Do I need surgery for a defective valve in my leg?

Q: I am 26 years old and have varicose veins since childhood. I never had a problem till recently. I got SVT (superficial vein thrombosis) in my right leg where I had the varicose veins. The lump was under my right knee. My colour Doppler results said that I have a defective valve in my right leg which caused this. I am cured of the SVT. I have recently got married. Should I get operated for my valve before I get pregnant or should I have a child first? Is laser treatment or conventional operation better?

A:There are two factors that I would like to consider; one, that the young lady has mentioned that she has had varicose veins from the childhood and two, the fact that she has had superficial venous thrombosis. The first issue is that one has to think of venous malformation like (Klippel Trenauney Syndrome) or even A-V malformation. If she has one of these conditions, then simple varicose vein surgery will not be successful. She will need an opinion from a vascular surgeon and if he suspects the same, then further investigations are needed. Regarding the superficial vein thrombosis; it may well be a straight forward thrombosis in the varicose veins but one cannot ignore the possibility of thrombophilia (Anti Phospholipid Syndrome). Since this lady is talking of getting pregnant it is imperative to exclude this condition, as this may well have a bearing on the fetal survival. Also she has to be careful during pregnancy about the Deep Venous Thrombosis and take precautions for the same. Regarding the operation by laser, I feel the expertise worldwide is limited so I personally do not think it is tested enough to be recommended for common use. The laser treatment should still be restricted for research institutions and for defined experimental cases and controlled trials.