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Question from a young mother with Varicose Veins

Q. I am a 33 yr old mother of two with varicose veins on both of my calves.  I walk my children to school and these veins are causing me a great deal of discomfort.  I have waited to have these treated until I was sure I was done having children.  What is the chance of them reoccurring after surgery?  I also have some spider veins.  What criteria do I have to meet  for this to be covered by insurance?  In my mind this is not cosmetic…but I am concerned that the insurance agency might disagree.

A. Although you mention discomfort, you did not mention specifically what you are experiencing.  The symptoms most commonly associated with venous insufficiency (varicose veins) are pain, which might be described as aching, throbbing, stinging, or burning.  Additionally, patients also commonly suffer from leg swelling, cramping (aka Charlie Horse), leg fatigue and heaviness, itching, and restless legs.  Venous insufficiency is most often inherited; do you have a family history of varicose veins?   Working in an occupation that requires standing for prolonged periods of time also places you at a higher risk (i.e., nurse, bank teller, school teacher, cosmetologists).

In regard to recurrence of varicose veins, it is possible that you may develop reflux (blood moving toward the foot) in veins that do not currently have any issues with insufficiency.  For instance, the two veins typically responsible for varicose veins are the great saphenous vein and the short saphenous vein.  Suppose you had reflux in one of the veins, but not both.  There is a possibility that you might develop reflux in the vein that is now functioning normally.  There is also a risk that a treated vein could re-open (aka recanalize) some time after the procedure.

There are two types of endovenous ablation:

1.  Endovenous laser thermal ablation

2.  Endovenous radiofrequency ablation

We perform only endovenous laser thermal ablation, as our experiences have demonstrated the risk of the veins re-opening almost non-existent.  Radiofrequency laser ablation is known to offer a less painful recovery, however we have found there is a much greater risk of the veins re-opening, so it is not a procedure we choose to offer.

All patients are evaluated by the clinic’s physician assistant to determine if they have disease that requires evaluation by ultrasound.   The ultrasound is typically covered by insurance if you have symptoms and your physical exam demonstrates evidence of varicose veins.  Once the ultrasound is done, the findings will be evaluated by one of our radiologists.  If reflux is present in your great or short saphenous vein and you are suffering symptoms, most often insurance will cover treatment.