Bay Area General Surgeons

Normal To Treat The "Main Veins" During Procedure for Sclerotherapy Rather Than The Spider Veins?

I am scheduled to have sclerotherapy on the spider veins in my legs. A nurse practitioner for a plastic surgeon is doing the procedure. She said she would need to treat the "main" veins feeding the spider veins. I have seen nothing in the literature noting the need for this. Is this accurate? I don't want unneccesary or dangerous work done. I thought just the spider veins would be treated (?). Can you advise? Thanks!

She is right that you should have the reticular veins that drive the spider veins treated. Without doing that, the spider veins are likely to recur. The spider veins are in the skin, the reticular veins are under the skin. The reticular veins are not, however the "main veins". These have names like greater,  lesser saphenous or perforating veins. When the treatment involves these veins, things can start to get dangerous. The danger comes from blocking off major outflow veins or from producing thrombosis in the deep venous system (DVT or Deep Venous Thrombosis). 

A sclerotheraputic agent that will not cause these larger veins to thrombose is a real advantage. Polidochanol is such an agent.

So it really does depend on what "main veins" means.I hope this helps.

Robert Swanson, MD

Bay Area General Surgeon

Are Procedures to Remove Vericose Veins Covered by Most Insurance Providers?

They do not bother me, aside from the fact that I hate having them on my legs. They've gotten really bad since I had a baby six months ago.

Most insurance plans have specific exclusions for cosmetic procedures. Each plan may use different language, but the end result is the same. Unless you are having a lot of pain that interferes with your daily activities, your insurance plan will probably consider any treatment for varicose veins as cosmetic, and as such it will not be covered. It sounds as though you would not qualify for insurance reimbursement - regardless of how ugly they are.

Robert Swanson, MD

Bay Area General Surgeon

Is Asclera (polidoconal) a Safer Sclerosant Than Sodium Tetradecyl Sulfate?

I had an anaphylactic reaction to scerosing agent sodium tetradecyl and now need more treatment. I possibly reacted to the preservative benzyl alcohol. Is polidoconal safer?

Although it is generally safer and less allergenic, the fact that you had a life-threatening reaction suggests that you should not have either agent - ever.

A good choice for you might be laser treatment of the feeding reticular veins - more painful and more treatments than with Polidocanol - or hyper tonic salt solution injected directly into the visible and offending spider veins. This will back fill the reticular vein feeders. I did this alone for years before I got and then abandoned a laser.

Hypertonic saline has very small amounts of hydrochloric acid and small amounts of sodium hydroxide - neither of which causes allergic reactions. There is also a miniscule amount of aluminum that should not cause a problem.

I now do a combination of Polidocanol for the feeding reticular veins and 23.4% salt solution for the spiders. The concentration of salt in the blood is only about 0.9%. The osmotic load with this concentration of hyper tonic saline is enormous and will usually destroy the reticular vein feeders - if they are not too big. Before I started using polidocanol, I used to get to them by filling the spiders and back filling the reticulars.

Hypertonic saline is very safe to use, but by knocking out the feeders with polidochanol, the spiders will gradually fade away. This is my first choice because it has the least problems.

Think twice before you let anyone inject anything that could kill you. Better yet, don't do it.

Robert Swanson, MD

Bay Area General Surgeon