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