EVLT Type Procedures Worth It for Varicose Veins?

Based on the description of your veins and your evaluation, I recommend you get a second opinion and make sure you see a Vein Specialist (not all Vascular Surgeons are Vein Specialist and not all Vein Specialist are Vascular Surgeons). Ultrasounds have limitations in that they are going to be to a large extent technician dependent. It is important that a good technician with adequate experience perform the ultrasound. In addition, a good ultrasound MUST include evaluation in the standing position; if this was not done, and is not that uncommon, then they could have easily missed reflux. Other factors like dehydration or excessive cold in the exam room may also lead to missed reflux. In addition, some places simply do not take adequate time. A detailed ultrasound will usually take 30 to 60 minutes to perform. Now, if there is in fact no reflux requiring EVLT and this is less likely. There are still other procedures like ambulatory phlebectomy that could be beneficial.  Hope this helps, best of luck.

If some time has passed since your last evaluation, I would consider getting another duplex ultrasound evaluating the deep and superficial venous systems for venous reflux. Occasionally, reflux is not apparent or difficult to see on certain days. It sounds like you have symptomatic venous disease. If reflux is NOT found again then  superficial foam sclerotherapy or microphlebectomy can also be good options for localized disease and pain relief.

If you truly have varicose veins, that is not normal and there should be some abnormality found on ultrasound.  Based on the described appearance of your legs and your symptoms ( aching legs) it would probably be worth seeking  a second opinion. Depending upon what the ultrasound shows , EVLT may not be an appropriate treatment option for your problem  but there would be alternatives such as phlebectomy or sclerotherapy .  

if you have varicose veins, they can be treated. Ask your vascular surgeon what Toby suggest to make your legs feel better. If they don’t ha e an answer go somewhere else and find someone who can address the veins that bother you. 

EndoVenous Laser Treatment (EVLT) has many advantages over the "old" vein stripping techniques of the past.   If you have thick, varicose veins, it is unlikely an isolated issue.   I would obtain another vascular ultrasound to see if there are other perforator or accessory veins feeding your large varicose veins.   If the ultrasound is still negative for greater or lesser saphenous vein reflux, consider microphlebectomy and sclerotherapy to treat your veins.  EVLT has a very high patient satisfaction rate and can often be covered by insurance if there are medical indications.   

EVLT is specifically indicated for the endovenous ablation of the greater saphenous vein in cases of venous reflux.  If your ultrasound is normal, chances are you would not benefit from EVLT. 

Hello Jennifer,I realize this is an old question and likely you've already had helpful responses since it is from 2015. Not everyone with varicose veins needs EVLT. Endovenous Laser Treatment (EVLT) is primarily used for incompetent saphenous veins and possibly perforators. If on ultrasound examination you did not have "laserable veins", then EVLT is not your answer. However, I disagree that stockings are your only choice. Sclerotherapy (injection of a medication to dry up and treat varicose and spider veins) is a mainstay of varicose vein treatment and is important in annual maintenance. Superficial Venous Insufficiency (varicose veins) are incurable and thus a person's tendency to make them never goes away. Like pruning a tree, as faulty branches show up, they should be treated, often with sclerotherapy, to remove them. If not, they will continue to accumulate. I hope this helps. Sorry for the late response 6 years later! Joking aside, I hope you have found a phlebologist who is treating your venous disease to eliminate symptoms and improve the cosmetic appearance of you legs. This is something you need to maintain or it will slip away on you. Best wishes.

All ultrasounds are not created equal! In my office, we spend about an hour evaluating all aspects of the deep, superficial and perforator veins of the legs.  We scan the patient while on the table and standing. There may be false negative studies when performed with the patient just lying down.  If you were dehydrated the day of the exam, it could have been a false negative.  It is unusual to see someone with very large varicose veins without some degree of dysfunction of the valves in the veins. These valves are very important in limiting the pressure that the superficial veins experience.  Not all patients with valve problems in the veins are good candidates for EVLT or radiofrequency ablation. It depends on where the valves are not working.
A second opinion is alway valuable.

You have several options for the treatment of varicose veins. The first step is to schedule a vein evaluation, make sure to select a physician who you can trust to understand your goals and help you make an informed healthcare decision. Consider a second opinion. 

I wouldn't hesitate getting a second opinion and second ultrasound mapping exam.  One should have the exam done with both the laying down and standing position.  If one has extreme venous congestion these multiple maneuvers can expose the true venous reflux disease that is causing your pain and unsightly veins.  A registered ultrasound technician that is boarded and well trained in venous evaluation should be able to get this done.