Why wouldn't my veins fully close after endovenous laser ablation?

I had EVLA 8 months ago. My legs are still sore from knee to ankle when light pressure is applied. I had a 7-month ultrasound which shows the veins failed to close from my knee to ankle. I'm 30 yrs old, is this unusual or of concern? What now?

Answers from doctors (12)


The Sheen Vein Institute

Published on Aug 19, 2013

The answer to your question is a little more complex than just yes/no. First off, if the doc who did your initial EVLA was not proficient in that procedure, they may have not put enough energy into the laser to effectively close your vein. That is one possible reason. Secondly, a lot of docs only do a laser on a person's leg and nothing else. The problem with this method of treatment is that if you have any refluxing side branches feeding off of your saphenous vessels, those refluxing branches can over time actually re-open the treated vein. This is why proper vein treatments require persistent follow ups with ultrasound and an initial treatment that addresses all aspects of a person's vein disease (large, medium and small veins).

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Answered by The Sheen Vein Institute

The answer to your question is a little more complex than just yes/no. First off, if the doc who did your initial EVLA was not proficient in that procedure, they may have not put enough energy into the laser to effectively close your vein. That is one possible reason. Secondly, a lot of docs only do a laser on a person's leg and nothing else. The problem with this method of treatment is that if you have any refluxing side branches feeding off of your saphenous vessels, those refluxing branches can over time actually re-open the treated vein. This is why proper vein treatments require persistent follow ups with ultrasound and an initial treatment that addresses all aspects of a person's vein disease (large, medium and small veins).

Published on Jul 11, 2012


Americas Vein Centers - Southborough

Published on Aug 12, 2013

From the sounds of it, you need additional treatment.

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Answered by Americas Vein Centers - Southborough

From the sounds of it, you need additional treatment.

Published on Jul 11, 2012


Intermountain Vein Center

Published on Aug 12, 2013

There is probably another vein that is feeding the open area. Usually, the most distal portion of the vein that is ablated will clot, scar, and close off unless there is a vein feeding it from below. You probably have more veins to treat. If your current treating physician is not board-certified, I'd suggest you find one that is accredited by the American College of Phlebology.

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Answered by Intermountain Vein Center

There is probably another vein that is feeding the open area. Usually, the most distal portion of the vein that is ablated will clot, scar, and close off unless there is a vein feeding it from below. You probably have more veins to treat. If your current treating physician is not board-certified, I'd suggest you find one that is accredited by the American College of Phlebology.

Published on Jul 11, 2012


Arizona Vein Specialists

Published on Aug 06, 2013

This is very common. Often, this area is not treated at all. See a vein specialist for a consultation.

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Answered by Arizona Vein Specialists

This is very common. Often, this area is not treated at all. See a vein specialist for a consultation.

Published on Jul 11, 2012


General Vascular Surgery Group

Published on Aug 06, 2013

This complicated question needs to be addressed by your MD.

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Answered by General Vascular Surgery Group

This complicated question needs to be addressed by your MD.

Published on Jul 11, 2012


Smith Vein Institute, LLC

Published on Aug 06, 2013

I would say that is usual and normal, assuming the ablation was from your knee to the groin. The vessels below the ablation site will usually stay open so long as there is an entrance and exit for the flow. I bring my patients back one month after their ablation for ultrasound-guided chemical ablation of the remaining open and abnormal vessels.


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Answered by Smith Vein Institute, LLC

I would say that is usual and normal, assuming the ablation was from your knee to the groin. The vessels below the ablation site will usually stay open so long as there is an entrance and exit for the flow. I bring my patients back one month after their ablation for ultrasound-guided chemical ablation of the remaining open and abnormal vessels.


Published on Jul 11, 2012


Bella MD Laser Vein and Aesthetic Center

Published on Aug 06, 2013

Those lower leg tributaries need to be closed or removed separately. Your MD cherry-picked if he did not tell you those would also need to be done. If he doesn't provide that service then he was not qualified in my opinion to treat your entire problem.

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Answered by Bella MD Laser Vein and Aesthetic Center

Those lower leg tributaries need to be closed or removed separately. Your MD cherry-picked if he did not tell you those would also need to be done. If he doesn't provide that service then he was not qualified in my opinion to treat your entire problem.

Published on Jul 11, 2012


Cosmetic Vein Centers of Texas

Published on Aug 06, 2013

Maybe the ablation was not performed below the knee.

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Answered by Cosmetic Vein Centers of Texas

Maybe the ablation was not performed below the knee.

Published on Jul 11, 2012


Vein Specialties of St. Louis

Published on Aug 06, 2013

While this is unusual, it can occur. The ablation doesn't normally start as low as the ankle due increased possible complications. In most patients, the valves in the lower leg are functional after the ablation. I would recommend treating this area with ultrasound-guided sclerotherapy.

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Answered by Vein Specialties of St. Louis

While this is unusual, it can occur. The ablation doesn't normally start as low as the ankle due increased possible complications. In most patients, the valves in the lower leg are functional after the ablation. I would recommend treating this area with ultrasound-guided sclerotherapy.

Published on Jul 11, 2012


Vein Center of Orange County

Published on Aug 06, 2013

While experienced doctors achieve closure rates over 95%, rarely some veins can be resistant to thermal ablation. The ultrasound should show whether thermal ablation can be repeated or, if not, that ultrasound-guided sclerotherapy can finish the job.

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Answered by Vein Center of Orange County

While experienced doctors achieve closure rates over 95%, rarely some veins can be resistant to thermal ablation. The ultrasound should show whether thermal ablation can be repeated or, if not, that ultrasound-guided sclerotherapy can finish the job.

Published on Jul 11, 2012


Vanish Vein and Laser Center

Published on Aug 06, 2013

EVLT usually is done from the groin down to about the knee or just below it. The saphenous vein is not treated in most instances from the mid-calf down because the nerves in that area are close to the vein and can be injured by the laser. The saphenous vein from the knee to the ankle is not usually treated unless it is causing varicose veins.

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Answered by Vanish Vein and Laser Center

EVLT usually is done from the groin down to about the knee or just below it. The saphenous vein is not treated in most instances from the mid-calf down because the nerves in that area are close to the vein and can be injured by the laser. The saphenous vein from the knee to the ankle is not usually treated unless it is causing varicose veins.

Published on Jul 11, 2012


More About Doctor Laser Vein Center

Published on Aug 06, 2013

No, after endovenous laser ablation it's normal for the veins to remain open from knee to ankle. If you are still having symptoms, you may need additional treatment or continued compression by way of stockings.

Answered by Laser Vein Center (View Profile)

No, after endovenous laser ablation it's normal for the veins to remain open from knee to ankle. If you are still having symptoms, you may need additional treatment or continued compression by way of stockings.

Published on Jul 11, 2012


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