You have multiple complicated problems involving both deep and superficial veins and artery. You should not undergo any surgery on superficial veins (EVLT). I would only consider conservative therapy such as compression hose and treatment at a wound center.

Published on Jul 11, 2012

You are a perfect candidate for venous evaluation. EVLT maybe part of the solution but from the severity of your symptoms I suspect there may be additional venous blockages. You need a full evaluation by an experienced vascular interventional radiologist. Complications of EVLT are extremely rare when performed by formally trained physicians in venous interventions. So things should only get better by proper care.

Bulent Arslan, MD, FSIR
Vascular/Interventional
Rush University Medical Center
Office 312-563-3105
Email: [email protected]

Published on Jul 11, 2012

If your left femoral vein is small from prior thrombotic event you may need your Great Saphenous vein for collateral venous drainage. If you're not already doing so, consider therapy with compression stockings, leg elevation, ankle pumping, weight loss and appropriate anticoagulation. Targeted laser closure may be appropriate depending on your venous ultrasound findings.

Published on Jul 11, 2012

The worst possible outcome is you can develop a clot and it claims your life. If you are hypercoaguable, maybe this is not the best procedure for you. I would discuss with your physician the risks, benefits and alternatives of the various procedures

Published on Jul 11, 2012

This is a very challenging question. You have post thrombotic syndrome and non-healing venous leg ulcers. It is possible to have treatment on anticoagulation with a goal of potentially healing your venous leg ulcers.

You should stay on adequate anticoagulation, and consider treatment only after ultrasound shows adequate outflow for your deep venous system. In some instances, we have seen ongoing deep vein obstruction and artificial reflux in the superficial system due to a siphon effect.

In these cases, the limb is using the saphenous system for primary venous return to the groin. Treatment of the great saphenous vein may make your condition worse if you have poor outflow.

I'd suggest given this scenario, you need multiple expert opinions to help guide whether you are a candidate for treatment at all. This includes making sure your ultrasound is performed by a credentialed sonographer and a dedicated center familiar with managing the spectrum of vein disease and leg ulcers.

The ulcers may me vein related or lymphatic, and the worst case scenario could mean potential for limb loss. Our advice, don't rush into treatment. Get educated on your options and make sure you are wearing properly fitted compression of appropriate strength daily.

Published on Jul 11, 2012