My name is Dr. Thomas Wright. I am a board-certified phlebologist, a certified vascular sonographer, and the medical director of Laser Lipo and Vein Center. Here are some questions I have answered about varicose vein treatment.

Q: I had a phlebectomy that was not successful, then laser ablation and sclerotherapy within 2 months of eachother. I now have shooting pains in my leg...is this something that is normal?
A: This is not typical. If the phlebectomy did not gice you any improvement in the appearance, that probably means they were not removed. If you noticed immediate improvement but then new varicose veins appeared, that would indicate that the underlying cause was not treated. That would be the purpose of laser ablation. Shooting pains in the leg could be part of the healing process or it is possible that a nerve injury has occurred. I would recommend discussing these symptoms with your doctor.

Q: I have some friends who've had varicose and spider vein treated, some with surgery and some with injections. Some people said that insurance covered it but others said that it didn't. What determines insurance coverage for vein treatments?
A: Varicose veins are part of a medical condition known as venous insufficiency and when sypmtomatic are usually covered by insurance. Some people may not even be aware of the some very common symptoms such as leg fatigue, tingling or restless in the legs and or swelling in the legs can be caused by venous insufficiency. The only way to know if you have venous insufficiency is to have an ultrasound evaluation. Spider veins without any symptoms are considered cosmetic and are not covered.

Q: From what I see online it seems that minimally-invasive options like endovenous ablation are always being recommended for varicose veins, and I can see why, but is there ever a time where surgery is preferred? Are there benefits to surgery?
A: From my perspective the times for when surgery is very limited. Possibly with an episode of acute superficial phlebitis involving the GSV near the junction would be one time when it might be considered. I cannot think of any major benefits or surgery over the minimally invasive procedures. Recurrences, complications, and patient acceptance are all better with the new less invasive surgeries.