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I am significantly overweight and have very painful varicose veins in my legs. Is it better for me to have surgery or endovenous laser treatment?
I use minimally invasive techniques for both obese and non obese patients with good results. Open surgery is not necessity in the overweight patient.
Losing weight should help to reduce the pain and swelling in your legs and veins. If you do want to have a procedure, there are many factors that determine which surgery or procedure you are a candidate for. You should see a vascular surgeon to discuss your options.
The only time I would recommend open surgery to endoluminal ablation is if the vein to be ablated is larger than 25mm or extremely tortuous. Obesity is not a contraindication for ablation and obese patients are better served with a minimally invasive procedure because it will reduce your risk of complications such as deep vein thrombosis.
You need to see a phlebologist who can give you an answer specific to your needs. Generally, endovenous thermal ablation of the greater saphenous vein is much preferred over a vein stripping procedure regardless of weight.
With the current technologies, there is really never a reason for stripping and ligation. Endovenous thermal ablation (laser or VNUSClosure) is a much better treatment combined with microphlebectomy (or sclerotherapy).
Endovenous laser treatment is the best choice for you. It is safer and less invasive with significantly less down time.
EVLT or ELVes/radiofrequency ablation are preferable in most individuals and even more so for overweight individuals. There are several reasons for this preference. First, general anesthesia is not used for EVLT or ELVes/radiofrequency ablation and overweight people are at a higher risk for complication for general anesthesia.
Another reason is that ligation and stripping procedures require incisions. In over-weight individuals carry there is an added risk of poor healing and infection with incisions from stripping procedures. This would be especially applicable to a groin incision that is usually required to treat the greater saphenous vein.