We present a woman with severe symptomatic recurrent
varicose veins who was treated with endovenous
laser ablation and transluminal occlusion of perforator with attempted phlebectomies for extensive
varices. The phlebectomies turned out to be near impossible due to friability of the veins. Her treatment was completed with post-operative ultrasound guided foam
sclerotherapy seven months later. She was subsequently diagnosed as
Ehlers Danlos syndrome type IV. A duplex ultrasound scan 18 months post-endovenous
laser ablation and transluminal occlusion of perforator and 11 months after ultrasound guided foam
sclerotherapy confirmed successful closure with virtual
atrophy of all treated veins. She was found to be reflux free and only showed a few scattered cosmetic reticular veins. Open
varicose vein surgery has been reported as being hazardous in the past in a patient with
Ehlers Danlos syndrome type IV. Our experience has shown that endovenous
laser ablation, transluminal occlusion of perforator and ultrasound guided foam
sclerotherapy appear to be effective in treating this patient with
Ehlers Danlos syndrome type IV, although phlebectomies were technically impossible.