Is it bad to get EVLT done if I don't have venous insufficiency, yet have a lot of reticular/spider veins?

Question

The first place I went to did a very superficial ultrasound study while I was lying down, performing the Vasalva maneuver. This study showed venous insufficiency in my saphenous veins. They recommended EVLT/sclero. Insurance denied that and had me go to a different place. Much more thorough exam, which determined normal veins. I do have a lot of reticular veins and spider veins I would like to take care of. Should I see another specialist? Is it bad to do EVLT if I don't have insufficiency?

Andres Zavala, DO · Answer

EVLT should only be done in the presence of reflux.  I would recommend getting another opinion since you've had conflicting results. The ultrasound evaluation should be done standing up while performing maneuvers like distal augmentation, proximal compression, valsalva and parana maneuver among others. Unfortunately, an ultrasound evaluation is in part technician dependent and sometimes reflux is missed if performed by an inexperienced technician even when it may seem thorough. If you do in fact have reflux, then EVLT is appropriate and may also help in more successful sclerotherapy of reticular and spider veins, as well as diminish likelihood of recurrence.

Bradley L. Ashpole, MD · Answer

There would be no reason to perform an EVLT on a normal vein.  Based on your description, I would have a tendency to rely more on the results of the second, more thorough exam.  You certainly can have the spider veins treated properly  with sclerotherapy.    Unfortunately, in my experience, that would be unlikely to be covered by insurance.

Tif Siragusa, MD · Answer

If you had a thorough ultrasound while standing that did not demonstrate reflux, I would seek direct treatments for you reticular and spider veins.  Further, do you have leg swelling, achiness, pain, or fatigue?  If you have none of these symptoms, you do not need to worry about doing an EVLT on your sapheous vein.  Unfortunately, there are a few vein practices (typically large chains, think McDonalds) who train their employees to make the vein look bad even when they are not.

Susan Fox, DO, RPVI · Answer

Why treat something that is not broken.  I would not respect the physician who is recommending this procedure when you do not have venous insufficiency.  There are risks with any procedure and if you do not have venous insufficiency then the benefits do not out weight the risks. I would not go back to a doctor who is recommending a procedure when you have no reason to be treated.

Michael Nguyen, MD · Answer

Thank you for your question. I recommend repeating Venous Doppler ultrasound for venous reflux. This time, try to be well hydrated, avoid caffeinated products prior to ultrasound imaging, exercise beforehand, be standing for reflux evaluation portion of the test, and make sure exam room and exam table are not too cold. By doing these above, you are preventing constriction of the vessels and increasing the chances of finding retrograde flow if reflux is really happening in your LE venous system. Varicose or dilated veins showing in the surface of the skin is one of many signs and symptoms of venous reflux. Also, discuss with your vein specialist the different treatment options if underlying venous insufficiency is present as well as treating your cosmetic concerns otherwise. Best ,

Albert Malvehy, MD · Answer

This is unfortunately a common problem. Some practices are either incompetent or unscrupulous and become EVLT-happy, doing saphenous ablations on everyone that walks in the office. We see many patients for second opinions and I find a number of normal veins when patients have told they needed a saphenous ablation. This is just plain wrong. There is no reason - not even a cosmetic one - to destroy a normal vein. Doing a saphenous ablation on a normal vein may even cause new spider veins to form! If one place did a thorough ultrasound and told you it was normal, stick with them. There is no incentive to lie to a patient about something being normal if it is not. Good luck.

Ivan Brooks, MD · Answer

I would recommend that you get another scan . If no reflux is found. I would not do EVLT. EVLT is a treatment for venous insufficiency.

Ramtin Massoudi, MD - Account Suspended · Answer

I would not recommend EVLT if there is no venous insufficiency.
More important is that: do you have any symptoms, have you tried compression stocking, what is your stage of venous insufficiency, there is 6 stages of venous insufficiency. please read about CEAP classification
What I recommend: second opinion
compression stocking
herbal medications to improve your vein health
exercise

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