I had slcerotherapy and an endovenous laser ablation on both my greater saphenous vein and lesser saphenous vein 7 months ago. Since then I have been more symptomatic and have continual aches/throbbing in one leg. The Dr. is unable to help. I saw a 2nd Dr. who said my treated veins were nearly all open or partly occluded. He suggested I wait 6-12 months to reevaluate. Both doctors are certified. What should I do?
What are these doctors certified in. A common misconception is that vascular surgeons are vein specialists. The reality is most know very little about treating vein disease. Most treat only part of a person's vein issues and call it a day. The reality is that a proper vein treatment involves treating all aspects of your vein structure in the legs that are abnormal, not just the saphenous veins and a few injections. This is probably why your vessels are still open or partially closed. The fact that your vessels are still open explains why you still have pain. If you had undergone a comprehensive treatment, your legs should be feeling really good at 7 months.
Published on Jul 11, 2012
Usually a follow-up appt is required about 1-2 wks after the procedure to check and make sure the veins closed. There are probably more veins that need to be treated. Are the physicians are certified by the American College of Phlebology?
If the veins have clot in them, they will hurt for a little while. Your treating physician should know by looking at the ultrasound if there are other veins that need to be treated. If the doctors are not Interventional Radiologists, then it might not be a bad idea to find one. The American College of Phlebology website has a section where you can find accredited physicians, either IR or surgeons.
Published on Jul 11, 2012
There are many etiologies of lower extremity pain. Enlarged truncal veins with reflux and large distal varices can cause pain, cramping and fatigue. If your major truncal veins have significant reflux and are still patent, this may be the cause of your pain. I always advise patients that successful treatment of their refluxing veins MAY alleviate pain. If your veins are still open, repeat treatment has a good chance of being successful and MAY relieve your pain. I do not think you have to wait for another year to consider re-treatment.
Published on Jul 11, 2012
Your leg symptoms are due either to unsuccessful vein treatment or a non-venous cause. If the second doctor performed a standing ultrasound and found treated veins were still open with reflux, you have your answer.
Published on Jul 11, 2012
Without all the information and seeing your ultrasound readings, it appears that your procedures were unsuccessful. If after 7 months this is the situation and you are still experiencing symptom, you should seek the opinion of a board-certified vascular trained surgeon. The American Board of Medical Specialties is the only real certifying board with the appropriate training. Waiting longer serves no purpose, except for your continued discomfort. I recommend you wear your compression hose in the meantime for your comfort.
Published on Jul 11, 2012
This is disturbing to hear on many levels. I do not comprehend why the 1st doctor is unable to help or whether they did the ultrasound or not diagnose. Ultimately, the veins will need to be closed by EVLT or foam sclerotherapy. Wear stockings until then. Good luck!
Published on Jul 11, 2012
If the veins are open, they will need to be treated again.
Published on Jul 11, 2012
1. Venous insufficiency is a chronic problem
2. EVLT success rate over 5 years is 95%; that means there is a 5% chance for them to revascularize over 5 years.
3. There is a chance that there is a feeding vein which was not seen (like a perforator) at the time of post-procedure
4. EVLT is a great procedure, but patients need to lose weight and exercise also
5. Also you have to check the arteries, and make sure you don't have
peripheral arterial disease
6. Other conditions that cause leg pain need to be checked (e.g., flat feet, diabetic neuropathy, kidney failure or conditions that cause edema like congestive heart failure (CHF).
Published on Jul 11, 2012
If your treated veins are open or partially occluded and you are symptomatic 7 months since the closure attempt, these veins should be retreated either by reclosure or sclerotherapy. The recommended treatment would depend on the ultrasound findings. I have seen patients have discomfort following closure procedures for 3 to 4 months, but 7 months is certainly too long to have discomfort attributed solely to the procedure. The other issue is whether or not your symptoms are venous in origin.
Published on Jul 11, 2012
It could be that your veins are not the source of your symptoms. Follow up with your treating physician to be sure.
Published on Jul 11, 2012