I have seen two vascular surgeons. Both said that my varicose veins have been scarred due to old clots and that EVLT or VNUS closure may not be possible. One suggested ligation, while the other recommended compression hose and possible sclerotherapy. These options would be on the table if my condition has not changed by the next appointment. What is best?
If you have deeper varicose vein disease, sclerotherapy may not be recommended. Using compression stockings may relieve your symptom temporally.
Published on Jul 11, 2012
First, find an interventional radiologist (IR) in your area to consult with. I would start there for another opinion. IRs are the best doctors for these types of procedures. There is usually always a way to help relieve the pain.
Published on Jul 11, 2012
Foam sclerotherapy may be an option since ligation is not usually a good option in most circumstances.
Published on Jul 11, 2012
It sounds like ultrasound-guided foam sclerotherapy would be your best option. Some practitioners are not comfortable or skilled with this procedure but in the right hands, ultrasound-guided foam sclerotherapy can adequately treat (eliminate) any problem vein. There is no cause for vein stripping or ligation on any patient in my opinion. All problem veins can be dealt with without traditional surgery.
Published on Jul 11, 2012
EVLT can be attempted, as it is more effective than sclerotherapy. Obviously, being able to "navigate" up the vein is essential. Occasionally, additional access sites are needed to skip over scarred areas. A ligation may not be as effective if the rest of the vein remains in place. Compression hose are intended to be only temporary, unless the deep veins have been damaged. Tributary veins should be treated with sclerofoam or phlebectomy if pathologic reflux is present.
Published on Jul 11, 2012
If your varicose veins are due to underlying saphenous insufficiency, the appropriate treatment is laser ablation of that vein. If the clots were in the varicose veins (which are more superficial) and these have resolved, I would recommend microphlebectomy under local anesthetic (the veins are remove through tiny punctures). Injection of these involves multiple visits, whereas phlebectomy is a one treatment visit. If your saphenous vein is scarred due to an old clot, I would not ligate. Instead, I would go to the highest straight area in the thigh and do an ablation.
Published on Jul 11, 2012
Sclerotherapy would be my recommendation.
Published on Jul 11, 2012
Closure procedures don't treat the varicose veins directly, but rather the leaking valves in the saphenous veins that are feeding the varicose veins. If your valves are the problem, then they need to be closed either by laser closure (preferred) or sclerotherapy. Next, the varicose veins can be treated by either microphlebectomies or sclerotherapy. If the saphenous vein is severely scarred, then ligation and stripping may be an option. However, the latter procedures are done very infrequently. Due to advancements, I have not had to do ligation and stripping in over 13 years.
Published on Jul 11, 2012
Try sclerotherapy first.
Published on Jul 11, 2012
It is hard to make a recommendation without more information, but it is fair to say that sclerotherapy could be your best option. The procedure can provide a good deal of relief as far as symptoms are concerned.
Published on Jul 11, 2012
I have yet to see a patient who is not a candidate for a minimally invasive procedure. Sometimes, patients are not suited for an ablation procedure; however, microphlebectomy is always an option if there are varicose veins present. Sclerotherapy is an acceptable alternative to microphlebectomy. Ligation is no longer considered a helpful procedure.
Published on Jul 11, 2012
Either option may be possible. It depends on if you can thread an ablation catheter in the vein. Otherwise, foam sclerotherapy may be the best alternative.
Published on Jul 11, 2012