How do I make sure the doctor identifies all my incompetent veins and treats them during EVLT?

Question

I am trying to choose a doctor that will take my concern seriously about me being bothered by spider veins caused by venous insufficiency and make sure all incompetent veins are removed.

Tif Siragusa, MD · Answer

Venous ultrasound tests are very dependent on the person doing the test.  I have personally evaluated dozens of patients who had an ultrasound at outside imaging centers and I repeat all of them. Not all sonographers are adequately trained or qualified to perform venous reflux tests.   While it is impossible to be 100% sure about any particular sonographer, it is good to know that the person performing the test is an RVT (registered vascular technologist).  This means they are specifically trained to identify if you have a problem with your circulation.Another thing to consider is the training and qualifications of the physician that will be treating you.  Vascular surgeons have been dealing with the treatment of varicose veins longer then any other type of specialist and seeing a board certified vascular surgeon likely improves your chances of being accurately diagnosed and appropriately treated.  Remember this disease is a disorder of your circulation and not just a cosmetic issue so take it seriously.When it comes to your veins, let your symptoms be your guide.  If you are told you have 6 veins that need EVLT and your legs feel great (normal) with no swelling after two EVLTs, that may be all you really need.

Hratch Karamanoukian, MD, FACS · Answer

There is truncal venous insufficiency - of the great saphenous (GSV) and short or small or lesser saphenous (LSV) which can be treated with standard EVLT catheters. These use 810 nm lasers. There are perforator veins that need a special type of EVLT catheters. These are 1470 nm lasers. There are other sources of minor reflux that are treated with US guided sclerotherapy. As well, there are special centers that have the experience to treat segmental reflux within saphenous veins with 1470 nm lasers. Segmental saphenous reflux can be treated without thermal energy (EVLT or VNUS) using ClariVein. They can't all be done at once as they need different fibers and generators and it would be too much to do all at once. Choose a center which has ALL of these technologies under one roof - there are not many out there ! The other points made by the surgeons below are great. choose a specialist who has added certification from the American Board of Venous and Lymphatic Medicine (ABVLM).

John Landi, MD · Answer

Vein treatment has now become a separate speciality called The American Board of Venous and Lymphatic Medicine and those with board certification in this speciality are called Diplomates of this board.  You can find a Diplomate in your area by going to the phlebology website or American Board of Phlebology website. Any diplomate should be able to solve your problems.  Also, there are other physicians who may not be diplomates but who do a large volume of veins who may also be able to treat you.

How do I make sure the doctor identifies all my incompetent veins and treats them during EVLT?

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