Often times our female patients have both leg varicose veins and pelvic varicose veins. Although these veins are in different locations both sources can be symptomatic to the patient. The question then becomes “which do I treat first?”
The problematic veins although similar in pathology and symptoms are treated in different methods. The legs are treated as an in office procedure involving the use of EVLA, sclerotherapy, and ambulatory phlebectomy. The pelvic veins are treated with a same-day hospital procedure called a venogram with coil embolization. The goal with both procedures is to close down incompetent veins that cause the symptoms. And while these are very different procedures often both procedures need to be performed to reduce the symptoms. The question of which procedure to do first really comes down to which problem is causing you the most pain.
There is not a 100% right or wrong answer to this question and so mostly it is a judgment call on the patient’s part. There are a few cases where the doctor may have a reason to treat one problem over the other but this is because it will be in the patient’s best interest.
Sclerotherapy uses ultrasound guidance to inject a medication into veins, causing the vein to scar and close permanently. This procedure is routinely used at IVC and patients want to know how this procedure compares to endovenous thermal ablation (EVTA) as far as pain caused during the procedure and recovery time after the procedure.
The sclerotherapy procedure often involves multiple injections along the course of the the problematic veins. These injections utilize a very small needle so most patients tolerate the procedure very well. Patients often ask if a local numbing agent could be used to anesthetize the area before the injection of the sclerosing agent. This technique is not used as this would require two needle sticks, one needle stick to inject a numbing agent and another needle stick to inject the sclerosing agent. In general most patients tolerate the sclerotherapy procedure well and do not need any anesthetic agent. Though most patients find both EVTA and sclerotherapy very tolerable, patients often find sclerotherapy the easiest of the procedures we perform.
Post-procedure pain is usually localized to the area where the vein was injected. This pain is not nearly as intense as the pain following the EVTA but will be noticeable for longer. In fact it may take several weeks for the veins to be resolved by the body. During this time you may experience tenderness from these areas. A mild pain reliever like ibuprofen helps but really the biggest factor is giving the body time to resolve the treated veins.