Should I Get Venous Doppler Studies Before Sclerotherapy?

While an ultrasound is helpful to determine your vein anatomy, it is not always necessary if you have mostly spider veins.  In my office, I perform the full range of vein procedures-- including endovenous ablation, microphlebectomy, and sclerotherapy.  While I always do an ultrasound on patients I suspect with larger vein issues, I do not perform ultrasound on all my patients with just spider veins.   A thorough clinical exam and history will tell me whether an... more

Most vein specialists would recommend venous doppler or Duplex Ultrasound Scanning prior to sclerotherapy. The exception would be for a person who only has small spider veins on the outer thigh. If you have leaky veins (reflux) and do not treat the underlying leaky or refluxing veins then the sclerotherapy is less likely to be effective. The advances in Duplex Ultrasound Technology and Endovenous Procedures has revolutionized the treatment of leg veins over the past 15 years.... more

Important considerations in sclerotherapy include the proper use of sclerosant solutions, but more importantly, the technique used for injection. Larger veins should be addressed prior to smaller end branches. As a fellow of the American College of Phlebology and a double board certified surgeon who is a Diplomate of the American Board of Phlebology and the American Board of Plastic Surgery, it is important for me to evaluate these venous patterns in a logical and comprehensive fashion... more

The experienced vein specialist should be able to detect during the first consultation if you need additional study before proceeding with the sclerotherapy. In some cases it might be necessary to get an ultrasound to make sure there is not a problem with a blood flow in the main vein. If such occurs it must get resolved first for the sclerotherapy to be effective.

If you only have small spider veins in the absence of signs/symptoms of venous insufficiency, it would be hard to justify obtaining a study that would likely show normal results. Most doctors who perform sclerotherapy do not obtain any studies for spider veins or small reticular veins in the absence of clinical evidence of venous insufficiency.

In my practice, for just spider veins without signs and symptoms of venous insufficiency, I don't get the studies.  In cases where I suspect that venous insufficiency exists, I would refer to a vascular surgeon who may order that work up.

Yes. Before elective vein procedures it is important to get Doppler studies to make sure that you don't have venous insufficiency, also called venous reflux disease. This ensures better success when this condition is excluded as it is less likely for you to have recurrence of spider veins, reticular veins, feeder veins and varicose veins once the venous reflux is treated and sclerotherapy is performed. Venous reflux is treated with VNUS Closure or EVLT.