I am an active 45 year old who had endovenous laser ablation done on the great saphenous vein and lesser saphenous vein. After 4 months of complications, I had an ultrasound to determine the source. It turns out that the GSV was open at the top and partially occluded near the knee. The LSV was also partially occluded. My treating physician said to wait 6+ mo & reevaluate. I am tired of the pain. What should I do?
Wait six months to see if the problem has improved. If not, you may need sclerotherapy. However, if your pain is not tolerable, you may want to urge your physician to manage it. Should he/she refuse or if his/her recommendations do not suit you, there is always the option of seeking a second opinion.
Published on Jul 11, 2012
I am sorry for your complications and pain. My advice depends on whether the vein has completely opened up. If this is the case, then re-treatment is in order. However, if the vein is partially occluded, then it is best to wait and re- evaluate.
Published on Jul 11, 2012
You should wear support stockings. Secondly, since you are symptomatic, a good case exists for foam
sclerotherapy and/or endovenous laser treatment again. Make sure to be treated by an experienced vein specialist.
Published on Jul 11, 2012
Usually those types of things can be retreated with sclerotherapy, unless the proximal portion of the GSV is big enough to ablate. Still, sclerotherapy should do the trick. Even with a partially occluded vein, sometimes sclero will close the rest down. The portion of the GSV that is open will most likely remain open until treatment is done. Make sure your physician is accredited by the American College of Phlebology.
Published on Jul 11, 2012
A second laser procedure may be needed or, perhaps, ultrasound-guided CO2 foam sclerotherapy can close off the remaining channels in the veins.
Published on Jul 11, 2012
If you are having pain and it has been over four months since your procedure, you are still having appreciable pain and your provider is suggesting you wait an additional six months and then reassess, it seems evidently clear you should seek a second opinion. I would suggest a board-certified vascular surgeon.
Published on Jul 11, 2012
It is very unusual for an lasered saphenous vein to remain partially open after expert ablation by an experienced physician. When it does occur, ultrasound-guided sclerotherapy is a good option to close the remaining open saphenous vein segments as long as there are large incompetent perforator veins. In the absence of thrombosis, the level of your discomfort can dictate whether you decide to wait or proceed with
alternative treatment.
Published on Jul 11, 2012
I suggest waiting 2 months after the procedure. By then, your doctor should get a better understanding of your healing process.
Published on Jul 11, 2012
You need to have your legs re-evaluated and treated. The reason you are having pain is because your treated vessels are still open and you probably also have refluxing side branches that are causing these veins to re-open. All of those side branches, in addition to the saphenous vessels, need to be treated. Closing these vessels down should help to eliminate your symptoms. Give my office a call and let us see what we can do for you.
Published on Jul 11, 2012
My recommendation is to seek a second opinion from an experienced vascular surgeon who performs these procedures. You should not be having this level of discomfort at this stage. I highly recommend you continue to wear compression hose in the interim.
Published on Jul 11, 2012
A small percentage of veins treated by closure may not close. Usually the percentage is directly related to the volume of closures done by the treating physician. First of all, I would ensure that your pain is not due to something else. Significant pain is usually not a symptom of incomplete closure or recanalization. I would also redo the venous duplex and consider closing anything left open by ultrasound-guided foam sclerotherapy. By 4 months, I doubt that there will be any further closure without intervention.
Published on Jul 11, 2012
About 5% of saphenous veins need to be retreated due to reopening and partial occlusion. If you are not comfortable with waiting six months to be reevaluated or to have treatment, seek a second opinion. Should you choose to go this route, make sure the vein specialist you choose is experienced and accredited/board certified.
Published on Jul 11, 2012
Ultrasound-guided foam sclerotherapy (USGFS) can close the rest of the veins. Also, compression stockings should be worn following the treatment to help keep the sclerosant in the veins, which better ensures their closure.
Published on Jul 11, 2012
Total or partial recanalization (reopening) of veins is not unusual after endovenous laser ablation. If found early, partial recanalization can be treated with ultrasound-guided foam sclerotherapy. If the recanalization is complete, the vein might need to have the endovenous laser treatment done again. Not all practitioners who do endovenous laser have the training and knowledge to do ultrasound-guided foam sclerotherapy. Make sure your doctor has the experience to perform the procedures and the experience to treat this problem after venous laser ablation.
Published on Jul 11, 2012
If still causing symptoms, there are injection or catheter-based closure procedures.
Published on Jul 11, 2012