Had a closure done today. Dr could not get by my knee in the vein. Any suggestions?

The dr was unable to get the cath to go through the GSV vein in the area of my knee so he pulled out, he said i had a dvt at some point. so he went in above knee and closed very short portion of GSV towards my groin. is this going to help? what will happen to the lower part of the vein that he didnt close?

Doctor Answers 4

Knee area couldn't be closed

Very good question and it can happen that the superficial veins have sclerosis because of previous phlebitis. If you look at the patho-physiology of venous insufficiency there is usually significant reflux involving the proximal thigh GSV. By treating the proximal GSV the refluxing part should be fixed and if there are persistent veins or symptoms those can be treated with sclerotherapy. Depending on the preoperative ultrasound sometimes I will ablate the GSV with two access points. 

Issaquah Vascular Surgeon
5.0 out of 5 stars 1 review

EVLT - endovenous laser therapy in Williamsville NY

I have done EVLT since 2007 and sometimes, in cases where there has been SVT (NOT DVT), the catheter can not be manipulated past areas of scarring near vein valves. In that case, you can ablate the vein using 2 access points. Access point 1 could be in the lower leg to get the leg area ablated below the knee. Access point 2 could be in the lower thigh, bypassing the are where the catheter could not he passed. The area in between the 2 can be injected with sclerosant solution under ultrasound guidance. 

Hratch L Karamanoukian MD FACS 

Endovenous ablation

It is thought that for best results access should be done below the knee and ablation should be performed from the junction (groin) to access point.  Sometimes there are barriers that prevent catheters from advancing, such as previous scar tissue, multiple branches, or intraluminal narrowing.  In my experience, 98% of the time this can be resolved with using a combination of guide wire and external manipulation.

In your case, I would likely do an ultrasound guided sclerotherapy injection next,or chemical closure to close off the segment of your great saphenous vein that was not ablated.

Michael Nguyen, MD
Miami Physician

Expectations with EVLT

In a perfect situation, when one is performing an EVLT, the physician should be able to access the greater saphenous vein (GSV) below the knee and pass the laser fiber to the groin without any difficulty.  However, we don't always live in a perfect world.  Several things can make the passage of the fiber more difficult.  If the patient has had previous sclerotherapy,  if they have had episodes of thrombophlebitis, if the vein is very tortuous (twisted), then it may not be able to pass the fiber as desired.   I would have to see your ultrasound report to see where your pathology exists, but I would expect that treating the upper portion of the diseased vein will still help.  The lower portion of the vein is probably already partially closed.  Treatment with sclerotherapy at a later date can be very effective in closing a partially open vein.  Hope that helps.

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.