It can be true that you may have perforators that are contributing to your current vein issues. However, the need for general anesthesia and "minimally invasive surgery" is a little overkill. From my perspective, "minimally invasive" means a local anesthetic, not general anesthesia. That said, I would agree that refluxing perforators do need to be addressed, as do any other refluxing tributaries within the legs. However, these vessels and perforators can be adequately treated using other truly minimally invasive procedures like ultrasound-guided foam sclerotherapy, where the extent of anesthesia is really just a few numbing shots to the skin. No general anesthesia. My guess is that your doc is not well-versed in these newer techniques and prefers that surgical technique. Which method you chose is up to you.

Published on Jul 11, 2012

There are many ways to address varicose veins, incompetent perforators, and the great saphenous vein. In many instances, additional treatments are unnecessary as the GSV, when closed, often negates the need for additional treatment. In other words, sometimes the perforators are actually normal after thermal ablation. Keep in mind that perforator veins are direct communications between the superficial and deep venous systems, and that many exist in the limbs. The mere presence of perforators does not indicate they need treatment.

If you have large perforators that remain a problem after the great saphenous vein is closed, then additional ablation may be indicated. How to treat them remains controversial, and many insurance carriers provide no coverage for treating this element of disease. As for 'anesthesia', our hope is that this is referring to local anesthesia so that you remain awake during the procedure. Only in rare instances is general anesthesia indicated. It has been shown that the incidence of blood clots is higher when general anesthesia is combined with endovenous laser of the GSV and ambulatory phlebectomy.

If the perforators are along the great saphenous vein, the overwhelming majority of providers will recommend treating the GSV alone and across the perforators. In our experience, this is often all that is necessary. I will qualify my comments as I do not have a full picture of your pathology and ultrasound findings. As said in the opening sentence, there are many ways to treat varicose veins and their source.

Published on Jul 11, 2012

My advice is to get a second opinion. Many times abnormal perforator veins will resolve after an EVLT without treating the perforator veins directly. Beyond that, EVLT and most perforator treatments do not require general anesthesia or even conscious sedation. The vast majority can be performed in an outpatient setting with you awake. Most abnormal perforator veins can be closed with ultrasound-guided foam sclerotherapy (a simple injection of the abnormal vein). Don't rush into treatment if you're not comfortable. Have someone else evaluate you, perform an ultrasound, and render their opinion. Best of luck!

Published on Jul 11, 2012

Unless you have skin ulcers, there is no great reason to treat the perforators. You do not need general anesthesia. I hope they are not planning on doing that. Wishing you all the best!

Published on Jul 11, 2012

There is no need to close the perforators unless they are the feeding vessels into a venous ulcer. Many people will have perforator incompetence, which will not have to be treated. Also, perforator closure can be done awake with tumescent anesthesia. See an experienced board-certified vein specialist.

Published on Jul 11, 2012