Options for Varicose Veins?

I am 30, I had a laser procedure done at NYU hospital by doctor last January with no results. I am very disappointed and heart broken.

I have a bulging vein on my left leg and now on my right leg a vein came up to the surface and started to bulge out a bit, and another small blue vein is starting to appear above my right knee.

I wore compression stockings in the winter, now summer, I dont want to wear them. What are my other options? I also have no insurance to go back for more.

Doctor Answers 3

Varicose veins still present after VNUS Closure and EVLT

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It is very interesting that VNUS CLosure is marketed for varicose veins, but in fact, is FDA approved for venous reflux disease. It is used to treat venous reflux disease involving the great saphenous vein, short (lesser) saphenous vein or perforator veins. However, it is being used for varicose veins by those who are not properly trained or who are using it for that reason. It can work to close varicose veins but can leave you with other vein problems that require additional expertise, often by doctors who are phlebologists.

Some doctors that perform VNUS or EVLT only know how to do this one procedure. Phlebology requires a whole armamentarium of treatment modalities and it behooves you to be aware of this and to seek someone who is not just a 'catheter jockey'. Anyone can do the VNUS CLosure procedure in my opinion. But only experienced phlebologists know how to take care of the rest of your vein issues.

The doctor who treated you is probably not experienced in these procedures and in the attempt to sign you up for the procedure promised you the world. With proper evaluation, the physician should be able to tell you up front if the varicose veins associated with venous reflux disease of the great saphenous system will go away following VNUS Closure or EVLT. In fact, depending on how far they are from the thigh and in what distribution they occur in the leg, published studies show that less than 30 % of varicose veins go away and disappear after VNUS Clousre of the great saphenous vein.

If proper evaluation is performed, a phlebologist with large experience should be able to tell you at the time of consultation if additional treatments are needed such as microphlebectomy, sclerotherapy or laser procedures for spider veins, reticular veins or feeder veins.

In any case, nothing wrong was done. You had proper treatment for venous reflux disease and now you must see a phlebologist with experience to take care of the rest of these problems. There is no one procedure which treats all of these vein problems - and they all need different types of treatments and you should have sought someone who does all of them.

Most large cities have phlebologists who take a comprehensive approach to treat vein disease.

Interesting question...

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i would need to see and assess you in order to answer the question definitively but it sounds like the real source of reflux was not addressed by your "laser" procedure.  i am not sure what procedure you had done but it doesn't sound like it was what you were looking for in terms of results.

commonly after closing one of the saphenous veins with laser, i will need to accompany that with either an ambulatory phlebectomy or sclerotherapy.  one laser treatment does not a complete vein treatment make.  varicose veins are lifetime problems that are best approached as "managing them" rather than getting a cure from treatment.  the latter is rarely possible.


Craig Crippen, MD
Kelowna Physician

You have several options for bulging varicose veins.

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Your options include:

1. Ultrasound guided sclerotherapy (injection of a sclerosant solution)

2. Ultrasound guided endovenous laser treatment

3. Radiofrequency ablation of varicose veins

4. Surgical Vein Stripping

Among these three, the first three are considered to be minimally invasive, have fewer complications and a faster recovery time. Ultrasound guided sclerotherapy is a faster outpatient procedure and can actually be done without anesthesia but multiple treatments may be required. If given a choice, I would probably go with ultrasound guided endovenous laser treament (EVLT). EVLT probably has the highest cure rate of the three minimally invasive procedures and an excellent safety profile. Choose your surgeon carefully. I suggest you consult with a vascular surgeon or someone who specializes in treating venous diseases in your part of the country in person to properly evaluate your condition, determine whether you are a candidate for any of these procedures, and recommend the best treatment option for you. I would think it unlikely that the treatment you received was endovenous laser, as this procedure has an excellent cure rate.

Good luck!

Bryan K. Chen, MD
San Diego Dermatologist

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.