It's been 4 wks since I had EVLT and Phlebectomy of my left leg. I continue to have the same chronic, daily leg swelling that I did before treatment. I have a follow-up appt in 3 mths but I am less than optimistic. What should I expect next?
It depends whether the EVLT successfully closed the abnormal vein in your leg. Some people, especially women, can have left leg swelling from May-Thurner Syndrome, which is compression of the left iliac vein by the crossing right iliac artery against the spine. If your leg vein has closed successfully and swelling persists, Pelvic Venous US, an MR Venogram or CT venogram will be needed to evaluate for May-Thurner Syndrome and other pelvic venous problems. Some people may have post-thrombotic syndrome causing leg swelling which results after an episode of previous deep vein blood clot in the leg.
Published on Jul 11, 2012
That would signify that the problem is not vein related. It could be arterial but that would be something for your physician to determine through some tests.
Published on Jul 11, 2012
Chronic swelling in the legs from vein disease can take months to resolve despite EVLT and phlebectomy. However, EVLT and phlebectomy alone often only allows you to treat some of the abnormal veins in your vein network. In my experience, in order to properly treat a patient's leg swelling, you need to treat all aspects of your vein structure that is abnormal. This includes any spider veins or reticular veins above and below the knee. Performing EVLT and phlebectomy alone will not allow you treat all of these vessels. This may be why your swelling has not resolved.
Published on Jul 11, 2012
In my experience, there are usually multiple factors that cause leg swelling. Therefore, treating the patient's superficial venous insufficiency usually improves swelling (if it was a contributing factor to the swelling), but does not usually resolve all the swelling.
Published on Jul 11, 2012
Tough question there are many causes for swelling not just veins. See your provider
Published on Jul 11, 2012
There are many reasons why you still have swelling: you might still have insufficiency of the small saphenous veins, you might have insufficient perforators, you might not be walking enough or not wearing the right compression stockings.
There are some other reasons that are not "vein related", but will be too much to elaborate...
You need a re-evaluation sooner than 3 months.
Published on Jul 11, 2012
I always explain to my patients pre-operatively, that it cannot be guaranteed that the leg swelling is due to the saphenous incompetence. However, if a trial of conservative therapy (leg elevation, exercise, compression hose of at least 20-30 or 30-40mmHg pressure correctly fitted) reduces the edema, ablation very often alleviates the problems. If the swelling is only in the left it could be of lymphatic nature but if in both, it could be cardiac. You should follow-up with your vascular surgeon before 3 months. I would also highly recommend you continue compression hose. Apply them in the morning before you get out of bed.
Published on Jul 11, 2012
It could be that your leg swelling was NOT due to reflux of the saphenous system and varicose veins. There are a multitude of causes of leg swelling such as deep venous reflux, lymphedema or medications. You probably need further work up for the cause of the leg swelling.
Published on Jul 11, 2012