EVLT and ultrasound guided scerlotherapy or phlebectomy?

Question

I feel a little bit overwhelmed by what is required to treat my condition. If u have reflux in common femoral and slight reflux in femoral is that a manifestation of overflow from gsv reflux? Will treating superficial solve the deep. Or will i just have more bad veins develop because of the deep insufficiency. Also is ultrasound guided scerlotherapy a better treatment then a phelebectomy. Long term. Thanks.

Vincent Gardner, MD · Answer

So, as I read this, you have reflux in both your deep and superficial systems. Treating the symptomatic superficial reflux sometimes makes the deep vein reflux better but will likely not resolve the issue. If you’re symptomatic with leg pain and swelling, most likely you’ll get relief or at least improvement from treatment of the incompetent superficial veins. Unfortunately, there’s no guarantee, and the only way to know is to treat you and see how you respond to the treatment. Having said that most people notice improvement with treatment of symptomatic superficial venous reflux disease. With regards to which is best&hellip;.ultrasound guided sclerotherapy or microphlebectomy&hellip;.it really depends. For large varicose veins I tend to use micro phlebectomy because I think there’s a better long-term result. A lot of people have gone to using US sclerotherapy and that’s fine for a lot of situations. What you have to know is after treatment with sclerotherapy the veins will clot&hellip; That’s the whole point of the treatment is to irreversibly damage the veins, so your body will then come in and through your own inflammatory response, remove or dissolve the veins overtime. If you’re treating large surface veins with sclerotherapy, they will clot and often become painful and take a long time to resolve. Also, they will frequently need to be punctured and the old blood drained, which can be uncomfortable. Both can be very effective, but I tend to favor microphlebectomy for the above reasons. Good luck with your treatment and I bet you’ll be glad that you did it.

Thomas Wright, MD · Answer

Treating the superficial venous reflux in the saphenous vein and its tributaries does not harm and often helps the deep venous circulation.  Overall your vein circulation in the affected legs will improve with the treatment of the superficial reflux. Yes overall Ultrasound guided sclerotherapy is more versatile , less invasive and more comprehensive than phlebectomy.  For a very large vein phlebectomy still has a roll, but 95% of varicose veins, they are better treated with Ultrasound Guided Sclerotherapy.

Joseph Cipriano, DO · Answer

Common femoral and femoral reflux is a representation of deep system reflux and are reflections of the same problem downstream. This can communicate to the superficial system and give rise to insufficiency in the GSV, SSV and give rise therefore to spider veins, reticular veins and varicosities. 
Most veins of our bodies, superficial or deep, grow with one-way valves that prevent blood from moving backwards. Without regular movement of blood back to the heart within veins we have backup of pressure within our veins. Unfortunately this communicates to the next valve and puts it at higher risk for damage "snowballing" its effect. This is reflux. Simply put veins allowing blood to move in reverse of their original design.
There currently is no treatment to resolve deep system insufficiency.
Superficial insufficiency is the same problem affecting veins above the level of your muscles therefore superficial. There are treatments for the superficial veins such as EVLT (heat), phlebectomy (surgical), additional heat based modalities, additional surgical treatments, adhesives, detergents and/or conservative measures.
...but as you've guessed it, deep system insufficiency is the mother of these superficial veins you see. Deep system insufficiency stems from multiple origins that can be associated with genetics, medical diagnosis', and behaviors. The easiest of these to modify can be medical diagnosis' and arguably the most difficult may be human behavior (lol). Without changes to the "stressors" though this will continue to "pressure" the development of new veins. Conservative measures are some of the easiest maneuvers that can help prevent this, including but not limited to, elevation of legs at rest, compression stockings and exercise as well as avoiding or adapting situations that promote development of new veins.
Ultrasound guided sclerotherapy vs phlebectomy is situational and the appropriate answer, each is correct in their own right.
Hopefully this shed some light on the issue. Take care and have a great day!

EVLT and ultrasound guided scerlotherapy or phlebectomy?

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