How can I relieve post-EVLT pain? NSAIDs are not helping.

I had EVLT about 2-3 weeks ago and I'm still experiencing sharp pain. It's mostly when I stand or walk. Even when I wear a compression stocking during standing or walking, there is no relief. But if I don't wear the stocking, it feels like my vein is exploding. I checked with my vascular surgeon and he said I have a clot. What should I do? Is there any way to get the pain to subside? NSAIDs are not helping. Is it possible to remove the clot? If so, will the pain go away then?

ANSWERS FROM DOCTORS (24)


Answered by Vein Center of Louisiana

If you have a clot there isn't much you can do other than pain meds. You should definitely wear your stockings & continue NSAIDS & any anti-thrombolytic drugs your doctor may have prescribed. Did you misword your question perhaps?

Published on Feb 05, 2015

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Answered by Vein Center of Louisiana

If you have a clot there isn't much you can do other than pain meds. You should definitely wear your stockings & continue NSAIDS & any anti-thrombolytic drugs your doctor may have prescribed. Did you misword your question perhaps?

Published on Jul 11, 2012


Answered by NE Laser Vein Institute LLC

The doctor that performed the EVLT should be taking care of this, or the vascular surgeon who examined you. It is very difficult to diagnose without an actual exam.

Published on Feb 03, 2015

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Answered by NE Laser Vein Institute LLC

The doctor that performed the EVLT should be taking care of this, or the vascular surgeon who examined you. It is very difficult to diagnose without an actual exam.

Published on Jul 11, 2012


Answered by Elmore Medical Vein & Laser Treatment Center

The most important things to reduce discomfort after EVLT are compression stockings and walking. Going without compression stockings even for a short period of time while awake can increase discomfort. We have our patients wear stockings for a minimum of 3 weeks. We also tell our patients anytime they get stiff or sore to walk. Two 30 minute walks daily is our requirement. Trapped blood (clot) in a treated vein is a common part of healing and will reabsorb over time. Ice packs are also helpful.

Published on Feb 03, 2015

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Answered by Elmore Medical Vein & Laser Treatment Center

The most important things to reduce discomfort after EVLT are compression stockings and walking. Going without compression stockings even for a short period of time while awake can increase discomfort. We have our patients wear stockings for a minimum of 3 weeks. We also tell our patients anytime they get stiff or sore to walk. Two 30 minute walks daily is our requirement. Trapped blood (clot) in a treated vein is a common part of healing and will reabsorb over time. Ice packs are also helpful.

Published on Jul 11, 2012


Answered by Vein Specialties of St. Louis

With EVLT, there can be a couple days around the 2 week mark when you may have a little increase in discomfort due to deeper inflammation resolving and small nerve endings "waking" up. We recommend our patients massage the area to desensitize the nerves and promote circulation. Wearing compression hose is also helpful, as well as low heat to the area as often as possible (10 mins every hour in a perfect world). If concerned, seek a second opinion or return to your surgeon.

Published on Feb 03, 2015

Answered by Vein Specialties of St. Louis (View Profile)

With EVLT, there can be a couple days around the 2 week mark when you may have a little increase in discomfort due to deeper inflammation resolving and small nerve endings "waking" up. We recommend our patients massage the area to desensitize the nerves and promote circulation. Wearing compression hose is also helpful, as well as low heat to the area as often as possible (10 mins every hour in a perfect world). If concerned, seek a second opinion or return to your surgeon.

Published on Jul 11, 2012


Answered by Georgia Vascular Institute

If the pain is along the tract of the EVLT, this may be secondary to thrombophlebitis, or inflammation of the vein. This is relatively common after EVLT. The clot he is referring to is in the treated vein, which is normal. You can try warm compresses at the site for about 15 minutes, three times a day along with Ibuprofen. If this doesn't improve, the clot may have to be removed for relief.

Published on Feb 03, 2015

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Answered by Georgia Vascular Institute

If the pain is along the tract of the EVLT, this may be secondary to thrombophlebitis, or inflammation of the vein. This is relatively common after EVLT. The clot he is referring to is in the treated vein, which is normal. You can try warm compresses at the site for about 15 minutes, three times a day along with Ibuprofen. If this doesn't improve, the clot may have to be removed for relief.

Published on Jul 11, 2012


Answered by Restoration Vein Centers

In the past 10 years, I have never seen what you are describing. Post-procedure pain usually peaks at 3-5 days but even then, it isn't described as a sharp pain. The procedure is intended to clot the vein, but this may be different than a deep blood clot. At this point, you should consider being re-evaluated by your or another vascular surgeon and have a Doppler to evaluate the status of your treatment.

