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How much can my legs take??
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How much can my legs take??

I am 47 and have had varicose veins since my 20s! I had my first 'stripping' surgery when I was approx. 24. Over the years I've had sclerotherapy several times with varying degrees of success. Two years ago I underwent the new form of surgery with the laser to remove more of my large protruding veins. My question is, how many veins can be removed, destroyed before I don't have enough left? And why do they keep popping out?  It seems like I just get things to look relatively normal and a bunch more show up.
2827584_tn?1340583296
First things first. The only vessels that are treated with endovenous laser ablation are the ones that should have been stripped. Stripping is very specific. It refers to a procedure in which either the greater or lesser saphenous vein is tied off at it junction (either the groin or behind the knee) and the vessel pulled out via a second incision either at the knee or ankle for the greater or lower calf for the lesser saphenous vein. I see many patients giving me the history of a "stripping" where neither trunk was touched. All that was done was to make a bazillion incisions all over the leg and pluck out the branches without ever addressing the source. I can't address the specifics of your legs without more info but I would bet that you underwent your original surgery without any evaluation such as a doppler duplex study. This was followed by sclerotherapy with ongoing superficial venous reflux via an incompetent greater or lesser saphenous vein which results in recurrence in 90% of patients within 5 years. It sounds like you may have finally had appropriate evaluation because that would have been a necessity before performing an endovenous ablation.
In response to your question, the varicose veins are blown out veins carrying blood backwards and adding to the burden of the normal veins. Getting them out of the system lightens the load on the normal ones. The only exception is when the deep venous system is occluded and the varicosity is the only way blood can return to the heart. This should be obvious with an appropriate duplex doppler study. I strongly believe that no intervention should be made for varicose vein disease without first performing this study as it would not be uncommon to do the wrong thing and either not be successful or even make things worse. By the way, your initial surgery would have been about a decade after stripping had become an office procedure everywhere else in the world. The technique of removing the branches through mere needle holes in the office was described in 1975. The stupidous thing in the world was to put people under general anesthesia which dilates these veins and then rip them out. The recovery was significantly longer than using tumescent anesthesia which constricts all the vessels and results in little or no bleeding and little or no down time.
I guess I've ranted enough. It is frustrating to bat "clean up" after inappropriate therapy for vein disease. You get one shot to do it right. It can be frustrating because of the plasticity of the system but, by following a consistent algorithm, excellent results can be obtained.
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Thank you for your response.  I honestly don't remember if I had a doppler study before my first surgery.  But you're correct, I have a bazillion scars from all the incisions from that one.  I definitely had the doppler before the recent ablation and the recovery time was much shorter and much easier with that procedure! It's just frustrating to me because even after having had that done -- and things do look so much better -- I am still getting new veins popping out here and there.  I guess it's just a lifelong problem I have to deal with.  And I do realize there are a lot worse things out there I could have been burdened with.  Thank you again for your time.
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2827584_tn?1340583296
The good news is that if a proper job was done to ablate the truncal reflux, then any recurrent veins are typically due to failures of perforating veins and appropriately treated with sclerotherapy.
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