My dr said they'll only do 1 vein per day and an ultrasound after each visit. Does this make any sense? Thank you!

Getting 5 veins done, believe it's evlt (not 100% sure). I was told they'd do one vein each day and an ultrasound on another day after the procedure. So a total of 10 visits on 10 different days. It just seems a bit absurd my insurance would require this or is there any medical reasoning behind this. If I am being ripped off, does the doctor own my ultrasound results or can I take them to another doctor so I do not have to pay for more?

Doctor Answers 11

Timing of Vein Treatment by EVLT or Radiofrequency Ablation

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One of the limitations in performing vein closure by either EVLT or Radiofrequency ablation is the amount of local anesthesia that can safely be used at a single setting.  Because of the need to inject anesthetic around the entire length of the vein, a large volume may be required. 

Positioning is another issue. It is not possible to do the great saphenous vein treatment at the same time as the small saphenous vein treatment due to their location in the leg, the great being in the front and inside while the small is in the back of the calf.

Normally, the when the great saphenous vein is closed, an anterior or posterior accessory vein can also be closed. However, some insurance companies will not cover both procedures at the same time and require a time internal.

I personally have done about 1000 vein closures by radiofrequency ablation, and think that 10 vein closures seems quite high. Always good to get a second opinion if you have any questions.  See a vascular surgeon with a vein practice.


Clifton Vascular Surgeon
5.0 out of 5 stars 3 reviews

Endovenous ablation treatment one at a time

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It is safe to do 1 superficial vein at a time to prevent any complication and also to follow up with ultrasound 3 to 7 days post procedure for each endovenous ablation treatment. The reason is to evaluate patency of the deep system and closure of the vein that was treated.

Safety First

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Like with most things in medicine.  Treatment plans should be tailored to the individual patient.  While it is possible to do more than one ablation at at time, there may be reasons why doing one at a time is best in your case.  The more procedures that are done in one day, the higher the risks of clotting or other complications.  Also, you can expect to have some pain after each procedure which is generally worse the first few days, so separating the treatments can minimize some of the discomfort and ensure that you will be able to walk enough afterwards. If you are too sedentary because of too much pain resulting from multiple large veins treated on one day, your risk of clotting rises.  It is also important to do a follow up ultrasound within several days after each ablation.  Having said all this, the follow up ultrasound visits could be easily combined with the next vein to be treated, as long the follow up shows no complications there is no reason why your next ablation could not be done on that same visit.  If there are any complications,then the procedure would be cancelled.  While this may be an inconvenience for the practice, it is a reasonable accommodation for the patient.  And yes, you have the right to request your records!

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Multiple veins multiple treatments

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in a healthy individual there is no contraindication to treat more than 1 vein on the same leg.  Clot formation can be missed if ultrasound is performed too early.  I would get a second opinion as to why this decision is being used.  You do own your medical records and are entitled to get copies.  

Vein procedures

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It is most common to do one vein per day.  We often will combine some smaller or accessory veins with larger veins to expedite the procedures.  Some insurances now ask that 2 veins be done together depending on which veins they are.  Medicare wants the GSV and SSV performed on the same day.  Sometimes this is possible. Sometimes, a person's veins may spasm or their blood pressure drops from the sight of needles or blood and this becomes difficult.  I would discuss with your doctor the possibility of combining some of the procedures to help you time wise. 

Susan Fox, DO
Hollywood Phlebologist
5.0 out of 5 stars 8 reviews

Multiple veins on same day

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The common practice is to do one vein at a time and is usually followed by an ultrasound. If there is an accessory vein that needs treatment then that can be combined with GSV ablation. I have treated SSVs on both legs in one setting if needed. So overall depends on the patient and surgeon comfort level. Its hard to treat GSV  and SSV at same time but can be done. 

Ramandeep Sidhu, MD
Issaquah Vascular Surgeon
5.0 out of 5 stars 8 reviews

Multiple procedures for vein ablation

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It is common to have different veins treated on different days. There are a variety of reasons for this. An ultrasound following the procedure is also appropriate. However, 5 veins on 5 separate days seems like a bit much, without knowing all of the specific details.  In most instances, any veins beyond 4 that need to be treated are accessory veins and they can often be treated at the same setting as the other veins. It is important to remember that every case is different and your treating doctor should be willing to answer questions related to your specific case.  

Jeffrey Gosin, MD, FACS
Atlantic City Vascular Surgeon
5.0 out of 5 stars 2 reviews

EVLt

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If your veins are in both your legs then a standard practice is either to do both legs at the same time or treat one leg at a time. No need for the frequent scans every day and after each individual vein! You can have one final check scan once the treatment is completed 

Sameh Dimitri, MD
London Vascular Surgeon

Single vs Multiple Ablations in One Day

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The situation you describe is quite common as many times this is the schedule dictated by the insurance companies.I appreciate the historical concern for blood clots as this may be the original stated reason for this type of scheduling but some insurance companies are now requiring a small saphenous vein to be done the same day as the great saphenous vein.  This is more convenient for the patient and quite doable for the surgeon.  But, of course, the insurance companies reimburse less for a second vein treated on the same day which is the real reason why the insurance companies have resorted to this mandate.  

Take care,
Dr. Chang

John W. Chang, MD
Coral Gables General Surgeon

Multiple ablation procedures

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Thank you for your question.

Most board certified vein specialists (phlebologists) will do a scan several days after each ablation procedure to ensure that there is no clot formation. 

Sometimes, not often, venous ablations can be combined, where more than one vein is treated at one visit. 

This depends on whether the same laser technology is used for each vein - sometimes a perforator vein is treated and this is a different laser than the laser used for ablation of the saphenous vein.

So, to answer your question - it is not ridiculous - your physician is being cautious and doing what is recommended in the published phlebology literature.

You should check his/her credentials on the Phlebology.org website - this may make you more comfortable.

Doing several ablations in one session increases risk for deep vein clots and that is why they are done as stand alone procedures. 

Swell-x pt is recommended after ablation procedures to reduce inflammation and pain. 

Good Luck
Dr Karamanoukian

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.