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How much better is endovenous laser treatment than sclerotherapy?

This question was asked in Brookfield, Illinois and has 4 answer(s) as of 03/17/2015.
My wife needs ultrasound guided sclerotherapy behind her knee. She has had it done successfully close to the surface of the skin, but this is the first time it must be ultrasound guided. Our insurance will only cover the UGS, not endovenous laser treatment. The doctor said if it was him, he would rather have the endovenous laser treatment. Is the laser treatment worth the thousands out of pocket we would have to spend?


Doctors Answers (4)

We do not do endo laser therapy, but use radio frequency energy. It is easily confused and is of little difference in our opinion; the endo treatment is superior to sclerotherapy in that it lasts longer and feels better to the patient. It is not clear which specific vein you are considering, as that has some bearing on the technology choice. It is difficult to give more detail without seeing the ultrasound report.

This depends upon which vein is being treated. If it is a more superficial branch, perforator veins or the thigh extension vein, then USGS could be an option. If it is the short saphenous veins, then insurance typically covers it. Medicare and all carriers usually approve this for the long or short saphenous. Many carriers do not cover ablation to other veins.

Ultrasound guided sclerotherapy and endovenous laser treatment are used to treat different veins. Ultrasound guided sclerotherapy (UGS) is used to treat tributaries of the saphenous veins and often requires two or three treatments, while endovenous laser treatment (ELT) is used to treat the saphenous veins itself but usually only needs to be done once. I do not know the details of your condition, but for the appropriate vein it is a excellent option.

It is difficult to answer your question about which is the better choice without knowing more about the vein to be treated and its location. However, for treating venous reflux in the saphenous trunks which does include the small saphenous vein (SSV) along the back of the calf of the lower leg up to and possibly past the back of the knee, then the endovenous laser is CLEARLY SUPERIOR in closing those relatively high pressure problem veins. For lower pressure branch varicose veins, the ultrasound guided foam sclerotherapy is very good, once the main source has been treated (usually a saphenous vein or perforating vein). Many insurance companies previously denied coverage of USG using a sclerotherapy foam (same chemical as used in conventional sclerotherapy, but converted into foam by adding a small amount of gas) as being "experimental" even after it had been used for decades, but changed their decisions as they found it to be a cheaper (although less effective for saphenous veins) alternative - but it is not always the appropriate treatment. Insurance companies can always decide what they are willing to reimburse for covered conditions, but deciding on a medical treatment should be a medical decision as well as a financial consideration.

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