My wife has had multiple ultrasounds. One ultrasound tech found a bad perforator at 5mm, but they wanted to do open surgery. Another ultrasound tech from the Dr she wanted to use who does laser and RF could not find the perorator. What to do?
Go with whomever is most reputable and trustworthy. There are many doctors out there who learn to do these from a rep who knocks on their door, then hangs a sign calling themselves a vein center. Do your due diligence and research the physician, his background and the clinic before signing up for a procedure. Real customer reviews/feedback are also something to consider. Also, trust your gut. Don't just shop for the answer you may want to hear?.
Published on Jul 11, 2012
Perforators can be difficult to treat. Laser is a good option, as well as sclerotherapy and/or ligation. Your vein doctor would be your best option to discuss your unique situation.
Published on Jul 11, 2012
Was there any other bad varices found on the ultrasound? Sometimes if there are just perforator veins that are bad but are not causing symptoms like pain or skin discoloration then they are left alone. Typically, sclerotherapy injections can be done, or a laser ablation can be done. I don't know why an open surgery was suggested, that is completely unnecessary. Make sure the clinic you go to has physicians that are accredited by the American College of Phlebology.
Published on Jul 11, 2012
That is the problem when the ultrasounds are done by techs and not by doctors. In my office, I am the one doing the ultrasound for EVERY patient. This is done so that we do not have discrepancies.
Published on Jul 11, 2012
Do some research and find out who the vascular surgeons are in the area. They should have a reputable vascular lab. Get the Doppler ultrasound done there.
Published on Jul 11, 2012
It is certainly frustrating when there are discrepancies from different ultrasound reports on the same leg. Here are several factors to consider. The body position you were in when tested for reflux is important. Menstrual cycles can affect the size and function of superficial veins. Reflux (incompetence) as well as vein dilatation can be more easily
found around the time of menstrual periods and may be hard to demonstrate otherwise. Thus, repeating the ultrasound around menses may help.Recent strenuous exercise can affect ultrasound findings along with ambient temperature. Heat exposure and hard exercise both can unmask otherwise equivocal reflux. Duplex ultrasound is extremely operator-
dependent, which means findings will vary widely accordingly to the skill level of the sonographer. Getting a third and final ultrasound at an impartial facility considering the above factors sounds like a good plan.
Published on Jul 11, 2012
Unfortunately, I don't have a great answer for you. Was either ultrasound done in their morning versus afternoon? Later in the day reflux usually shows more if she was on her feet earlier in the day. It's not a perfect test and some ultrasound techs are better than others. That being said, if she does have a refluxing perforator I would strongly recommend RF versus open surgery. We have done many perforator RFs in our office and they all have remained closed with no recovery time.
Published on Jul 11, 2012
An isolated perforating vein is rarely an indication for surgery unless the saphenous system is normal or has been previously treated and there must be symptoms due to the abnormal vein. The presence of an abnormal perforator without symptoms is not an indication to fix this. You should see a vein specialist who either does the ultrasound or has a certified RVT doing the sonogram. The position of the patient (lying or standing) when performing the test may also affect the appearance of the veins.
Published on Jul 11, 2012