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!

Doctor Answers 7

It depends on what is meant by "Main Veins".

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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.

Bay Area General Surgeon

Feeding Veins are important to treat first.

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What you appear to be describing are feeding(reticular or blue veins).  Think of your veins like a tree with the trunk being the saphenous vein system, the branches being the reticular or blue feeding veins and the leaves being the spiders.  Treating the spider veins alone will have a high recurrence rate if the reticular and/or saphenous system is malfunctioning.  If you have many reticular veins then these should be treated first. It may be wise to obtain a venous reflux ultrasound to evaluate any refluxing valves in the saphenous system before starting the sclerotherapy treatments.

John Landi, MD
Naples General Surgeon

Sclerotherapy technique - feeder veins first

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These are called feeder veins so that the veins leading to the spider veins and telangiectasias are treated before the surface veins are treated so that the treatment is 1) more effective and 2)  less likely to recur.

Who does the best job of sclerotherapy?

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Without knowing more about the office that you called, I would say that the best way to get your veins treated in an appropriate manner would be to consult a physician.

You can look for a dermatologist in your area or go to Vein Clinics of America...a "chain" of sorts but the physicians are trained to evaluate, with doppler , the need for deep vein treatment. Yes, getting rid of these first means that you will get better result with the superficial ones that are attached to them.  I can recommend them highly as I have been their patient also!!!

Beverly Johnson, MD
Silver Spring Dermatologic Surgeon

Only physicians should perform sclerotherapy

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While it is not regulated or required, it is my firm belief that only MDs should perform sclerotherapy. Over the years I have seen complications and improper injection techniques by people who are not MDs performing sclerotherapy. Before you do this procedure, I would clarify what she is injecting and why. The other MDs who have responded to your post are correct - main veins are not injected normally. Only small spider and reticular veins are injected with sclerotherapy.

Only physicians should inject leg veins

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I frequently treat the smaller, more unsightly leg veins quite successfully without touching the larger ones. No one other than a physician should be doing sclerotherapy, for all of the reasons already stated below. I personally do all of my patients' leg vein injections. Rather than asking the plastic surgeon to do something that they clearly prefer to delegate to someone else, I recommend you go to another office where the doctor does these treatments themselves.

Leg Vein Treatments Should Be Performed By MD Only

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I personally treat all of my leg vein patients myself as I feel that sclerotherapy (a treatment which requires experience, knowledge of the anatomy and proper training) should always be performed by a physician.  Therefore, I recommend you ask the plastic surgeon to perform the procedure rather than the nurse practitioner. Every individual is different and therefore every case treated differently, but in general, when it comes to sclerotherapy, you can choose to only treat the smaller, spider veins.  That being said, to really answer your question involves an evaluation and a more lengthy discussion which you should have with the plastic surgeon. 

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.