Comprehensive Approach Resolves Complex Venous Reflux

Patient: Female, 72 years old
Date of Initial Presentation: Prior to staged treatments
Procedures: Multiple vein treatments, including endovenous ablation and Varithena® injections

Background:
Diane, a 72-year-old woman, had long-standing varicose veins and symptoms affecting her legs. She experienced bulging veins along the sides of her thighs and calves, leg swelling and heaviness, and a unique pain described as “painful pedicures.” She also reported tenderness over her calves and ankles and frequent nighttime urination, which resolved after treatment.

Diagnosis and Testing:
Ultrasound exams showed significant reflux, meaning blood was flowing backward in both her great saphenous veins (GSV) in each leg. There was also reflux in her left anterior accessory saphenous vein, but no evidence of deep vein blockage.

Treatment Timeline:

Stage 1: Ablation (using heat) of the left GSV and AASV to stop reflux.

Stage 2: Ablation of the right GSV.

Stage 3: Ultrasound-guided Varithena® treatment to close the small residual vein in her right lower leg below the knee, which resulted in nearly complete closure with only minor reflux remaining.

Stage 4 (Current Visit): Final ultrasound-guided Varithena® treatment of the residual vein in her left lower leg.

Results:
Following these staged procedures, Diane experienced:

• Complete resolution of leg swelling and tenderness
• Normalized sensitivity in her calves and ankles
• Her nocturnal urination stopped
• She achieved good cosmetic appearance of her legs

She expressed high satisfaction with her results and is interested in cosmetic sclerotherapy for small residual visible veins called telangiectasias

Discussion:
This case shows how a planned, step-by-step approach to treating venous reflux can result in significant symptom relief and improved leg function. Her “painful pedicures” were a sign of severe distal venous pressure and inflammation, demonstrating how distal symptoms can be linked to underlying reflux. The combination of staged ablation and targeted Varithena® injections provided comprehensive correction of abnormal blood flow, leading to her impressive recovery.