I have had had one EVLT surgery done and it did not seem to help much. It actually seemed to worsen the situation because a new varicose vein emerged directly over my knee cap which is very painful. I have lots of spider veins on my foot and ankle area....I read that there is a limit to the amount of times a doctor can do sclerotherapy. My fear is that If I go ahead now and clear up my ankle and foot that it may all come back my last pregnancy and then they will not be able to repair it. Advice?
I Get Vericose Veins from Pregnancies. Should I Wait to Repair Veins Until I Am All Done Having Children?
Doctor Answers (8)
Varicose Veins and Pregnancy - Treat Them or Wait?
There is no real limit to the amount of times an individual can undergo sclerotherapy for lower extremity veins. Typically optimal results require anywhere from 2 to 4 sessions spaced about 4 to 6 weeks apart. I recommend individuals undergo treatments in the fall and winter to get their legs ready for short and bathing-suit seasons (spring and summer). It is likely that you will develop new veins with each pregnancy, and whether you wish to treat them as they develop or wait until you are dong having children is really up to you. That being said, I think it is always advantageous to treat them sooner than later and so I would recommend you not wait. Click on the link below for a demonstration video of how we perform sclerotherapy in our practice.
Sclerotherapy can be done as many times as needed.
You don't have to worry, sclerotherapy can be done as many times as needed to clear to spider veins. Usually 3-5 sessions are average to clear spider veins @ $450/session. It is true that you may gain some new varicosities with each pregnancy but having had previous sclero won't be a problem. Just do sclero after each pregnancy to keep those great looking legs. Sincerely,
Get venous evaluation.
Since you have already had one EVLT with a recurrence of veins at the knee, I would recommend having a venous reflux ultrasound done before your next pregnancy. If you have reflux that has caused the painful recurrence, this should be treated. The ultrasound will also show the status of the valves in the opposite leg which will give some info on your chances of developing veins in that leg. If you have reflux in the leg that you had EVLT, I would treat the reflux and the varicose and spider veins before a new pregnancy since they will most llikely worsen during the pregnancy realizing that there still is a chance of new veins forming with a pregnancy. Also, there is no limit as to how many times you can have sclerotherapy.
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Perforator Venous Reflux Disease
Although you had EVLT of the great or lesser saphenous veins, there may be other sources of venous insufficiency contributing to the development of spider and reticular veins around the ankles, also known as corona phlebectasia - i.e. a fan shaped pattern of small intradermal veins on the medial (inside) or lateral (outside) aspect of the ankle and foot is called corona phlebectatica. Corona implies that they "crown" the ankle. A Board Certified phlebologist (vein specialist) can do special Doppler studies to look for and treat these with foam sclerotherapy or perforator vein EVLT procedures. Otherwise, they will recur and you will need repeated injections
Varicose veins and pregnancy
Varicose veins can also stem from perforator veins (veins that connect your deeper venous system to the superficial system you can actually see). So although you had a EVLT of your great saphenous vein (most commonly), it may not prevent others reticular and varicose veins from developing. The best way to know is to get an ultrasound. You can then have sclerotherapy of the remaining vessels if necessary. Pregnancy can make varicose veins worse, so treating them prior to getting pregnant may help prevent them from worsening from what they are now. Good luck.
Treat varicose veins before your next pregnancy
Varicose and other veins which occur during pregnancy tend to go away or at least become smaller within 2 months of delivery. Those veins that remain after 2 months will become worse with the next pregnancy and lead to the development of even more veins. I therefore recommend treating leg veins BEFORE pregnancy. Treating veins before they are made worse will PREVENT new veins from arising as well as make the pregnancy go more smoothly. Why have aching legs during pregnancy when they can feel great if they are treated before.
Pregnancy and veins
If you are prone to veins - reticular, spider, and/or varicose - these will commonly all worsen during pregnancy. Some may resolve post pregnancy, and new ones may develop or worsen if untreated and you get pregnant again. Quite frankly it's up to you when you decide to treat them. EVLT doesn't make your leg veins worse and the new vein you got probably would have developed whether or not you did the EVLT. Some people are frankly, just more prone to getting veins. There is no limit to the number of sclerotherapy sessions you may undergo in your lifetime, so you can do those treatments as many times as you'd like for the smaller veins. For the larger veins, I might suggest you consider having them resolved post pregnancy just because sometimes if the vein is large, you can get a clot there, especially if your delivery is traumatic--not a clot that will harm you - but a large, bulbous clot that hurts and will have to be resolved at some point.
Misconception about varicose veins and Pregnancy
It is commonly thought that a patient should wait until all children are borne before proceeding with treatment for venous insufficiency, commonly presenting as varicose veins. In fact, addressing the "venous reflux" will make symptoms more tolerable during pregnancy when the uterus enlarges, compresses the veins and causes valve dysfunction.
Many different pathways of relux are present in our venous sytems so it is not surprising that a new vein popped up after EVLT. There are other places where the vein can be sealed to prevent this from happening. Unless most of the superficial "reflux" has been addressed (sometimes meaning more than one procedure), the spider veins will keep recurring.