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 15

Varicose Veins and Normal Ultrasound?

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.


Varicose Veins and Normal Ultrasound?

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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.


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. 

Reasons to undergo EVLT procedures

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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. 

Several options treatment

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. 

Several options treatment

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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. 

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Varicose veins without reflux on ultrasound

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.  

Varicose veins without reflux on ultrasound

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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.  

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.

Not necessary

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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.

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 2 reviews

EVLT Is Not A Waste of Money

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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

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

Sameh Dimitri, MD
London Vascular Surgeon

Treating veins using EVLT

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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

Sameh Dimitri, MD
London Vascular Surgeon

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

Varicose Veiins with normal ultrasound

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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

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

Get second opinion.

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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

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.

Leg Varicose Vein Procedures, EVLT, Effectiveness

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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.

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.