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 17

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.



Clifton Vascular Surgeon
5.0 out of 5 stars 3 reviews

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. 

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Excellent results can be had for EVLT procedures for varicose veins

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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.   

Charles K. Lee, MD, FACS
San Francisco Plastic Surgeon
5.0 out of 5 stars 16 reviews

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Missed Reflux?

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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.

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. 

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

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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.

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

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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

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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

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