Is sclerotherapy absolutely necessary after EVLA?

The ablation procedure address is the underlying circulation disorder that causes Venus insufficiency. Sometimes patients also have associated visible varicose veins or spider veins. The ablation procedure should alleviate any symptoms that you may have had including swelling, aching, pain, and discomfort. If your symptoms are better and your leg feels good and you do not have any visible veins that you would like addressed, there is no indication for further therapy.

Sclerotherapy after EVLA is usually optional for veins that remain after the laser vein procedure.  When the veins are small sclerotherapy can help  the cosmetic appearance of the legs.  In some studies up to 80 percent of patients with spider veins have symptoms.  This can range from itching to aching burning, rushing etc.  If you have any of thees symptoms, the sclerotherapy may help with this as well. 

Sclerotherapy is usually done for spider veins or to treat varicose veins.  If you do not have varicose veins then it seems that the sclerotherapy would be done for spider veins and this is considered a cosmetic procedure.  If you do not want to treat spider veins then there should be no reason to have sclerotherapy.

Sclerotherapy is not necessary after EVLA.  If it is not being done for cosmetic reasons and there are no symptomatic surface veins then it is fine not to have the sclerotherapy.

After medically treating reflux with EVLA or RFA, guided ultrasound sclerotherapy or phlebectomy are options to consider if there is remaining reflux in tributary veins and if symptoms are present. Otherwise, sclerotherapy treatment can be done cosmetically as an option to treat spider veins. After cosmetic sclerotherapy, use sun protection and wear compression stockings for a week. Hyperpigmentation and or matting might occur and it is a temporary side effect. Your physician can also advise you on how to treat this temporary side effect of sclerotherapy. 
All the best, 

Sclerotherapy is necessary for cosmetic apearance and occasionaly for closure of larger , tributary veins. 

Sclerotherapy is not necessary after an ablation.  It can often improve cosmetic results but often is not medically necessary.  If you have no bulging veins and if you are not symptomatic then no further treatment is needed.  Chronic venous insufficiency is a chronic disorder and you are likely to need further treatments at some time in your life but if you are asymptomatic, there is no need to have further procedures done at this time.  At times it can be tempting to treat the pathology on the ultrasound but physicians need to remember to treat the patient, not the ultrasound findings and I have found that by waiting, many times veins that initially were dilated and incompetent on an initial ultrasound exam will shrink back to normal size and regain normal function once the more proximal reflux has been treated with an ablation.  If you have no bulging veins and no symptoms, I would leave it be or seek a second opinion before treating.  I will never discourage my patients from getting a second opinion.