Which procedure works better on varicose veins, sclerotherapy or EVLT?

When should one of these procedures NOT be done on veins?

Answers from doctors (8)


More About Doctor David Green, MD

Published on Oct 27, 2021

Endovenous Ablation (EVA) is administered using a catheter delivery heat through a laser (EVLT) or radiofrequency energy (RFA). EVA is usually limited to treating the Great Saphenous Vein (GSV) or the Small Saphenous Vein (SSV) when they are insufficient (no longer transporting blood as they should). These veins are often not visible or palpable but are examined by duplex ultrasound examination. If the GSV or SSV is insufficient along with Varicose Veins (which are visually apparent and palpable as bulging, protruding, tortuous, firm veins under the skin), usually EVA is administered prior to treating the Varicose Veins.

After EVA, the Varicose Veins are best treated by Sclerotherapy. An alternative to Sclerotherapy is Phlebectomy, which involves making small incisions in the skin followed by removal of small segments of the Varicose Vein. Phlebectomy leaves small scars and almost always leaves segments of the Varicose Veins behind. Sclerotherapy can remove all segments of Varicose Veins without producing any scars.

Answered by David Green, MD (View Profile)

Endovenous Ablation (EVA) is administered using a catheter delivery heat through a laser (EVLT) or radiofrequency energy (RFA). EVA is usually limited to treating the Great Saphenous Vein (GSV) or the Small Saphenous Vein (SSV) when they are insufficient (no longer transporting blood as they should). These veins are often not visible or palpable but are examined by duplex ultrasound examination. If the GSV or SSV is insufficient along with Varicose Veins (which are visually apparent and palpable as bulging, protruding, tortuous, firm veins under the skin), usually EVA is administered prior to treating the Varicose Veins.

After EVA, the Varicose Veins are best treated by Sclerotherapy. An alternative to Sclerotherapy is Phlebectomy, which involves making small incisions in the skin followed by removal of small segments of the Varicose Vein. Phlebectomy leaves small scars and almost always leaves segments of the Varicose Veins behind. Sclerotherapy can remove all segments of Varicose Veins without producing any scars.

Published on Jul 11, 2012


Modern Vein & Laser Center

Published on Sep 04, 2017

These procedures are NOT to be done if there are no symptoms. Each procedure has its indication, to be discussed with your doctor.

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Answered by Modern Vein & Laser Center

These procedures are NOT to be done if there are no symptoms. Each procedure has its indication, to be discussed with your doctor.

Published on Jul 11, 2012


Hratch Karamanoukian, MD, FACS, RVT, RPVI, RPhS

Published on Sep 01, 2017

This is a question that can only be answered by the treating physician and the answer is based on whether or not there is venous insufficiency or if the vein is amenable to ablation. Ablation procedures treat venous insufficiency and should be reserved to treating refluxing vein segments. Varicose veins are treated with sclereotherapy or microphlebectomy.

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Answered by Hratch Karamanoukian, MD, FACS, RVT, RPVI, RPhS

This is a question that can only be answered by the treating physician and the answer is based on whether or not there is venous insufficiency or if the vein is amenable to ablation. Ablation procedures treat venous insufficiency and should be reserved to treating refluxing vein segments. Varicose veins are treated with sclereotherapy or microphlebectomy.

Published on Jul 11, 2012


Vein Specialties of St. Louis

Published on Aug 31, 2017

Both are different modalities. Typically EVLT is done on larger slightly deeper saphneous veins which are refluxing and causing the surface varicose veins. An experienced vascular trained surgeon can also remove some of the surface varicose veins at the same time (microphlebectomy) with very good results. In my clinic sclerotherapy is used for spider veins, deeper refluxing perforator veins and short segments of larger veins if needed. I prefer the removal of larger veins as there are less complications and visits.

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Answered by Vein Specialties of St. Louis

Both are different modalities. Typically EVLT is done on larger slightly deeper saphneous veins which are refluxing and causing the surface varicose veins. An experienced vascular trained surgeon can also remove some of the surface varicose veins at the same time (microphlebectomy) with very good results. In my clinic sclerotherapy is used for spider veins, deeper refluxing perforator veins and short segments of larger veins if needed. I prefer the removal of larger veins as there are less complications and visits.

Published on Jul 11, 2012


Vanish Vein and Laser Center

Published on Jan 08, 2015

Varicose veins are due to malfunctioning of the valves of usually the saphenous system of veins. The first step in the treatment on varicose veins is to find the refluxing valves with an ultrasound. Next the valves need to be sealed then the varicose veins can be treated by sclerotherapy or removal through micro incisions. I prefer the micro incisions and reserve sclerotherapy for spider veins.

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Answered by Vanish Vein and Laser Center

Varicose veins are due to malfunctioning of the valves of usually the saphenous system of veins. The first step in the treatment on varicose veins is to find the refluxing valves with an ultrasound. Next the valves need to be sealed then the varicose veins can be treated by sclerotherapy or removal through micro incisions. I prefer the micro incisions and reserve sclerotherapy for spider veins.

Published on Jul 11, 2012


The Vascular Institute at Teton Radiology

Published on Feb 13, 2013

Sclerotherapy treats spider veins only. For true varicose veins, EVLT (endovenous laser treatment) is necessary.

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Answered by The Vascular Institute at Teton Radiology

Sclerotherapy treats spider veins only. For true varicose veins, EVLT (endovenous laser treatment) is necessary.

Published on Jul 11, 2012


Vein Treatment and Aesthetic Center

Published on Dec 20, 2012

EVLT is by far the best treatment for the larger veins called varicose veins. The veins must be over .4cm in diameter in order for the insurance companies to consider them medically necessary and cover the treatment.

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Answered by Vein Treatment and Aesthetic Center

EVLT is by far the best treatment for the larger veins called varicose veins. The veins must be over .4cm in diameter in order for the insurance companies to consider them medically necessary and cover the treatment.

Published on Jul 11, 2012


Advanced Vein Center

Published on Dec 18, 2012

Endovenous laser procedures are not the treatment for varicose veins which are tortuous and close to the skin. Varicose veins can be treated by foam sclerotherapy or stab phlebectomies.

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Answered by Advanced Vein Center

Endovenous laser procedures are not the treatment for varicose veins which are tortuous and close to the skin. Varicose veins can be treated by foam sclerotherapy or stab phlebectomies.

Published on Jul 11, 2012


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