Published on Feb 02, 2015

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Answered by Restoration Vein Centers

In the past 10 years, I have never seen what you are describing. Post-procedure pain usually peaks at 3-5 days but even then, it isn't described as a sharp pain. The procedure is intended to clot the vein, but this may be different than a deep blood clot. At this point, you should consider being re-evaluated by your or another vascular surgeon and have a Doppler to evaluate the status of your treatment.

Published on Jul 11, 2012


Answered by Vascular Center and Vein Clinic of Southern Indiana

Patients with chronic venous insufficiency commonly undergo venous ablations for relief of the symptoms. Most patients do respond favorably to the procedure by having a reduction in leg pain and swelling. In the immediate post-procedural period, some patients have an inflammatory state that typically responds to anti-inflammatory medications. Wearing compression stockings helps with relief of symptoms. However, risks of EVLTs may include deep vein thrombosis, nerve injury, and in rare cases infection.

Published on Feb 02, 2015

Answered by Vascular Center and Vein Clinic of Southern Indiana (View Profile)

Patients with chronic venous insufficiency commonly undergo venous ablations for relief of the symptoms. Most patients do respond favorably to the procedure by having a reduction in leg pain and swelling. In the immediate post-procedural period, some patients have an inflammatory state that typically responds to anti-inflammatory medications. Wearing compression stockings helps with relief of symptoms. However, risks of EVLTs may include deep vein thrombosis, nerve injury, and in rare cases infection.

Published on Jul 11, 2012


Answered by Vein Specialty Medical Clinic, Inc.

Trapped, thrombosed (clotted) blood is a common reason for pain after EVLT and all linear laser ablations. It is much less common with radial laser systems. The condition can cause annoying pain for weeks & is usually in the lower half of the thigh & knee. A follow-up ultrasound is diagnostic. Ultrasound-guided aspiration of all or most of the clot under local anesthesia must be done. This is very routine and helps lessen pain remarkably. In my experience, radial laser is tolerated better.

Published on Feb 02, 2015

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Answered by Vein Specialty Medical Clinic, Inc.

Trapped, thrombosed (clotted) blood is a common reason for pain after EVLT and all linear laser ablations. It is much less common with radial laser systems. The condition can cause annoying pain for weeks & is usually in the lower half of the thigh & knee. A follow-up ultrasound is diagnostic. Ultrasound-guided aspiration of all or most of the clot under local anesthesia must be done. This is very routine and helps lessen pain remarkably. In my experience, radial laser is tolerated better.

Published on Jul 11, 2012


Answered by Optima Vein Care

Typically, pain after the EVLT or other endothermal ablation procedures progressively decreases after the first 7 to 10 days. Some patients do experience pain for a longer period, but typically after 4 to 8 weeks the pain should be resolved. If NSAIDs are insufficient, stronger pain medications can be utilized. I am not sure what your vascular surgeon was indicating by a clot? Go back to him or her and discuss this further.

Published on Feb 02, 2015

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Answered by Optima Vein Care

Typically, pain after the EVLT or other endothermal ablation procedures progressively decreases after the first 7 to 10 days. Some patients do experience pain for a longer period, but typically after 4 to 8 weeks the pain should be resolved. If NSAIDs are insufficient, stronger pain medications can be utilized. I am not sure what your vascular surgeon was indicating by a clot? Go back to him or her and discuss this further.

Published on Jul 11, 2012


Answered by Advanced Vein Center

This kind of pain is very unusual. I hope he re-examined your leg with ultrasound. Ask for something stronger for pain and continue wearing the compression hose.

Published on Feb 02, 2015

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Answered by Advanced Vein Center

This kind of pain is very unusual. I hope he re-examined your leg with ultrasound. Ask for something stronger for pain and continue wearing the compression hose.

Published on Jul 11, 2012


Answered by Cosmetic Vein Centers of Texas

The ultrasound picture after EVLT always looks like a clot. The vein will slowly shrink over six months. High dose ibuprofen 600-800 mg three times a day is the best treatment after this procedure. The sharp pain may be from local sensory nerve involvement with the laser treatment. This pain will lessen over time as well.

Published on Feb 02, 2015

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Answered by Cosmetic Vein Centers of Texas

The ultrasound picture after EVLT always looks like a clot. The vein will slowly shrink over six months. High dose ibuprofen 600-800 mg three times a day is the best treatment after this procedure. The sharp pain may be from local sensory nerve involvement with the laser treatment. This pain will lessen over time as well.

