Would it be wise to wait on ELA to see if my leg symptoms ever get worse? Can I start with sclerotherapy for now?

I feel I'm being rushed into getting an endovenous laser ablation. I've been diagnosed with grade 2 venous problems. Also, my symptoms are mild and my reticular and spider veins are both less than 4mm. Can I wait on ELA until my symptoms get worse? Will sclerotherapy do for now?

Answers from doctors (12)


More About Doctor David Green, MD

Published on Dec 29, 2021

You can have Sclerotherapy to remove blue-green Reticular Varicose Veins and Spider Veins without having to undergo endovenous ablation. Even if you have endovenous ablation, it will not have any effect on the appearance of the blue-green Reticular Varicose Veins and Spider Veins - they will persist unchanged.

Is the Saphenous Vein that is being proposed for treatment with endovenous ablation enlarged and with significant reflux? Do you have actual Varicose Veins? Do you have actual symptoms due to Varicose Veins or Saphenous Vein insufficiency?

Answered by David Green, MD (View Profile)

You can have Sclerotherapy to remove blue-green Reticular Varicose Veins and Spider Veins without having to undergo endovenous ablation. Even if you have endovenous ablation, it will not have any effect on the appearance of the blue-green Reticular Varicose Veins and Spider Veins - they will persist unchanged.

Is the Saphenous Vein that is being proposed for treatment with endovenous ablation enlarged and with significant reflux? Do you have actual Varicose Veins? Do you have actual symptoms due to Varicose Veins or Saphenous Vein insufficiency?

Published on Jul 11, 2012


More About Doctor Vein Center for Women PC

Published on Aug 15, 2018

While it is true that no vein procedure is needed to treat varicose veins immediately, delaying also has a price to pay. If you have proven venous insufficiency requiring an ablation procedure, once the diagnosis is made we recommend 20-30mmhg compression stockings during the daytime, on a regular basis.

I did not use the word daily. I do know that it is not possible for a patient to be 100% compliant with stockings. The insurance companies—at least most of them—want you to wear stockings for a minimum of 12 weeks before approving to pay for ablation. This gives the patient a good time to evaluate his response to stockings and ability to wear it daily. It also gives the patient time to get a second opinion and get to know all about the procedure, including potential complications.

After 12 weeks of compliance with stockings, we repeat a venous ultrasound to measure the reflux and diameter of the veins involved. In our experience, even with good compliance with stockings, larger veins and larger reflux in the veins invariably continue and worsen. This means continued chronic venous hypertension, which gets transmitted to all the veins in the leg and leads to more spider veins, more retic veins and bulging veins while waiting.

The second portion of the question about doing sclerotherapy alone is a bad choice if there is blatant reflux and other varicose veins present. The result will not be satisfying to you. In our practice, we do not recommend the option of doing sclerotherapy before the ablation.

Answered by Vein Center for Women PC (View Profile)

While it is true that no vein procedure is needed to treat varicose veins immediately, delaying also has a price to pay. If you have proven venous insufficiency requiring an ablation procedure, once the diagnosis is made we recommend 20-30mmhg compression stockings during the daytime, on a regular basis.

I did not use the word daily. I do know that it is not possible for a patient to be 100% compliant with stockings. The insurance companies—at least most of them—want you to wear stockings for a minimum of 12 weeks before approving to pay for ablation. This gives the patient a good time to evaluate his response to stockings and ability to wear it daily. It also gives the patient time to get a second opinion and get to know all about the procedure, including potential complications.

After 12 weeks of compliance with stockings, we repeat a venous ultrasound to measure the reflux and diameter of the veins involved. In our experience, even with good compliance with stockings, larger veins and larger reflux in the veins invariably continue and worsen. This means continued chronic venous hypertension, which gets transmitted to all the veins in the leg and leads to more spider veins, more retic veins and bulging veins while waiting.

The second portion of the question about doing sclerotherapy alone is a bad choice if there is blatant reflux and other varicose veins present. The result will not be satisfying to you. In our practice, we do not recommend the option of doing sclerotherapy before the ablation.

Published on Jul 11, 2012


Artery and Vein Specialists of Idaho

Published on Mar 03, 2014

It is your decision to proceed with any surgical treatment. I am not sure what grade 2 means, as this is not a standard terminology for vein specialists.

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Answered by Artery and Vein Specialists of Idaho

It is your decision to proceed with any surgical treatment. I am not sure what grade 2 means, as this is not a standard terminology for vein specialists.

Published on Jul 11, 2012


Intermountain Vein Center

Published on Dec 31, 2013

You can have sclerotherapy first on those spider and reticular veins, but there is a good chance those veins will just come back, especially if those veins that need to be ablated are the true source of those spider and reticular veins. Without knowing your ultrasound results, I would say the chance is still pretty good. If your symptoms are mild, then you can wait. There is no rush in having these types of procedures. Just make sure your physician is accredited through the American College of Phlebology.

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Answered by Intermountain Vein Center

You can have sclerotherapy first on those spider and reticular veins, but there is a good chance those veins will just come back, especially if those veins that need to be ablated are the true source of those spider and reticular veins. Without knowing your ultrasound results, I would say the chance is still pretty good. If your symptoms are mild, then you can wait. There is no rush in having these types of procedures. Just make sure your physician is accredited through the American College of Phlebology.

Published on Jul 11, 2012


Arizona Vein Specialists

Published on Dec 08, 2013

Your symptoms will get worse. We do not know how rapidly since every individual is different. If your symptoms seem to bother you or interfere with work or lifestyle, then it is OK to have EVLT. Realize that venous symptoms are subtle and much less severe than arterial symptoms. Sclero may not last as well if your venous insufficiency is causing pressure to back up into the affected veins.

