Jeffrey S. Stein, MD

Unfortunately it is not unusual or "abnormal" for varicose veins to recur many years after having procedures to treat superficial venous insufficiency. There can be many reasons for this and sometimes they are treatable. Over time you can develop deep venous insufficiency, or an accessory vein that was inconsequential can enlarge and cause symptoms or the appearance of surface varicosities. Weight gain and the use of steroids can accelerate this process. It would probably be worthwhile to follow up with your vascular surgeon.

Most patients with varicose veins can be adequately evaluated using venous duplex ultrasound from the level of the groin crease and below. There are circumstances where a CT scan or MRV might be needed and valuable before proceeding with treatment. If your examination or history suggests a problem above the groin crease then these tests may be necessary. If you have a prior history of blood clots or varicose veins involving the labia, lower abdomen, or buttocks then a CT scan/MRV may be important to determine if there is a blockage or venous insufficiency in the veins of the pelvis or abdomen. An ultrasound is more than adequate in the case of routine varicose veins.

There is generally no need to discontinue or change your HRT therapy before or after routine sclerotherapy or spider veins. 

If you are having a more involved procedure like saphenous vein ablation then your surgeon may wish you to discontinue HRT in the period immediately before and after the procedure. Unfortunately there is not much reliable data on this situation though many surgeons and patients "would rather be safe than sorry".

Spider veins can appear on your ankles as a result of venous reflux in the saphenous vein. They can also occur without reflux being present. The fact that your spider veins are most prominent at the level of the ankle suggests that they are the result of a poorly functioning saphenous vein. Your vascular surgeon properly examined the venous circulation to determine if reflux is present so that the proper treatment is recommended.

You can certainly have sclerotherapy without having the other procedures. Unfortunately, if the spider veins are caused by the underlying problem of saphenous insufficiency the results of sclerotherapy are not likely to be long lasting and more veins are likely to appear over the next 6-12 months. "Chasing" these new veins with further sclerotherapy is likely to become expensive and not very effective. Treating the saphenous reflux as a first step removes the underlying cause that produces the spider veins and will improve the results of sclerotherapy while reducing the chances of new spider veins appearing.

If the results of the ultrasound are correct you are probably best off having an ablation of the saphenous vein before proceeding with sclerotherapy to achieve the best, and longest lasting results. If you are hesitant to proceed with intervention you might want to consider getting another ultrasound at an independent, accredited vascular lab which does not stand to gain financially if the results show reflux.

Good luck whatever you decide to do.

J.S. Stein, M.D.

Epic Vein and Vascular Center, Inc.

Forehead veins may be appropriately treated with either microsurgical phlebectomy or sclerotherapy. Both methods give good results with a low risk of complications. It is very important to be examined by a qualified and experienced specialist prior to the procedure to be sure that these are actually veins (and not arteries) and to assess whether there is an underlying condition that caused the problem.