Published on Jul 11, 2012


Answered by Mercy Imaging Centers

Pain persisting this long is unusual. If you were my patient, I would aspirate your treated vein with a needle to try to remove some of the fluid that is often with the clot to decrease pressure and rule out the (unlikely) possibility of an infection. You could also try increasing the NSAIDs to 1,000 mg ibuprofen or equivalent every 6 hours (with food!) and alternate with tylenol (or acetominophen) to a strict limit of 3,000 mg per day. Tylenol and NSAIDs team up well. The clot can't be removed

Published on Feb 02, 2015

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Answered by Mercy Imaging Centers

Pain persisting this long is unusual. If you were my patient, I would aspirate your treated vein with a needle to try to remove some of the fluid that is often with the clot to decrease pressure and rule out the (unlikely) possibility of an infection. You could also try increasing the NSAIDs to 1,000 mg ibuprofen or equivalent every 6 hours (with food!) and alternate with tylenol (or acetominophen) to a strict limit of 3,000 mg per day. Tylenol and NSAIDs team up well. The clot can't be removed

Published on Jul 11, 2012


Answered by Aesthetic Surgery and Dermatology offices of Adrienne E. Stewart MD

Sorry, we only treat cosmetic vein exposures not varicose veins. I would stay in touch with the office who performed your treatment or seek a second opinion ASD.

Published on Feb 02, 2015

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Answered by Aesthetic Surgery and Dermatology offices of Adrienne E. Stewart MD

Sorry, we only treat cosmetic vein exposures not varicose veins. I would stay in touch with the office who performed your treatment or seek a second opinion ASD.

Published on Jul 11, 2012


Answered by The Sheen Vein Institute

I am guessing that your clot is not a DVT. That said, when I treat a person with EVLT, I will inject all of the refluxing branches in that leg that can be visualized with ultrasound. Failure to do this in a person with a lot of vein disease can result in persistent pain in that leg because these veins are putting pressure on the treated vein. Your doc just needs to treat those internal veins and the pain resolves within a few days.

Published on Feb 02, 2015

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Answered by The Sheen Vein Institute

I am guessing that your clot is not a DVT. That said, when I treat a person with EVLT, I will inject all of the refluxing branches in that leg that can be visualized with ultrasound. Failure to do this in a person with a lot of vein disease can result in persistent pain in that leg because these veins are putting pressure on the treated vein. Your doc just needs to treat those internal veins and the pain resolves within a few days.

Published on Jul 11, 2012


Answered by California Vascular Care

It is very important that you ask your vascular surgeon if the clot is in the superficial vein or deep vein. There are different treatments for different type of blood clots. We have not had patients who have experienced that much pain. Did the surgeon inject you with a anesthetic and maybe he hit a nerve? If so, it will likely take a while for the pain to subside.
Please go back to discuss these concerns with your surgeon.

Published on Feb 02, 2015

Answered by California Vascular Care (View Profile)

It is very important that you ask your vascular surgeon if the clot is in the superficial vein or deep vein. There are different treatments for different type of blood clots. We have not had patients who have experienced that much pain. Did the surgeon inject you with a anesthetic and maybe he hit a nerve? If so, it will likely take a while for the pain to subside.
Please go back to discuss these concerns with your surgeon.

Published on Jul 11, 2012


Answered by The Vein Clinic

Talk to your DR about the option of using a higher dose of pain reliever and using compression stockings during the day.

Published on Feb 02, 2015

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Answered by The Vein Clinic

Talk to your DR about the option of using a higher dose of pain reliever and using compression stockings during the day.

Published on Jul 11, 2012


Answered by Smith Vein Institute, LLC

I'm not sure precisely what he means by "you have a clot." He may be referring to a tributary branch that has clotted off, which is very common. Besides NSAIDs, my patients often get additional pain relief by applying Arnica Montana cream or gel to the affected area. You can find it at most health food/vitamin stores. Additionally, Walmart carries it under the brand name Arnicare. It's also helpful to keep active and walk or exercise daily, as this speeds up the healing process.

Published on Feb 02, 2015

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Answered by Smith Vein Institute, LLC

I'm not sure precisely what he means by "you have a clot." He may be referring to a tributary branch that has clotted off, which is very common. Besides NSAIDs, my patients often get additional pain relief by applying Arnica Montana cream or gel to the affected area. You can find it at most health food/vitamin stores. Additionally, Walmart carries it under the brand name Arnicare. It's also helpful to keep active and walk or exercise daily, as this speeds up the healing process.

Published on Jul 11, 2012


Answered by Texas Vein And Cosmetic Specialists

A clot can mean different things. A blood clot usually implies a clot in the deep vein. If that were the case, then you would likely be on blood thinners. If by clot, he meant the vein he treated or clotted varicose veins, this responds to heat and compression. Occasionally, I will make a small incision and release the clotted blood in the varicose veins or treated vein, if someone is symptomatic. Return to your treating physician and discuss this with him or her further.

Published on Feb 02, 2015

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Answered by Texas Vein And Cosmetic Specialists

A clot can mean different things. A blood clot usually implies a clot in the deep vein. If that were the case, then you would likely be on blood thinners. If by clot, he meant the vein he treated or clotted varicose veins, this responds to heat and compression. Occasionally, I will make a small incision and release the clotted blood in the varicose veins or treated vein, if someone is symptomatic. Return to your treating physician and discuss this with him or her further.

