I had EVLT and phlebectomy 6 weeks ago. My veins look worse than before the procedures. Why?

The ultrasound showed a proper closure of the vein, no blood clots. It feels ok from the groin to the knee but around the knee more veins appeared and it hurts. I do wear compression stockings every day since the procedures, but I have the same heavy throbbing feeling. The doctor said everybody heals differently and it may take more time, but offered to do sclerotherapy if I would like. Is it possible he messed up with a mini phlebectomy and now the results are worse than before?

Answers from doctors (6)


Cosmetic Vein Centers of Texas

Published on Feb 16, 2016

Spider veins show up around the knee and lower thigh after EVLT in about 10% of patients.

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Answered by Cosmetic Vein Centers of Texas

Spider veins show up around the knee and lower thigh after EVLT in about 10% of patients.

Published on Jul 11, 2012


Vein Specialties of St. Louis

Published on Feb 12, 2016

Without seeing you in person, it is difficult to assess the problem. The venous system can be complicated, and there can be many small connecting perforator veins not visible at the time of the procedure. These can, in turn, create new bulging/spider veins. Additionally, if not enough veins were removed at the site, they could also dilate. The condition you have is known as chronic venous insufficiency, and new veins are possible. You are correct to wear the compression hose. If you are concerned, you could seek a second opinion from a board-certified vascular trained surgeon who specializes in these treatments for assessment, including ultrasound. Sclerotherapy may be the option for this problem.

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Answered by Vein Specialties of St. Louis

Without seeing you in person, it is difficult to assess the problem. The venous system can be complicated, and there can be many small connecting perforator veins not visible at the time of the procedure. These can, in turn, create new bulging/spider veins. Additionally, if not enough veins were removed at the site, they could also dilate. The condition you have is known as chronic venous insufficiency, and new veins are possible. You are correct to wear the compression hose. If you are concerned, you could seek a second opinion from a board-certified vascular trained surgeon who specializes in these treatments for assessment, including ultrasound. Sclerotherapy may be the option for this problem.

Published on Jul 11, 2012


Advanced Vein Center

Published on Feb 12, 2016

If the procedure was successful, the veins should not look worse. Your legs should also feel better. So something is not right. You should probably get another opinion.

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Answered by Advanced Vein Center

If the procedure was successful, the veins should not look worse. Your legs should also feel better. So something is not right. You should probably get another opinion.

Published on Jul 11, 2012


The Sheen Vein Institute

Published on Feb 12, 2016

Given that your doc did the EVLT and the phlebectomy, the reason your legs are not really better is because your doc only addressed a small part of your vein issue. You have to keep in mind that vein disease is an inherited disorder; it can affect anything from head to toe. So, in the legs, your doc treated probably a yard of vein structure, whereby you probably have over 50 yards of abnormal vein structure. The EVLT and phlebectomy is only the beginning of the treatment that most people require. The remaining 49 yards should be addressed. Only then can you feel the full benefit of the treatment because since vein disease is primarily a circulatory defect, you will not see a dramatic improvement in the way your legs feel until more of the circulatory issues are addressed. Now, the reason you are seeing more around your knee is because when you close vein branches down, you force the blood that was in them to redirect. In your case, they went to some of the veins in and around your knee, which just happens to be defective as well. Thus, the new visible veins. If you want your legs to feel good, you need to fix the entire leg. It does not appear that your doc knows how to do this. I would recommend you see an experienced, board-certified vascular surgeon.

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Answered by The Sheen Vein Institute

Given that your doc did the EVLT and the phlebectomy, the reason your legs are not really better is because your doc only addressed a small part of your vein issue. You have to keep in mind that vein disease is an inherited disorder; it can affect anything from head to toe. So, in the legs, your doc treated probably a yard of vein structure, whereby you probably have over 50 yards of abnormal vein structure. The EVLT and phlebectomy is only the beginning of the treatment that most people require. The remaining 49 yards should be addressed. Only then can you feel the full benefit of the treatment because since vein disease is primarily a circulatory defect, you will not see a dramatic improvement in the way your legs feel until more of the circulatory issues are addressed. Now, the reason you are seeing more around your knee is because when you close vein branches down, you force the blood that was in them to redirect. In your case, they went to some of the veins in and around your knee, which just happens to be defective as well. Thus, the new visible veins. If you want your legs to feel good, you need to fix the entire leg. It does not appear that your doc knows how to do this. I would recommend you see an experienced, board-certified vascular surgeon.

Published on Jul 11, 2012


Vanish Vein and Laser Center

Published on Feb 12, 2016

Sometimes new veins will form following a closure or microphlebectomy procedure. This is called neovascularization. Often times, there is a reason for this, such as a valve that failed to close or a feeding vein into the new veins. An ultrasound can specifically look for a feeding vein and determine whether one exists. If not, sclerotherapy and/or microphlebectomies should resolve the problem. It also may take months to heal from your procedure.

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Answered by Vanish Vein and Laser Center

Sometimes new veins will form following a closure or microphlebectomy procedure. This is called neovascularization. Often times, there is a reason for this, such as a valve that failed to close or a feeding vein into the new veins. An ultrasound can specifically look for a feeding vein and determine whether one exists. If not, sclerotherapy and/or microphlebectomies should resolve the problem. It also may take months to heal from your procedure.

Published on Jul 11, 2012


Susan B Fox, D.O. RPVI, FSVM

Published on Feb 12, 2016

You may need an ultrasound to see if there is insufficiency still present in the veins below the incision or in an incompetent vein. This could be the problem, or when the vein was closed it rerouted down other veins that are becoming more prominent, or your body could be producing new veins. Hard to say. I would get a new ultrasound to see if there is any insufficiency and have him/her do sclerotherapy on those veins. That should help

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Answered by Susan B Fox, D.O. RPVI, FSVM

You may need an ultrasound to see if there is insufficiency still present in the veins below the incision or in an incompetent vein. This could be the problem, or when the vein was closed it rerouted down other veins that are becoming more prominent, or your body could be producing new veins. Hard to say. I would get a new ultrasound to see if there is any insufficiency and have him/her do sclerotherapy on those veins. That should help

Published on Jul 11, 2012


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