More Veins Than Ever 2 1/2 Months After Closure

Question

I had the Vnus Closure treatment 2 1/2 months ago.The last few weeks I have had large blue veins branching out from the upper front of my thighs,along the side and backs of my thighs and knees. Some behind legs are starting to bulge. Never had any veins on my thighs before Closure. What is happening?

Tif Siragusa, MD · Answer

After undergoing radiofrequency ablation of your vein the circulation in your leg should be improved and any increased pressure in your superficial leg veins should resolve.  If you are noticing more veins, an ultrasound would be very helpful in confirming your treated vein remains closed, ruling out a blood clot, and making sure that there are not any other veins that have become problematic.  If your ultrasound comes back normal, the your physician will most likely discuss the options of micro-phlebectomy and sclerotherapy based on the size of the veins that are bothering you.  At this point, I would recommend returning to the physician who treated you for venous reflux and discuss your concerns with them.  They would more then likely order another ultrasound to re-evaluate your circulation.

Hratch Karamanoukian, MD, FACS · Answer

The process of getting new veins in the gorin and upper thigh after vein stripping or after mechanical ablation (VNUS Closure) is well described. After vein stripping, neovascularization commonly occured within 2 years and caused a profound proliferation of veins in the upper thighs and groin which was treated with sclerotherapy.After VNUS Closure, such proliferation of veins requires repeat ultrasound to ensure that there isn't an accessory saphenous vein which is being sourced through the saphenofemoral junction. If there is, this can be treated with ultrasound guided foam sclerotherapy or if the veins are quite large, a combination of US guided foam sclerotherapy and microphlebectomy.New veins behind the knee and the lateral (outer) aspect of the leg can arise from the small saphenous vein system. Collaterals between the great saphenous which was ablated with VNUS Closure and the small saphenous through the intersaphenous vein could cause the problem you describe.Get a doppler ultrasound exam from a vein specialist, preferably one with credentials from the ABVLM.

John Landi, MD · Answer

Post closure procedure, if new veins begin to form, then a reason for their formation needs to be evaluated. This is best done by a follow up venous reflux ultrasound. You need to ensure that the treated veins are closed, that there is not another source (refluxing valve) feeding the new veins or that you now have new vein formation (neovascularization). Depending on the ultrasound findings, then appropriate treatment can be started. This may require closing other valves, sclerotherapy or microphlebectomies. You should return to your treating physician or follow up with a vein specialist.

Timothy Mountcastle, MD · Answer

i would get another ultrasound to make sure no dvt is present.  more than likely all those veins were there before vnus and you just didnt pay as much attention to them.

	bulging veins are not always treated with just vnus alone. sometimes a microphlebectomy is also needed.

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