Why are my veins still huge after EVLT?

I had EVLT in April of this year. I still have huge varicose veins. They are not painful anymore but I was under the impression my legs would look better cosmetically.

Answers from doctors (5)


Orange County Vein Care

Published on Mar 12, 2019

Endovenous laser therapy (EVLT) is aimed at closing underlying venous insufficiency in the superficial truncal veins of the legs (GSV, SSV, and in some AASV). In this way, EVLT takes care of the source of the problematic varicose veins and symptoms. Most will need an additional procedure to either remove the varicose vein surgically (phlebectomy) or inject it with a sclerotherapy solution. Very few will not need this, especially if varicose veins drain directly in the course of the occluded vein treated by EVLT.

If your treating physician does not offer any other options, it's best to look for another clinic who can comprehensively treat you. Good luck!

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Answered by Orange County Vein Care

Endovenous laser therapy (EVLT) is aimed at closing underlying venous insufficiency in the superficial truncal veins of the legs (GSV, SSV, and in some AASV). In this way, EVLT takes care of the source of the problematic varicose veins and symptoms. Most will need an additional procedure to either remove the varicose vein surgically (phlebectomy) or inject it with a sclerotherapy solution. Very few will not need this, especially if varicose veins drain directly in the course of the occluded vein treated by EVLT.

If your treating physician does not offer any other options, it's best to look for another clinic who can comprehensively treat you. Good luck!

Published on Jul 11, 2012


Center for Advanced Vein Care

Published on Sep 19, 2018

An important misunderstanding in health care—by patients, some doctors, and insurance companies—is that EVLA is really just a 'partial treatment'. When I say that, what I mean is that it treats ONE of the broken or poorly functioning veins (at a time), but doesn't treat the whole issue.

EVLA treats veins that are straight enough for the laser fiber to go through, so it's not effective for the majority of the twisty/turning veins that you may see on the skin surface.

The straight larger veins for which EVLA is used are 'buried under the surface' of your skin. You generally can't see them, but they are connected to the veins on the surface. Think of a big tree branch and how it is connected to smaller ones, where the leaves are.

Treating that bigger, buried vein with EVLA often significantly helps the symptoms of poorly functioning veins. It CAN decrease the size—and therefore the appearance—of the veins you see on the surface of the skin. But the veins on the surface are NOT treated, specifically, by EVLA.

Since insurance companies concentrate on medical necessity, if your symptoms related to broken veins resolves with EVLA, they won't cover the 'stuff' you see. That's the reality. Even though the veins on the surface may still cause a lot of problems, the insurance companies require that you meet their criteria for medical necessity in order for them to pay for your treatment.

The fact is, you can have improvement of the cosmetic appearance by EVLA alone, sometimes. But there are many other options that can be used to improve both the cosmetic appearance and further the health of your veins. Your insurance may not cover it, so you would have to be willing to pay out-of-pocket for those treatments.

Importantly, though, if the vein treated by EVLA was not treated first, most of the cosmetic stuff won't go away or would come back. So EVLA plays an important role in health and appearance of your veins.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/8667_1532726377.jpg
Answered by Center for Advanced Vein Care

An important misunderstanding in health care—by patients, some doctors, and insurance companies—is that EVLA is really just a 'partial treatment'. When I say that, what I mean is that it treats ONE of the broken or poorly functioning veins (at a time), but doesn't treat the whole issue.

EVLA treats veins that are straight enough for the laser fiber to go through, so it's not effective for the majority of the twisty/turning veins that you may see on the skin surface.

The straight larger veins for which EVLA is used are 'buried under the surface' of your skin. You generally can't see them, but they are connected to the veins on the surface. Think of a big tree branch and how it is connected to smaller ones, where the leaves are.

Treating that bigger, buried vein with EVLA often significantly helps the symptoms of poorly functioning veins. It CAN decrease the size—and therefore the appearance—of the veins you see on the surface of the skin. But the veins on the surface are NOT treated, specifically, by EVLA.

Since insurance companies concentrate on medical necessity, if your symptoms related to broken veins resolves with EVLA, they won't cover the 'stuff' you see. That's the reality. Even though the veins on the surface may still cause a lot of problems, the insurance companies require that you meet their criteria for medical necessity in order for them to pay for your treatment.

The fact is, you can have improvement of the cosmetic appearance by EVLA alone, sometimes. But there are many other options that can be used to improve both the cosmetic appearance and further the health of your veins. Your insurance may not cover it, so you would have to be willing to pay out-of-pocket for those treatments.

Importantly, though, if the vein treated by EVLA was not treated first, most of the cosmetic stuff won't go away or would come back. So EVLA plays an important role in health and appearance of your veins.

Published on Jul 11, 2012


Vein Specialties of St. Louis

Published on Sep 10, 2018

Many non-surgeons do not remove the bulging varicose veins at the time of the EVLT. This procedure is called microphlebectomy. As a vascular-trained surgeon, I will remove many of these at the same time, all under local anesthetic as it reduces the risk of superficial clotting, skin staining and, of course, appearance.

Insurance will typically cover this at the same time. There is no need to go to a surgery center, have conscious sedation, and increased risks, etc.

At this stage, your insurance may cover this procedure but without symptoms, it may be considered cosmetic. If considered cosmetic, insurance will not cover it.

All said, I do not recommend injecting these large varicose veins.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/623_1499902138.jpg
Answered by Vein Specialties of St. Louis

Many non-surgeons do not remove the bulging varicose veins at the time of the EVLT. This procedure is called microphlebectomy. As a vascular-trained surgeon, I will remove many of these at the same time, all under local anesthetic as it reduces the risk of superficial clotting, skin staining and, of course, appearance.

Insurance will typically cover this at the same time. There is no need to go to a surgery center, have conscious sedation, and increased risks, etc.

At this stage, your insurance may cover this procedure but without symptoms, it may be considered cosmetic. If considered cosmetic, insurance will not cover it.

All said, I do not recommend injecting these large varicose veins.

Published on Jul 11, 2012


More About Doctor Laser Vein Center

Published on Sep 10, 2018

The reason you still have large varicose veins is that your treatment is incomplete. EVLT closes the saphenous vein but it only closes a small percentage of branch varicose veins. To close the larger branches, you need either a phlebectomy or foam sclerotherapy.

Answered by Laser Vein Center (View Profile)

The reason you still have large varicose veins is that your treatment is incomplete. EVLT closes the saphenous vein but it only closes a small percentage of branch varicose veins. To close the larger branches, you need either a phlebectomy or foam sclerotherapy.

Published on Jul 11, 2012


Vanish Vein and Laser Center

Published on Sep 10, 2018

A closure procedure seals the leaking (refluxing) valves of the veins feeding the varicose veins, but does not treat the varicose veins. The varicose veins may decrease in size following a closure but the majority will not. These varicose veins will need a separate procedure such as microphlebectomies or foam sclerotherapy to eradicate them.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/1053_1499982262.jpg
Answered by Vanish Vein and Laser Center

A closure procedure seals the leaking (refluxing) valves of the veins feeding the varicose veins, but does not treat the varicose veins. The varicose veins may decrease in size following a closure but the majority will not. These varicose veins will need a separate procedure such as microphlebectomies or foam sclerotherapy to eradicate them.

Published on Jul 11, 2012


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