Published on Jul 11, 2012


Answered by Lakeshore Veins and Wellness

It is somewhat unusual to have sharp pain 2-3 weeks post-EVLT. I do recommend you are seen again by your vascular surgeon. It is possible to express coagulum from a superficial clot to relieve pressure and decrease pain if that is the cause of your symptoms.

Published on Feb 02, 2015

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Answered by Lakeshore Veins and Wellness

It is somewhat unusual to have sharp pain 2-3 weeks post-EVLT. I do recommend you are seen again by your vascular surgeon. It is possible to express coagulum from a superficial clot to relieve pressure and decrease pain if that is the cause of your symptoms.

Published on Jul 11, 2012


Answered by Vanish Vein and Laser Center

The symptoms you describe do occur occasionally after a closure procedure. Everyone has different levels of pain tolerance. Wet heat to the treated vein may help and, if necessary, tylenol with codeine or percocet would give you more pain control. If you have palpable nodules along the course of the treated vein, these can be drained with local anesthesia and a small needle.

Published on Feb 02, 2015

Answered by Vanish Vein and Laser Center (View Profile)

The symptoms you describe do occur occasionally after a closure procedure. Everyone has different levels of pain tolerance. Wet heat to the treated vein may help and, if necessary, tylenol with codeine or percocet would give you more pain control. If you have palpable nodules along the course of the treated vein, these can be drained with local anesthesia and a small needle.

Published on Jul 11, 2012


Answered by North Shore Vein Center

I am assuming that he is saying there is a "clot" within the ablated vein. If this is the case, then the pain you subscribe can be normal. The nerve runs very close to the vein as well. Many times we offer patients a short course of a Medrol dose pack to quiet the inflammation if NSAIDS are ineffective. This, along with stockings and time, should be enough.

Published on Feb 02, 2015

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Answered by North Shore Vein Center

I am assuming that he is saying there is a "clot" within the ablated vein. If this is the case, then the pain you subscribe can be normal. The nerve runs very close to the vein as well. Many times we offer patients a short course of a Medrol dose pack to quiet the inflammation if NSAIDS are ineffective. This, along with stockings and time, should be enough.

Published on Jul 11, 2012


Answered by Advanced Vein & Vascular Center Inc.

It sounds as if you have a more severe case of phlebitis. There really is no other way to address this other than consistent round-the-clock use of NSAIDs, hot compresses, and time. Sadly, it can take weeks or months to resolve. Without actually seeing the results of your examination this is all we can tell you. Seek a thorough evaluation from a board certified vascular surgeon.

Published on Feb 02, 2015

Answered by Advanced Vein & Vascular Center Inc. (View Profile)

It sounds as if you have a more severe case of phlebitis. There really is no other way to address this other than consistent round-the-clock use of NSAIDs, hot compresses, and time. Sadly, it can take weeks or months to resolve. Without actually seeing the results of your examination this is all we can tell you. Seek a thorough evaluation from a board certified vascular surgeon.

Published on Jul 11, 2012


Answered by East Tremont Vascular

The pain you have is quite common after ELVT if it is around the medial thigh. It should subside gradually. If your vein was of a large diameter and also superficial, then a microthrombectomy under local anesthesia could give you pain relief, along with anti-inflammatory medications and warm compress.

Published on Feb 02, 2015

Answered by East Tremont Vascular (View Profile)

The pain you have is quite common after ELVT if it is around the medial thigh. It should subside gradually. If your vein was of a large diameter and also superficial, then a microthrombectomy under local anesthesia could give you pain relief, along with anti-inflammatory medications and warm compress.

Published on Jul 11, 2012


Answered by Beach Cities Vein and Laser Center

The degree of pain that is experienced after EVLT depends on a number of factors, including which laser was used, how much energy was delivered, how superficial the vein is, as well as the individual's pain tolerance. Everyone who undergoes EVLT forms a clot in the vein, so don't be alarmed by this. Wearing stockings and taking ibuprofen also helps (as you know). Other options include Vicodin or puncturing the vein with an 18 gauge needle and draining the clot.

Published on Feb 02, 2015

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Answered by Beach Cities Vein and Laser Center

The degree of pain that is experienced after EVLT depends on a number of factors, including which laser was used, how much energy was delivered, how superficial the vein is, as well as the individual's pain tolerance. Everyone who undergoes EVLT forms a clot in the vein, so don't be alarmed by this. Wearing stockings and taking ibuprofen also helps (as you know). Other options include Vicodin or puncturing the vein with an 18 gauge needle and draining the clot.

Published on Jul 11, 2012

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