Patient History and Consultation
- 76-year-old female presents with severe bilateral lower extremity swelling and discoloration. She also reported a heavy feeling in her legs which limited her ability to walk.
- Flaking skin with a non-healing wound on the right anterior shin. These changes have progressed over the past 6 years.
- CEAP 4B disease bilaterally.
- The patient has been using compression therapy for over 12 months.
Patient Plan and Treatment
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Doppler Ultrasound: Shows significant bilateral Great Saphenous vein reflux of 2 seconds or greater from saphenofemoral junction to below the knee Great Saphenous vein.
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EVLT: Bilateral Laser ablation of the Great Saphenous vein using tumescent anesthesia and conscious sedation. The legs were treated separately, about 3 weeks apart.
Patient Follow-Up
- The patient returned 8 weeks after treatment of both legs.
- Ultrasound was performed confirming occlusion of bilateral Great Saphenous veins.
- Significant improvement in swelling and discoloration.
- Near complete healing of right anterior shin wound.
- Improved skin texture.
- Improvement of heavy feeling and discomfort in legs. The patient is now able to walk more throughout the day.
Before and After Images
Discussion
- Our patient presented with skin changes and active non-healing wounds secondary to chronic venous insufficiency. This affected her ability to walk throughout the day.
- Doppler ultrasound diagnosed bilateral GSV insufficiency.
- EVLT was performed with mild sedation in an outpatient office. Procedure time 20 minutes.
– Alternative treatments include VenaSeal, Sclerotherapy, etc. - 8-week initial follow-up shows significant improvement in leg swelling, discoloration, and skin texture. Wounds are also almost completely healed.
- Improved ability to walk, improved quality of life.