I have had severe venous insufficiency for many years and have had a total of 8 EVLT procedures. I currently get disability because of the problems I have. It makes it difficult to hold a job. My doctor said I have less than a 30 percent chance of it working this time. Is it worth going through all of this again?
The success rate of EVLT is about 98% at 2 years. Therefore, I think what has happened to you is normal. I think you should seek a second opinion.
Published on Jul 11, 2012
Sadly there is no way of answering that question. Wear your support stockings and enjoy your life. If you love your job then you should go back.
Published on Jul 11, 2012
You should seek a second opinion from a Board Certified Vascular surgeon who specializes in these vein procedures. Correctly done the failure rate for EVLT is very low.
Published on Jul 11, 2012
It is hard to say what is the best treatment course without more information. I sounds like you have bad vein problems and have already had a good bit of treatment . I think it is best to discuss your doctor and share your concerns. He or she should be able to address them.
Published on Jul 11, 2012
Sometimes when you shut down a vessel it forces the blood to re route itself and in doing such can exacerbate other vessels- making it possible for other problems to pop up. Are you experiencing symptoms at this point?/ any pain or discomfort?- or can it be managed without additional invasive procedures- and tx it more conservatively. If the success rate is not one that you are comfortable with then i suggest one of two things: either try it again with the same physician- and hope for a better outcome or perhaps get a second opinion as to what a different treatment plan would entail.
Either way - good luck to you.
Published on Jul 11, 2012
That's a difficult question to answer without knowing more details about your case. EVLT has an overall 95% success rate in expert hands, which means a 5% chance of failure. Whether you are in the 5% category or not depends on two factors: the expertise of your treating physician, and your individual response to treatment.
If the vein to be treated is < 3.5 mm, is very tortuous, or has segmental scar tissue from previous treatment or thrombosis, the chance of success is slim because it will be difficult to thread the laser fiber up the vein. The venous back-pressure from advanced congestive heart failure can also work against you.
Bottom line: if you trust your doctor, I would rely on his/her advice in this matter; if not, seek a second opinion.
Published on Jul 11, 2012
It's unusual to need 8 EVLT unless you are having perforator veins treated. An ultrasound will tell you what is left to do and the best treatment modality ie: EVLT vs. sclerotherapy vs. phlebectomy. You may want to get another opinion from a vein specialist.
Published on Jul 11, 2012
EVLT is a procedure that has a very high success rate in terms of long term closure of the saphenous veins. The instances when it does not work fully, some factors such as technique of the procedure (not enough energy delivered), inadequate compression after the procedure (patient driven), the severity of the underlying condition(s) that started the problem, on-going situations that continue to stress the venous system, and others. If you had multiple EVLT procedures and they were initially successful, but now you have recurrence, I would suggest a thorough evaluation of deeper issues that may be causing resurgence of your reflux problem.
Published on Jul 11, 2012
Without knowing all the facts, it is difficult to give advice.
Published on Jul 11, 2012
It would be most unusual to require so many closure procedures, but I do not know your entire history. There are also alternatives to EVLT including ultrasonic guided foam sclerotherapy, Varithena and Clarivein. I would recommend that you get another opinion from a board certified vein specialist.
Published on Jul 11, 2012
Having 8 EVLTs is unusual. I would recommend a vascular surgery consult with someone who does both venous ablations and stab phlebectomy. I believe you need to have a Venous duplex ultrasound from and ICAVL accredited lab.
Published on Jul 11, 2012