- Treatments & Info
- Find a Doctor
- Ask a Doctor
- Before & After
I had the VNUS procedure, which closed the main veins on both legs successfully. But subsequent evaluation revealed that new branches have opened and they are delivering blood to the same varicose veins below the knee. Should I repeat this procedure? Or, is there a better treatment (sclerotherapy, laser ablation, etc)?
There are several choices for refluxing veins, whether they be original or recurrent. Thermal ablation procedures like VNUS closure work well when the veins below the surface have no sharp curves and are of a long, continuous length. Phlebectomy and sclerotherapy are more appropriate for other veins, including surface varicosities.
An ablation is a reasonable option. If the vein is large, the ablation might work well with microphlebectomy.
Without knowing exactly which veins are now contributing to the problem, it is impossible to say if the Venefit (new name for VNUS) procedure can be safely done on those "new" veins. An ultrasound exam would be necessary to determine the size, location, and reflux of any potential veins that need treatment. Laser ablation is a similar procedure to Venefit, in that both use heat to destroy veins. Venefit, or radiofrequency ablation, has been shown to cause less post-procedural pain and bruising. Sclerotherapy chemically scars the vein when the liquid or foam sclerosant is injected. Another technique would be stab phlebectomy, which is a minor surgical procedure in which varicose veins are pulled out and removed through small incisions in the skin. Each technique has its pros and cons, and often, more than one technique is used on a single person to treat their venous reflux disease. Remember, venous reflux disease is not cured by current techniques and there is no medicine that will make refluxing veins healthy again. What we aim to do with all our techniques is improve and eliminate venous reflux which, in turn, relieves symptoms and enhances circulation of the legs.
You should undergo ablation of the new branches. VNUS closure and laser ablation both work well, but their use is dependent on the preference of the physician. I prefer laser ablation. If the branched vein is large enough to accept the laser or radiofrequency catheter, then this should be the procedure of choice. If the branch is too small, then ultrasonic directed sclerotherapy would be the next procedure of choice.
An accurate duplex exam is the most important aspect in determining which treatment is the best.
The success rate for either VNUS or laser ablation is better than with other treatment methods such as sclerotherapy. The secondary varicose veins below the knee can be treated with phlebectomy or sclerotherapy after your ablation.