I had the VNUS procedure, which closed the main veins on both legs successfully. But subsequent evaluation revealed that new branches have opened and they are delivering blood to the same varicose veins below the knee. Should I repeat this procedure? Or, is there a better treatment (sclerotherapy, laser ablation, etc)?
Each persons anatomy can vary and other vein failing can occur. Not all of these branches are appropriate for laser ablation (RF or Laser). If very superficial, ultrasound- guided sclerotherapy can be effective and can take several treatments. If there are varicose veins on the surface, I typically remove these at the time of the initial procedure (microphlebectomy) through tiny punctures and they are gone. If your surgeon is an experienced and vascular trained surgeon, he will be able to advise which procedure is appropriate for you.
Published on Jul 11, 2012
There are several choices for refluxing veins, whether they be original or recurrent. Thermal ablation procedures like VNUS closure work well when the veins below the surface have no sharp curves and are of a long, continuous length. Phlebectomy and sclerotherapy are more appropriate for other veins, including surface varicosities.
Published on Jul 11, 2012
Without knowing exactly which veins are now contributing to the problem, it is impossible to say if the Venefit (new name for VNUS) procedure can be safely done on those "new" veins. An ultrasound exam would be necessary to determine the size, location, and reflux of any potential veins that need treatment. Laser ablation is a similar procedure to Venefit, in that both use heat to destroy veins. Venefit, or radiofrequency ablation, has been shown to cause less post-procedural pain and bruising. Sclerotherapy chemically scars the vein when the liquid or foam sclerosant is injected. Another technique would be stab phlebectomy, which is a minor surgical procedure in which varicose veins are pulled out and removed through small incisions in the skin. Each technique has its pros and cons, and often, more than one technique is used on a single person to treat their venous reflux disease. Remember, venous reflux disease is not cured by current techniques and there is no medicine that will make refluxing veins healthy again. What we aim to do with all our techniques is improve and eliminate venous reflux which, in turn, relieves symptoms and enhances circulation of the legs.
Published on Jul 11, 2012
The success rate for either VNUS or laser ablation is better than with other treatment methods such as sclerotherapy. The secondary varicose veins below the knee can be treated with phlebectomy or sclerotherapy after your ablation.
Published on Jul 11, 2012
An ablation is a reasonable option. If the vein is large, the ablation might work well with microphlebectomy.
Published on Jul 11, 2012
An accurate duplex exam is the most important aspect in determining which treatment is the best.
Published on Jul 11, 2012
You should undergo ablation of the new branches. VNUS closure and laser ablation both work well, but their use is dependent on the preference of the physician. I prefer laser ablation. If the branched vein is large enough to accept the laser or radiofrequency catheter, then this should be the procedure of choice. If the branch is too small, then ultrasonic directed sclerotherapy would be the next procedure of choice.
Published on Jul 11, 2012