Question:
My first posting to this group. Feedback from both non-profesionals who have been in a similar situation as well as if there are any vascular surgeons reading this group (especially those who do, or are familar with Endovenous Laser Treatment). Here is my situation. I have a venous ulcer on my right foot. I am being treated by a vascular surgeon using "una boots" and he has also tried the new growth factors like Regranex. The ulcer will not completely heal. The surgeon did a duplex scan and it was determined that I have alot of refluxing in the lesser saphenous vein (also known as the "small saphenous vein") there are also 2 faulty perforator veins and also one vein problem in the "deep system". The vascular surgeon wants to do a vein stripping of the lesser saphenous vein. He says that surgeons rarely go into the deep system, and as far as the 2 perforators, "they usually take care of themselves" (in other words, he feels that they usually get better on their own once the major reflux source is removed). He said: worst case scenerio, we might have to go in at a future time to do the perforators, but he feels there is a good chance we won't need to. I read about the newer operation: Endovenous Laser Treatment, in which the vein is sealed by laser instead of being removed (much less invasive then stripping). I went to a radiologist that does it and he did a duplex scan. He says I am a candidate, but thought I would be better off staying with the vascular guy because he thought he would be doing both vein and perforators. (which is not the case). Question: Would I be better off getting the Endovenous Laser for the vein and if necessary, in the future, pursue getting the perforators taken care of (if needed) or: Would I be better off staying with the vascular surgeon, let him just strip the lesser vein, and if needed, have him do the perforators in the future? (the radiologist, of course, would not be able to do any surgery for the perforators)..... All feedback will be welcome. And especially, if there any vascular surgeons who also do EVLT (Endovenous Laser Treatment).

Answer: I have no experience with EVLT. It's one approach to ablating the saphenous system. IMHO, a superior treatment is VNUS, which uses radiofrequency to warm, collapse and ablate the vein. State of the art in treatment of varicose veins would be VNUS to ablate the saphenous system and Trivex to remove the incompetent perforators. Clearly superior to the old concept of saphenous vein stripping and stab avulsion.