published on Jul 11, 2012
If your saphenous vein is refluxing only from the hip to the knee, treating only this region is fine. That said, what you should be asking is what else your doc is going to treat. People with vein issues like you, do not just have one vein that is problematic. The vein structure in your leg is an intricate network of large veins, medium sized veins and small veins. Proper vein treatment requires addressing all facets of your vein structure. Therefore if your doc does not have any plans on treating the remainder of your abnormal vein structure, I would recommend finding one who does. Only then will you see the results that you are looking for.
Published on Jul 11, 2012
The treatment described is the typical approach for GSV ablation. It is usually not necessary to ablate the GSV all the way to the ankle; distal ablation involves additional risks and post op pain.
Published on Jul 11, 2012
You typically treat from the sapheno-femoral junction at the groin to the lowest point of reflux. In some cases I will treat lower down but this should only be performed by an experienced vascular surgeon who specializes in these treatments. Otherwise there is a higher risk of complications such as nerve damage.
Published on Jul 11, 2012
Normally the ablation is from the knee up.
Published on Jul 11, 2012
The reason for treating the greater saphenous vein only to the knee is that from the knee to the ankle the saphenous nerve is very close to the saphenous vein and could be injured from the heat of the laser. In addition to this there are usually either none or only one valve below the knee area which rarely contributes to the formation of varicose veins. I try to always laser to the level of the upper calf (Boyd's Perforator) and I inject the vein from the mid calf to ankle with foam sclerotherapy.
Published on Jul 11, 2012
Treating the thigh portion of the great saphenous vein with laser is the safest way to treat reflux in the majority of cases. If the patient has more problems in the portion of the great saphenous vein or its branches below the knee, then it can be safely treated with the use of ultrasound-guided foam sclerotherapy.
Published on Jul 11, 2012
Generally, the thigh vein is the treated portion in most cases.
Published on Jul 11, 2012
That is usually the best way. Remaining vein below the knee can be thrombosed with foam or removed by microphlebectomy, if needed.
Published on Jul 11, 2012
The short answer is no, there is no such thing as what that doctor "should" have done. Any method is within standard of care.
Long answer is that there is only a small percentage of physicians who treat the entire great saphenous vein from the groin to the ankle. This group is more skilled in accessing the vein since it is smaller and more difficult to access near the ankle. This group has more knowledge in
avoiding potential neuropathy complication when crossing the knee joint. This group has deeper understanding about the importance of below knee segment of great saphenous vein in contributing to the patient's symptoms.
If my mother was to get vein ablation, I would seek a physician from this group.
Published on Jul 11, 2012
Yes, it should be OK as long as the patient is doing well.
Published on Jul 11, 2012