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I am 34 years old and have severe spider veins. My legs ache sometimes, but there is no sign of swelling. My left GS has .66 sec reflux. The right was WNL. I am a runner and of normal weight. A vascular surgeon has suggested the VNUS closure procedure. I am nervous. What are the risks vs benefits?
Your doctor should be going over the risks and benefits with you since he or she will quite possibly perform the procedure. If you are not particularly symptomatic, you don't have to have treatment. You can revisit the issue in another year. When running, you can wear compression hose. You can also try sclerotherapy for your spider veins if you have cosmetic concerns.
You have borderline reflux in the vein but if you have symptoms, VNUS closure will likely benefit you. Very few risks occur in a healthy, normal person. That said, this is a discussion for you and your MD.
Common discussion of risks should include bleeding, infection and blood clots, although these are extremely rare. Side effects do occur and this can include bruising, swelling and tenderness over the treated vein. These side effects generally resolve over a few days to weeks. Benefits include relief of painful varicose veins, leg cramps, swelling, and fatigue. Discuss these risks thoroughly with your treating physician.
Potential risks: bleeding, infection, skin burn, blood clot, nerve damage and darkening of the skin. All of these risks are less than 1%.
Potential benefits: improve the aching feeling.
I would never recommend having the VNUS the procedure done on a normal vein (your right leg). If the symptoms in your problematic leg are minimal (no swelling, skin changes, or varicose veins), I probably wouldn't recommend the procedure. The exception would be if there is a patch of spider veins along the course of the abnormal refluxing vein(s).
Reflux of 0.66 seconds is minimal and well below my threshold for endovenous ablation. Although insurance companies have followed Medicare's recommendations of 0.5 sec as the threshold, in my extensive experience this is set way too low. We measure out beyond 10 seconds and usually find our
patients who do best are those with insufficiency of greater than 3-5 seconds and significant symptoms of venous insufficiency (daily leg cramps at night, leg swelling, heaviness and achiness) which adversely affect their day-to-day quality of life. Of course, signs of advanced venous disease include skin discoloration in the ankle area, impending bleeding, ulceration or active bleeding, even in the absence of pain. These are excellent indications for endovenous ablation. Consider more research. Try compression hose and see if your legs feel much different with than without hose. If you do not notice improvement of your legs with hose, you will likely not notice much difference after a closure. Spider veins in the ankle area and distal leg are also signs of venous insufficiency, but in my practice are not enough of an indication to justify endovenous ablation.
First of all, you have minimum reflux since .50 is normal. Closure procedures, either VNUS or laser, seal the leaking valves to improve the venous return. This reduces the backflow of blood into varicose veins. Either procedure should also help with leg symptoms such as aching, heaviness, cramping and even restless legs. If you do not have varicose veins, I am not sure how much the reflux is contributing to your symptoms. The risks of venous closure are minimum, but there is some post-procedure pain, swelling and even numbness. There are other risks, such as deep vein thrombosis (DVT), but they are very infrequent.
.66 sec is not at all significant reflux. If there's no pain or swelling, then the VNUS closure procedure is not needed. Sclerotherapy can treat spider veins and may be all that's needed.