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Answered by Arizona Vein Specialists

Your symptoms will get worse. We do not know how rapidly since every individual is different. If your symptoms seem to bother you or interfere with work or lifestyle, then it is OK to have EVLT. Realize that venous symptoms are subtle and much less severe than arterial symptoms. Sclero may not last as well if your venous insufficiency is causing pressure to back up into the affected veins.

Published on Jul 11, 2012


Vein Center of Orange County

Published on Dec 02, 2013

In the absence of complications, you can certainly postpone treatment until your symptoms become worse. However, sclerotherapy will not work very well in areas being fed by the underlying saphenous vein until the saphenous vein is treated.

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Answered by Vein Center of Orange County

In the absence of complications, you can certainly postpone treatment until your symptoms become worse. However, sclerotherapy will not work very well in areas being fed by the underlying saphenous vein until the saphenous vein is treated.

Published on Jul 11, 2012


Vein Specialties of St. Louis

Published on Nov 26, 2013

This is not a life threatening problem and can definitely be delayed if you wish. Many people have some venous reflux that is often not detected until they are scanned for another reason. Sclerotherapy for the superficial spider veins can be done at any time, but if they are caused by the underlying reflux the treatment may not be as effective. Wearing a compression stocking will certainly keep your symptoms under control and slow down the process for now. It is also possible that this may never progress from where you are now. IF you feel more comfortable waiting for a while and, conservative therapy, compression hose (20-30 mmHg thigh-length would be best), exercise, hydration and weight control is advisable.

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Answered by Vein Specialties of St. Louis

This is not a life threatening problem and can definitely be delayed if you wish. Many people have some venous reflux that is often not detected until they are scanned for another reason. Sclerotherapy for the superficial spider veins can be done at any time, but if they are caused by the underlying reflux the treatment may not be as effective. Wearing a compression stocking will certainly keep your symptoms under control and slow down the process for now. It is also possible that this may never progress from where you are now. IF you feel more comfortable waiting for a while and, conservative therapy, compression hose (20-30 mmHg thigh-length would be best), exercise, hydration and weight control is advisable.

Published on Jul 11, 2012


Aluna Vein Centers

Published on Nov 26, 2013

Venous disease is a chronic disease; it can can progress very slow or very fast depending on multiple factors:

1. Genetic background: if one family member has it, you have 47% chance of getting it. If both parents have it, you have 97% chance of getting it.

2. Age related: as you get older it gets worse and you will get more symptoms

3. Hormones, multiple pregnancy, obesity, smoking, cancer, cancer treatment, history of blood clot, trauma, standing or sitting for long time can all cause varicose veins to get worse

4. Exercise and compression stockings can help

With the above information you can make a better decision. If you decrease some of the risk factors (weight loss, if that is a risk factor for you), you might decrease the progress of the disease

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Answered by Aluna Vein Centers

Venous disease is a chronic disease; it can can progress very slow or very fast depending on multiple factors:

1. Genetic background: if one family member has it, you have 47% chance of getting it. If both parents have it, you have 97% chance of getting it.

2. Age related: as you get older it gets worse and you will get more symptoms

3. Hormones, multiple pregnancy, obesity, smoking, cancer, cancer treatment, history of blood clot, trauma, standing or sitting for long time can all cause varicose veins to get worse

4. Exercise and compression stockings can help

With the above information you can make a better decision. If you decrease some of the risk factors (weight loss, if that is a risk factor for you), you might decrease the progress of the disease

Published on Jul 11, 2012


More About Doctor Laser Vein Center

Published on Nov 26, 2013

Yes, of course you can wait. With grade 2 superficial varicose vein problems, the decision when to treat really depends on when the patient wants to get them treated. Also, sometimes insurance companies dictate when
this can happen as well, or whether they will pay for it. Sclerotherapy is an option now, but it will be less effective if there is underlying saphenous vein reflux.

Answered by Laser Vein Center (View Profile)

Yes, of course you can wait. With grade 2 superficial varicose vein problems, the decision when to treat really depends on when the patient wants to get them treated. Also, sometimes insurance companies dictate when
this can happen as well, or whether they will pay for it. Sclerotherapy is an option now, but it will be less effective if there is underlying saphenous vein reflux.

Published on Jul 11, 2012


Vanish Vein and Laser Center

Published on Nov 26, 2013

There is no urgency to do a closure procedure for spider and reticular veins. Symptomatic treatment with sclerotherapy and adding support hose when feasible is a reasonable alternative.

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Answered by Vanish Vein and Laser Center

There is no urgency to do a closure procedure for spider and reticular veins. Symptomatic treatment with sclerotherapy and adding support hose when feasible is a reasonable alternative.

Published on Jul 11, 2012


Bella MD Laser Vein and Aesthetic Center

Published on Nov 25, 2013

You can wait, but when the time comes you will need to have all of your problem veins addressed. Treating certain veins for cosmetics now is a waste because they will return unless the culprit reflux vein is treated.

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Answered by Bella MD Laser Vein and Aesthetic Center

You can wait, but when the time comes you will need to have all of your problem veins addressed. Treating certain veins for cosmetics now is a waste because they will return unless the culprit reflux vein is treated.

Published on Jul 11, 2012


Veins etc. at Comprehensive Cardiovascular Consultants

Published on Nov 25, 2013

You should not rush into any procedure, even endovenous laser ablation. If you have concerns, do more research and consult with a skilled vascular surgeon who can explain everything from the benefits to the downsides (side effects). When you are ready, then take on the procedure.

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Answered by Veins etc. at Comprehensive Cardiovascular Consultants

You should not rush into any procedure, even endovenous laser ablation. If you have concerns, do more research and consult with a skilled vascular surgeon who can explain everything from the benefits to the downsides (side effects). When you are ready, then take on the procedure.

Published on Jul 11, 2012


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