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I went to my doctor for severe edema, and after a duplex screen, he suggested I have an edovenous vein ablation. Is this necessary? He stated I had reflux that was causing the swelling. I don't have varicose veins, but he is concerned about clots.
If your edema is not to do with some other cause such as heart failure, and there is documented reflux on duplex ultrasound exam, then an ablation would be a reasonable treatment. If your edema can be managed by compression hose and you are happy with that, then you can postpone the ablation for now.
Sometimes ablation of isolated superficial insufficiency can help swelling in the abscence of any other cause, but there are many causes of leg swelling. Difficult to comment over the internet without seeing you.
Clots are not usually caused by isolated venous insufficiency.
Reflux in those saphenous veins can cause edema and if those veins are refluxing it would be wise to treat. Reflux in those veins will cause more problems with time.
Based on what you are saying, it sounds like you have vein disease since your doc found evidence of reflux in your leg(s) by duplex ultrasound. That being said, edema can be caused by vein disease as can it be caused by other things...heart failure, liver disease, kidney disease, etc. If your doc has ruled out all of these potential other causes, you can probably safely say that your swelling may in fact be vein related. Now from here, you need to see how much vein disease you actually have. In my experience, an isolated saphenous vein reflux (the vessel your doc wants to ablate) is not usually enough to cause significant swelling in the legs. Most people have a lot of other vein disease beyond the saphenous vein that are also refluxing. So, if your doc is telling you that the ablation alone will eliminate your swelling, you may very well be disappointed (never say never but more than likely). In order to properly treat a person's vein issues and effectively eliminate the swelling, the doc needs to treat all aspects of the problematic vein structure from inside all the way to the skin. This will allow you to neutralize the pressure and pooling of blood in the leg often the source of the swelling. Now, as far as clot risk, vein disease because of the decreased blood flow that comes with it, can increase your risk of developing blood clots. Is it a high risk, probably not but it can happen.
I cannot answer this question without an exam and review of the ultrasound.
The most common casues of leg edema in North America are venous insufficiency and obesity. One must not have large, bulging varicose veins to have venous insufficiency. The reason for treating an incompetent saphenous vein when the primary finding is edema thought to be due to the venous insufficiency is to reduce the abnormal venous pressures in the leg associated with the reflux and to resolve the edema. The skin changes associated with venous insufficeincy and edema may lead to infection or skin ulcers.
Edema od the legs is very common in patients with venous insufficiency. It is not always associated with visually obvious varicose veins. If your doctor has ruled out other causes of leg edema (leg swelling) and the ultrasound Doppler of your legs show venous reflux, the the endovenous laser is a very good option.
Reflux does not cause clots so I am not sure by what you mean about clots. There can be reflux of the superficial or deep systems or both. Each is treated differently. Reflux of the deep system is treated by compression stockings, elevation and sometimes compression pumps. Reflux of the superficial system is treated by ablation if it is symptomatic. Severe leg edema is not usually due to superficial reflux alone. Although you may be a candidate for ablation, you need to know that ablation may not resolve your edema.
Severe swelling to lower extremities has many causes and it is difficult to pinpoint the exact cause. I would not recommend treating your veins based upon those reasons. You can wear compression stockings and accomplish the same objective.