Is it common practice to have EVLT done two days in a row on the same leg? Charged $3800 x 2

Doctor Answers 10

No, not common practice

No, this is not common practice.  Common practice is to space out EVLT treatments 2 to 3 weeks apart to minimize pain, bruising, and blood clot complications.  It does not make sense to do the treatments 2 days in a row . . . .if you needed 2 treatments and the doctor wanted them done right away, why not do them on the same day?

The typical scenario is to either do all of the needed treatment on the same day or if it is felt that there is too much risk in treating both veins on the same day, then the treatments would typically need to be spaced out by at least a couple of weeks (it takes that long for the inflammation from the first treatment to resolve).

I would definitely talk with the facility about giving you a discount for the 2nd days treatment, as if they would have done them together on the same day, the cost of the 2nd treatment would have been dramatically less (the same equipment would have been used & it would have taken less time, dramatically decreasing your costs).  When billing an insurance company for 2 treatments on the same day, the 2nd treatment is paid at a much lower rate for the above reason.

EVLT treatment timing

The risk of doing EVLT of the small saphenous (short saphenous) increases the risk of DVT and some Board Certified Phlebologists would separate the two procedures, and typically do them a week apart, not the following day. Meaning that they would do the great sapheous vein or veins (if there is an accessory) on the same day and bring the patient back for the small or lesser or short saphenous on another day (a week later). If the great saphenous and accessory saphenous veins are very large (> 2cm), it is best to do them separately to avoid unnecessary post procedure pain. I

t is difficult to judge why it was done this way without knowing details of the veins treated.

Hopefully you were treated by someone who had extra certification from the American Board of Venous and Lymphatic Medicine. 

Questionable practice protocols ???

Many patients can have extensive venous disease which would require multiple sessions of EVLA.  If that is the case, most vein specialist would complete treatment to the major vessels of the front medial side of the limb...wait 3-6 weeks and then  treat the back side of the limb.  It is highly questionable to treat the same limb 2 days consecutively.   Other than medical reasons, billing reasons come to mind.  There is no global period with EVA procedures.  Other major surgeries like gallbladder surgery have a 90 day global period, so that anything completed for the patient in the ordinary care post gallbladder surgery with in the 90 day period would be included in the payment for the initial surgery.   If the surgeon completed both of the procedures on the same day, instead of 2 days in a row...the payment would be reduced as the insurance company will pay for the first procedure at 100% and then the 2nd procedure at 50%.  Hard to judge without all the facts,  but I see no medical reason to complete 2 EVA procedures back to back on consecutive days.  ?????? Hmmm

James E. White, MD
Chattanooga General Surgeon
4.5 out of 5 stars 3 reviews

Yes.

Any vein closure, be it EVLT, VNUS OR CLARIVEIN, is frequently done on different veins on different days especially if the greater saphenous vein is done on one day and the small saphenous on the next. If the greater and accessory saphenous veins are done, usually they can be done at the same time since the patient is in the same position for both veins.  When the greater is done, the patient is on their back and for the small saphenous, on their abdomen.  In addition to the need to change patient positions and change the entire sterile set up, other reasons to do the procedures on separate days are that since it is done under local/tumescent anesthesia we are limited by the amount of tumescent that we can safely use and also, the more that is done while awake, the longer the duration of the procedure and more uncomfortable it becomes. I rarely do the greater and small saphenous on the same day.

John Landi, MD
Naples General Surgeon
5.0 out of 5 stars 5 reviews

Daily procedures

IT is not uncommon to perform vein procedures on multiple days. We usually try to separate them by a few weeks if possible to allow the person to heal.  Sometimes, the procedures can be combined on one day. I would discuss this with the physician and see if combining the procedures is possible or separating them by a longer time period would be considered

Susan Fox, DO
Hollywood Phlebologist
5.0 out of 5 stars 4 reviews

Not common 2 days in a row

It is not uncommon to require more than one procedure. However, I do not perform them on consecutive days. 

Depending the veins....

Two different truncal vein veins (GSV and SSV) are preferred to do at different days. This will both for your comfort and safety. You can get back to you immediate daily activities without significant of pain or even discomfort (with our clinic without even daily pain medication), second, the risk of complications like DVT is going to be lower with smaller volume of the procedure.
On the other hand, one truncal vein with even larger branches can be safely treated at the same procedure.

Vahe Melkonyan, MD
Sherman Oaks Phlebologist
5.0 out of 5 stars 2 reviews

EVLT on Consecutive Days

I think it is head-scratching to perform EVLT's on consecutive days.  Either do them both on the same day or wait 1-2 weeks before performing the next EVLT.  Many patients prefer to split the procedures up so they can heal and recover in a time frame that they are comfortable with. Also, most of my patients want to work the next day so bilateral procedures may be a bit much for some.

Hope this helps and good luck!
Dr Chang

John W. Chang, MD
Coral Gables General Surgeon
4.4 out of 5 stars 12 reviews

Common Practice for Vein Treatment

Thank you for your question. Usually leg vein treatments are every 6-8 weeks as needed. Pricing will vary. I would recommend getting treated under the supervision of a Board Certified Dermatologist or Plastic Surgeon for safest and best treatment option. I hope this helps.

EVLT surgeon in Los Angeles

I perform EVLT procedures and have found that surgeons vary in terms of protocol.  I would suggest that you obtain more information about the reasons for spacing the treatments a few days apart from your surgeon. Raffy Karamanoukian Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

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.