Do the risks of EVLT outweigh the benefit if only treating for cosmetic purposes?

I’m scheduled for EVLT for two varicose veins, one behind my knee and one right below it in my calf. I’ve had these for years and they are not painful. I’m treating because these combined with spider veins are very unattractive.

Answers from doctors (4)


The Vein & Aesthetic Center of Boston

Published on Dec 21, 2017

Only you can make that decision. I go over the risks and benefits of each procedure and then let the patient decide. If the veins that are going to be treated with the EVLT procedures are feeding into the area of the spider veins then you need to do the EVLT first. It is however tough to explain to a patient that they could have pain following the EVLT that they did not have before the procedure. I would suggest doing one EVLT at a time. See how you feel after the first one and see if the associated spider veins improve. The associated spider veins will most likely still need sclerotherapy but that can be done after the other procedures.

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Answered by The Vein & Aesthetic Center of Boston

Only you can make that decision. I go over the risks and benefits of each procedure and then let the patient decide. If the veins that are going to be treated with the EVLT procedures are feeding into the area of the spider veins then you need to do the EVLT first. It is however tough to explain to a patient that they could have pain following the EVLT that they did not have before the procedure. I would suggest doing one EVLT at a time. See how you feel after the first one and see if the associated spider veins improve. The associated spider veins will most likely still need sclerotherapy but that can be done after the other procedures.

Published on Jul 11, 2012


Advanced Vein & Laser Centre, Ltd.

Published on Dec 20, 2017

This is an excellent question. Although the risks are minimal, they are present. In the strictest definition of medical necessity, if there are no symptoms, then there is no necessity.

As a practical matter, if the ultrasound (performed with the patient standing) shows reflux and the refluxing veins are connected to the spider veins, then it makes sense to treat the feeding veins first with EVLT and then spider veins with injections.

It is not uncommon for people who've had varicose veins for many years, not to complain of symptoms. Yet when the varicose veins are treated, the same person will comment that their legs feel lighter.



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Answered by Advanced Vein & Laser Centre, Ltd.

This is an excellent question. Although the risks are minimal, they are present. In the strictest definition of medical necessity, if there are no symptoms, then there is no necessity.

As a practical matter, if the ultrasound (performed with the patient standing) shows reflux and the refluxing veins are connected to the spider veins, then it makes sense to treat the feeding veins first with EVLT and then spider veins with injections.

It is not uncommon for people who've had varicose veins for many years, not to complain of symptoms. Yet when the varicose veins are treated, the same person will comment that their legs feel lighter.



Published on Jul 11, 2012


Metro Vein Centers

Published on Dec 19, 2017

Treating diseased vessels might improve the cosmetic appearance but additional sclerotherapy will be needed to treat the spider veins.

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Answered by Metro Vein Centers

Treating diseased vessels might improve the cosmetic appearance but additional sclerotherapy will be needed to treat the spider veins.

Published on Jul 11, 2012


Vein Specialties of St. Louis

Published on Dec 19, 2017

If you have been diagnosed with reflux in the underlying saphenous vein causing the spider veins, you have a higher risk of getting a clot in this vein or varicose veins due to decreased blood flow. However without symptoms (pain, aching, heaviness etc) it will be considered cosmetic by your insurance. If the varicose veins are not from a saphenous reflux (non-truncal) they can be removed through tiny punctures (mircophlebectomy) under local anesthetic. That said we do see people with asymptomatic varicose veins with reflux who will go ahead and treat them to prevent further problems. You would have to pay for this yourself.

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Answered by Vein Specialties of St. Louis

If you have been diagnosed with reflux in the underlying saphenous vein causing the spider veins, you have a higher risk of getting a clot in this vein or varicose veins due to decreased blood flow. However without symptoms (pain, aching, heaviness etc) it will be considered cosmetic by your insurance. If the varicose veins are not from a saphenous reflux (non-truncal) they can be removed through tiny punctures (mircophlebectomy) under local anesthetic. That said we do see people with asymptomatic varicose veins with reflux who will go ahead and treat them to prevent further problems. You would have to pay for this yourself.

Published on Jul 11, 2012


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