I had both saphenous veins treated, but on one side the Dr. could not guide the catheter halfway between the knee and femoral vein junction. After several attempts, he just ablated the distal portion. There is now a new varicose vein above. What should be the next step?
Have you followed up with the treating physician yet? Depending on the length of the untreated portion of GSV, your doctor may elect to ablate the upper portion, versus foam ablation versus observation and routine follow up.
Published on Jul 11, 2012
Get a second opinion. This should not be left alone and the initial treatment was not sufficient.
Published on Jul 11, 2012
Difficult question without ultrasound scan to review. If there is enough length they could attempt to close the upper portion. However, if this were the case, most physicians would have treated both segments during previous procedure.
Probably your best bet is to have the new VV removed with ambulatory phlebectomy - use of a small hook to pluck it out, understanding that without the source closed off, that vein will likely return every few years. May become a chronic maintenance sort of thing that can be addressed with sclerotherapy at regular (several year) intervals. Without scan and examination this is all just conjecture.
Published on Jul 11, 2012
You might consider a second opinion. I would need to see the anatomy on ultrasound to make a reasonable treatment recommendation. Options would include laser ablation (more flexible for complex anatomy), surgical ligation at the junction ( I prefer to avoid this), and/or sclerotherapy of the proximal portion.
Published on Jul 11, 2012
If the catheter cannot be passed to the saphenofemoral junction to decompress the saphenous vein in order to relieve surface varicosities,chemical ablation or surgery may be considered. I suggest starting with the
simplest and least invasive procedure, chemical ablation (ultrasound-guided
sclerotherapy).
Published on Jul 11, 2012
You may need to have your proximal saphenous vein in the upper thigh evaluated by duplex ultrasound to see the origin of the varicose vein. Your next treatment step will depend a lot on the status of the upper saphenous vein and the where the varicose vein arises from.
Published on Jul 11, 2012
If your provider was indeed unable to close (or ablate) the proximal portion of your Greater Saphenous Vein and if you do have varicosities which branch off that patent section of the GSV, you may want to consider a consult with a vascular surgeon. There might very well be several options of treatment but the one that comes most immediately to mind would be to ligate and remove the remaining section of the GSV and then remove the offending varicosities via microstab phlebectomies.
Published on Jul 11, 2012
There are several options, such as cannulating the vein above the area that would not pass and also treating this area with ultrasound-guided foam sclerotherapy. I usually will cannulate the vein in more than one area when I run into this problem.
Published on Jul 11, 2012
A laser (EVLT) is often more maneuverable than the RF catheter. Access can be obtained above the treated area and an attempt to pass through the proximal portion can be made. In addition, there are special wires (glide wires) that can assist the physician in passing catheters through tricky anatomy.
Published on Jul 11, 2012
It depends; there are various options. Your treating physician can ablate the upper vein from another puncture, or perhaps ultrasound-guided foam injection might be an option.
Published on Jul 11, 2012
Injection perhaps or phlebectomy.
Published on Jul 11, 2012