Trying to decide if I should proceed with EVLT and microphlebectomy?

Question

I am in my early 40s and am scheduled for EVLT and microphlebectomy on one leg with a reputable surgeon. I am however having second thoughts as I am concerned about chronic pain and discoloration. I am not bothered by my veins symptomatically right now (other than the cosmetic appearance) so I don't want to cause problems unnecessarily but I am also concerned about worsening of my venous disease given my strong family history. Is prolonged pain (weeks to months after procedure) common?

Tif Siragusa, MD · Answer

If you experience any swelling in your legs as well as bulging veins, the first line of treatment is daily use of 20-30 mmHg compression stockings.  This usually will help slow down the progression of the problem but usually does not make it go away.  The risks for EVLT and phlebectomy should be extremely low.  A lot of patients become a little nervous when they read about the potential complications.  Remember, we are required to list every problem that has ever occurred on the consent form, even if an individual doctor has never had that complication.  I'd speak with your doctor about what he has noticed to be the chances of developing any complications and I think you'll feel much better once you do.

Andres Zavala, DO · Answer

Treating varicose veins and underlying venous insufficiency sooner rather than later can help lessen risk of complications of advanced disease including increased risk of blood clots, venous ulcers and chronic skin changes that are not reversible. At times I have had patients that say "I have no pain" or "my legs feel fine" and proceed with treatment for "cosmetic purposes", only to find out after treatment that their legs "feel much better, lighter, have more energy" etc...  The symptoms are insidious and rarely happen overnight, so there are many that simply get used to the way their legs feel and assume discomfort or pain later in the day is normal. There are of course some patients that truly don't have symptoms, but in many cases these will develop later if left untreated. While treatment is certainly optional, I believe that treatment is often the best course of action; especially in someone that already has bulging varicosities or leg swelling.
 Pain after the procedure is usually very manageable and rarely last more than 1 to 2 weeks and in many patients only a couple to a few days. Just make sure you are being treated by a vein specialist with experience and discuss your concerns.

Richard J. Grisoli, MD · Answer

If you are having symptoms and have significant venous insufficiency, then I highly recommend the EVLT procedure. This will likely prevent you from developing a venous stasis ulcer on your leg down the line. When performed by an experienced physician, it is very safe and almost always effective.

Megan Deacon-Casey, MD · Answer

Getting venous insufficiency treated via an EVLT will not cause any long-term side effects, the procedure is done under local anesthesia right in the physician's office and you are up and around immediately after. Many of our patients come before work or even during their lunch break. Also, patients tolerate the procedure so well with very minimal pain. 
Venous insufficiency is hereditary and it tends to progress if left untreated, you may be asymptomatic right now, however you mentioned the need for a phlebectomy which means you have varicose veins that are bulging and those tend to get larger and bulge ever more with time.

Albert Malvehy, MD · Answer

"Why didn't I do this sooner?" This is the question I hear from almost all my patients after their treatment. People are afraid of the unknown, of the potential pain, of the cost, or they think it's just cosmetic; so they suffer and things just get worse. Get your problem fixed by someone you trust. You will be much happier.

Craig Schwartz, DO · Answer

The most important thing is to make sure you are being treated by a reputable, experienced vein specialist. As long as this is the case you should be fine. For many years, varicose veins were just considered cosmetic, but we know now that left untreated, venous insufficiency with reflux (the underlying cause of the varicose veins), can lead to long term complications, which is why it is now considered medically necessary. The EVLT procedure, performed in experienced hands, is very straightforward, done in the office setting under local anesthesia, and is associated with minimal downtime and very little discomfort, typically requiring nothing more than NSAID's post-op. Discoloration is exceptionally rare, and usually only occurs if the vein is very superficial. Understand that this disease process will never get better, and can only get worse over time, so it is best to treat well before potential complications set in.

Susan Fox, DO, RPVI · Answer

First off no physician can make something better that is not bothering you.  If you are treating it for cosmetic purposes that is one thing.  I would tell you vein treatments are not emergent usually.  IF it is not bothering you at the moment the continue with conservative therapy: taking Vasculera, elevating your legs, NSAIDS and compression hose.  Then, if this stops working, consider EVLA.  Most of our patients have amazing results with EVLA.  They do not have discoloration afterwards unless the vein is very superficial.  They do not have prolonged pain.  This is very rare in our office.  In our office around 50 % have no pain, 45% have 2-4 on a scale of 1-10 of pain and 5 % have more significant pain.  Most of the time people are pain free in a few days even if they do have discomfort.  Please talk to your physician about your concerns and see what they recommend.  You want to be sure that they are using a 1470 or similar laser.  Older generation lasers hurt much more.

Marcus A. Jimenez, MD, FACS · Answer

If you are being treated by a reputable surgeon who has a large experience with vein disease, I am sure they told you that there is no physiologic reason to have your veins treated in the absence of symptoms. That being said, if you would like to improve the look of your legs, it is a procedure that can be done with extremely low risk of long term complications. Usually a 20-30 minute procedure done with local anesthetic in an office setting. From a statistical standpoint, the drive to the facility is much riskier than the procedure itself in the right hands.

Ivan Brooks, MD · Answer

Prolonged pain is not common . It can last 1 month , occasionally can last up to serval months of tenderness. Without  documented reflux on ultrasound, I would hold off on EVLT treatment or closure .

Ramtin Massoudi, MD - Account Suspended · Answer

Hi Dear
If you are diagnosed with ultrasound that you have venous insufficiency and you have bulging veins. I recommend therapy at least compression stocking. There is couple of other things except pain and discomfort with venous insufficiency: 1. Deep Venous Hypertension (DVT), 2. Pulmonary Embolism (PE) 3. Venous Eczema and ulcer
These are some of the things might happen if you don't treat.
One of the most common symptoms after the procedure is pulling sensation, which you can prevent that by stretching exercises.
The other important factor during procedure is enough tumescent anesthesia so you don't have pain during and after procedure.
Thank you for your question
Sincerely, 
Ramtin Massoudi, MD

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