EVLT Type Procedures Worth It for Varicose Veins?

I am a 45 yr old female and have had varicose veins since age 28. I have been unable to wear shorts or skirts or a bathing suit in public for the last 10 years due to how thick and visible my varicose veins are. I've always worn compression hose. Due to aching, my primary dr. referred me to a vascular surgeon. Ultrasound was "normal" he said. He said continue the stockings nothing else. He said EVLT or like procedures are a waste of money. How can that be??

Doctor Answers 12

Reasons to undergo EVLT procedures

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. 


Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Not necessary

EVLA is only beneficial if you have reflux in the GSV or branch veins.  If your ultrasound is normal, then you most likely would not benefit.

Susan Fox, DO
Hollywood Phlebologist

EVLT Is Not A Waste of Money

Ultrasound is frequently done to rule out a deep vein thrombosis.  It is also performed in patients with varicose veins to determine how long it takes for valves to close.  Patients with varicose veins have valves that take longer to close.  When treating varicose veins, an ultrasound will determine if your valves are functioning properly.  EVLT is a proven method of treating varicose veins caused by valvular insufficiency, and certainly not a waste of money and diagnostic for appropriate treatment.

Donna M. Mendes, MD, FACS
New York Vascular Surgeon
5.0 out of 5 stars 1 review

Treating veins using EVLT

it is definitely worth it to have your veins treated. I have many people like you who had them for years with a significant impact on their quality of life

Varicose Veiins with normal ultrasound

Thanks for posting your case. Varicose veins are most commonly seen in the presence of reflux. The ultrasound did not show this in your case. Keep in mind the ultrasound has some limitations. First, the ultrasound technician may have missed the reflux. Second, you may have been dehydrated which can effect the ability to detect reflux. It never hurts to have a second opinion. Finally, the varicose veins may not be coming from the greater saphenous or small saphenous veins (the two most common problem veins). You may be seeing reflux occurring from a branch not looked at during the ultrasound. Even if there isn't reflux you can pursue an ambulatory phlebectomy to remove the varicose veins. Be well, Dr. M

Jared Mallalieu, DO
Annapolis General Surgeon
5.0 out of 5 stars 8 reviews

Get second opinion.

Varicose veins are almost always due to leaking(refluxing) valves of the saphenous system.  However, they can also be due to refluxing valves of other veins such as the small saphenous vein, anterior accessory saphenous veins, pelvic or pudental veins, etc. The bottom line is that, if you do have varicose veins, then there has to be a cause and it is probably a refluxing valve somewhere.  The physician  needs to identify it with a complete venous reflux ultrasound.  You should see a vein specialist who has experience in treating these problems.  

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

Leg Varicose Vein Procedures, EVLT, Effectiveness

I disagree with the vascular surgeon who saw you and would recommend that you get a 2nd opinion (and a repeat ultrasound as well) by another vascular surgeon, but one that specializes in vein treatments.  Based on the description you give, I think it is very likely that you have venous reflux disease and would benefit from treatment.  The only way to know if you would truly benefit from an EVLT is by getting a good quality venous reflux ultrasound of the legs.  Even if you are not a candidate for EVLT, there are plenty of other varicose vein treatments that you potentially could benefit from.  In my experience, about 70% of patients with varicose veins are candidates for the EVLT procedure.

In terms of the EVLT procedure itself, it is very effective (over 95% effectiveness rate) and is the most common procedure used for treatment of varicose veins in the United States.

EVLT and Venefit Procedures Treat Venous Reflux Disease and Not Varicose Veins - Buffalo, NY

EVLT and VNUS Closure are FDA approved to treat venous reflux disease and not necessarily varicose veins. The VNUS Closure procedure is now called the Venefit Procedure. Often, with EVLT and VNUS Closure procedures the burden of visible varicose veins are reduced. Varicose veins may need additional treatments such as microphlebectomy and sclerotherapy. Read the EVLT book provided on the link below. 

Endovenous treatment for reflux associated with varicose veins

since you have pain, varicose veins and have worn compression hose without improvement I would recommend a repeat duplex exam done elsewhere.  The odds are you have venous reflux of the superficial saphenous system.  I personally recommend and perform VNUS endovenous (RF) radiofrequency ablation of the affected saphenous veins since I feel it is safer and less traumatic than EVLT (laser).  RF uses temperatures of 85 or 120 degrees celcius and EVLT (laser) uses temperatures of 700 degrees celcius and depends on the surgeons ability to 'pull back the catheter' at a given rate.  RF does not require the treatment to depend upon 'rate of pull back'.  I personally have had RF on one leg and it is the best thing I have ever done for myself.  Reasearch has also shown that RF is 97% successful in multicenter trials and post operative bruising and pain is much less than EVLT. Hope this is helpful.  You can find a local surgeon at www . VNUS . com

Louise Ferland, MD
Richmond Plastic Surgeon
4.2 out of 5 stars 11 reviews

Symptomatic varicose veins can be treated in many ways

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.

Kevin M. Johnson, MD, FACS
Spokane General Surgeon
4.2 out of 5 stars 16 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.