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What is the risk of performing the procedure while pregnant. I am a surgeon pregnant (2nd tri) with my second. The pain is so great from LSV reflux that I cannot stand or operate. I am looking for answers as to what has been reported about complications.
No data that I'm aware of with ablation procedures in pregnancy. I'm not sure you could find anyone to do the procedure until you were post partum.
Michael D. Ingegno
The effects of laser on pregnant women is not fully documented. Most
of the synptoms do go away after delivery. The wearing
of medical compression stockings and elevating your legs whenever
possible will help.
Not aware of any being done during pregnancy. Would recommend graded compression stocking until after delivery. Risk of DVT is the concern.
As you can imagine, most surgeons are reluctant to perform any procedure on a pregnant patient. In our practice we usually remain conservative with supportive therapy.
Normally we recommend 30-40 mmHg compression for those with existing saphenous incompetence. This can be increased to 40-50 mmHg as the pregnancy progresses from 2nd to 3rd trimester. We would recommend a thigh length or fully panty hose to ensure compression of the entire LSV and worn on both legs.
Norman N. Bein MD FACS RVT
I do not see EVLT as an absolute contrindication. If compression stockings do not control your symptoms, then EVLT can be done safely.
I do not know if there is any proven data on performing laser ablation during pregnancy and, specifically, during the 2nd trimester. There just aren't enough numbers because very few of us would operate electively during pregnancy. Now, having said that, my feelings are the following- Most likely the procedure is safe to do especially if done without any sedation and minimum tumescent. There is, as you know, always a risk to the fetus and I would be very reluctant to recommend a procedure during pregnancy . Only you and your vein surgeon can weigh all the pros and cons and come to an agreement for laser treatment now or medical management until delivery.
1. Local anesthetic must be used and there may be a fetal absorption (ask your OB).
2. Small (<1%) risk of DVT and PE
3. Medical legal risk if there is any problem with childbirth or infant defects
4. Fetal absorption of vaporized venous intima (that's why many people get a burning taste in their mouth during the ablation)
5. Prone position for the SSV
Richard D. Kimmel, DO, FACOS, FCCP
While you are pregnant your body doubles the blood volume and the hormones cause the veins to relax and enlarge. Most of this will go away post partum. It is a very bad idea to treat while pregnant until 6 weeks post partum unless truly an emergency due to your being hypercoaguable. You are more more prone to getting a blood clot. In a normal person most quote the risk as 1 in 2500 to 1 in 5000. However when you are hypercoagulable this would be higher. As well, if you did get a blood clot you would have to be on heparin for the rest of your pregnancy since coumadin is teratogenic.
I would recommend against EVLT while pregnant.
While pregnany the best thing to do is wear compression hose 20 to 30 mm/hg or 30 to 40 mm/hg. I would recommend thigh highs. Elevate your legs at night and when possible
Hope this helps.