I have a bulging vein on my right calf (right leg reflux is 0.4-4.2; size 4.8-13.2mm). I have no symptoms on left leg (reflux is 0.54-1.9 and size 2.2-9.3mm). My doctor wants to do an ablation on both legs. Do I really need to have my left leg done if I have no symptoms?
Insurance coverage depends upon symptoms (heaviness, pain, cramping, aching, restless legs, etc.) and signs (varicose veins, skin changes, ulcers, etc.). So if you are asymptomatic, it will not be covered.
That said, when the blood is not flowing correctly (backflow from inherited damaged valves), it may be more prone to clotting. This is superficial and painful but usually not life-threatening. In your case, I would treat the symptomatic leg and continue to wear your compression hose most days on the other.
After the right leg is treated, you may find you do have symptoms but less severe than the other. You develop this reflux gradually, and think your leg "feels normal". I would then reevaluate you a month or so down the road.
Published on Jul 11, 2012
With veins that size, the longer you let it go, the greater the chance of having complications from varicose veins. The blood does not return to the heart normally, so the tissue around the varicose veins cannot get the oxygenated blood properly so there is risk of skin discoloration and necrosis, which can eventually lead to ulcerations. Now, many times that is over many many years, but the risk is still there. Having healthy circulation in your legs is very important to decrease the risk of tissue damage.
Published on Jul 11, 2012
Your left leg vein size is very large at 9.3mm with significant reflux. It is likely that your other leg will begin to hurt very soon. I am surprised that your insurance company is allowing this to be down if there are absolutely no symptoms though.
Published on Jul 11, 2012
Hi,
That is a great question. From what you have sent, it appears you have venous insufficiency, which is an indication you need treatment. We do not use EVLT in our office, we use radiofrequency ablation instead. If the left leg is not bothering you, then it is OK to wait, but just know that the condition will not improve or go away without treatment.
Published on Jul 11, 2012
The decision is up to you. In general, patients will become symptomatic sooner or later. Doing the procedure now will prevent further progression of venous insufficiency later.
Published on Jul 11, 2012
Symptoms are not the only indication for ablation. Not all abnormal veins need to be treated. I would assess the risk for future complications (such as variceal progression, thrombophlebitis, stasis) and make treatment recommendations based on the patient's risk profile.
Published on Jul 11, 2012
This is a personal decision on your part. If you have no symptoms, you would be entirely within reason to wait and see if conditions worsen enough to undergo ablation on the non-symptomatic leg. Sometimes by wearing compression regularly, you can avoid this. I have had a refluxing perforator in my calf without any other symptoms for 10 years, and wear compression 7-8 months of the year - has not worsened. Hope this helps.
Published on Jul 11, 2012
If all depends on whether you want to treat it now as a preventative measure, or whether you want to wait until the leg begins to bother you. Either way, it's your preference. Postponing EVLT does offer the advantages of deferring the expense (asymptomatic leg veins are not reimbursed by insurance) and the possibility a newer better procedure may be available at a later date.
Published on Jul 11, 2012
Your question is difficult to answer without an exam and discussion, but I would advise you have a thorough discussion with your doctor regarding all possible related symptoms (in both legs). If you truly are asymptomatic in the left leg, it is not unreasonable to have the right side treated and consider the left at a later date. You will likely have the left treated at some point if your ultrasound findings are accurate; meaning, at some point you will likely become symptomatic.
Published on Jul 11, 2012
Don't do it. You should only treat the leg that is problematic. If the other leg (the one with no symptoms) begins to cause problems, then you can address it with treatment.
Published on Jul 11, 2012
We do not do, nor is it ever necessary to do an ablation on a patient with no symptoms. You can always wait until symptoms develop.
Published on Jul 11, 2012
Treat the symptomatic one. Usually, the reasons to treat veins are pain or appearance.
Published on Jul 11, 2012
I would recommend that you have the problematic leg treated first and then reassess matters with the other leg later (since that particular leg is not causing symptoms).
Published on Jul 11, 2012
No, you don't need to undergo the endovenous laser ablation procedure if your leg has no symptoms. I would recommend only treating the symptomatic leg. Perhaps when the bad leg feels better, you may become aware of symptoms in the other leg. This is not uncommon. In sum, there is really no need to treat the leg until it bothers you.
Published on Jul 11, 2012
What you describe is seen frequently. One leg is symptomatic and the other is not, but both have reflux. I recommend correcting the problematic leg and following up with the asymptomatic leg. The asymptomatic leg can be treated with support hose and observation. VNUS closure is an elective procedure, and can always be done electively at a future time.
Published on Jul 11, 2012