My father has ulcers on his legs. He has had several over the past years that are very difficult to heal. His legs are brown in color and very swollen. The doctor wants to do Endovenous Laser Ablation (ELA) on him. My father takes coumadin and has a pacemaker. Do you recommend the ELA treatment at his age and condition?
I probably would discourage using any surgery on this patient. Compression stockings or other compression devices can be used to replace the surgery and not require stopping the coumadin, which is necessary for the pacemaker.
Published on Jul 11, 2012
The procedure is safe for a patient even at that age. The fact that he takes warfarin/coumadin and/or has a pacemaker is not a contraindication. I have done similar procedures in several octogenarians and nonagenarians with similar or worse co-morbidities with very good results.
Published on Jul 11, 2012
Congrats on your father being 92 years young. In our office we use radio frequency vs. laser - Less bruising, pain and recovery time. The end result is about the same. If your father is still active and can walk and get around, there is no reason not to proceed. We take care of patients his age and older, and it is safe with a pacemaker and on Coumadin, we just have the blood level check prior to procedure day. The treatment should help with the ulcers healing.
Published on Jul 11, 2012
We do this procedure in the office using local anesthetic and the total time from into the room and out the door is less than 1 hour and afterwards, our patients go to the mall nearby and walk for an hour before going home. We treat people on coumadin. So, I have treated people like your father. The decision to treat depends on what the ultrasound shows. In some cases, we inject sclerosant into the veins around the ulcer as the first treatment.
Published on Jul 11, 2012
Can't recommend either way, but it is a very safe treatment and may very well allow for quick healing of his ulcers if he has bad superficial venous reflux.
Published on Jul 11, 2012
Yes, vein ablation is safe for all ages, but the clinic that he will go to will make sure during his consultation. If there are open ulcers, then treatment would probably be best.
Published on Jul 11, 2012
The ELA procedure is a very safe procedure and the most significant complication would be prevented by the coumadin. So, the risk of the procedure would be small in your father even at his advanced age.
Published on Jul 11, 2012
Whether a person is a candidate for the Endovenous laser ablation procedure, depends on the person's activity level. That being said, if your father, even at 92 years old, is very active, he is a candidate despite his coumadin and pacer. If he is limited in his activity for whatever reason, I would be a little more cautious in subjecting him to the treatment.
Published on Jul 11, 2012
As long as your father is active and can walk, his age should not be a deterrent. Once a person develops ulcers, treating the underlying cause (the venous disease), is the optimal way to heal the ulcer and prevent recurrence. ELA can be performed safely on patients taking coumadin and those with pacemakers.
Published on Jul 11, 2012
This decision can only be made by the patient , their cardiologist, vein physician, and other physicians familiar with every aspect of their medical condition.
Published on Jul 11, 2012
We would only perform Endovenous Ablation on someone who is able to be active and walking after the procedure. I have performed this procedure effectively on several 80-88 years olds, but they were very active (bowling, dancing, etc). Coumadin isn't a contraindication for this procedure and I do not have patients stop taking it before the procedure. I would not perform microphlebectomies at the same setting to remove large varicose veins. You would have to review the pacemaker with his cardiologist first, but I do perform this on patients with pacemakers and cardiology clearance. I, personally, would not perform this procedure unless your father is physically active.
Published on Jul 11, 2012
I do recommend EVLT if it is done under local and tumescent anesthesia. Neither his age, coumadin or a pacemaker is a contraindication to the procedure. I would recommend that it be done by someone who has experience in doing EVLT. If your dad is a reasonable surgical candidate and if general anesthesia is NOT used then he should tolerate the procedure well.
Published on Jul 11, 2012
If incompetence of the saphenous veins is demonstrated to be a major factor in development of the leg ulcers, endovenous thermal ablation is a safe and effective technique even in a 92 year old patient. There usually is no reason to stop the Coumadin and the pacemaker does not prevent the procedure.
Published on Jul 11, 2012
Quite safe.
Published on Jul 11, 2012
I think the overall risk from complications of his untreated ulcers far outweighs the risk of the ablation. That is assuming that he is mobile and can walk post procedure. I would continue the Coumadin throughout treatment to minimizes his DVT risk.
Published on Jul 11, 2012