What Doctor to Go to for Sclerotherapy?

Question

I had an ultrasound and doplar study done that showed blockage in my greater saphenous vein from my groin to mid-calf.  An interventional Radiologist will perform ELT on that leg.I'd also like sclerotherapy on my other leg (and on the ELT leg after the healing is complete.)  This will be performed by the same MD, the interventional radiologist, who works exclusively in the vein clinic.Is this advisable or is it recommended that the sclerotherapy be done by a dermatologist or plastic surgeon? Which would mean going to a different clinic?

Raffy Karamanoukian, MD, FACS · Answer

This is an important question. The field of vein treatment is a separate discipline, much like dermatology is different than gynecology. The American Board of Phlebology and the American College of Phlebology both have physician locators for physicians who are diplomates of the American Board of Phlebology. The board certifies experts who are proficient in comprehensive vein treatment and surgery.

Joel Gotvald, MD, FACS · Answer

It is wise that you question the doctor performing your vein treatments, as all vein doctors are not created equal.  The complexity of the condition helps determine how highly trained the specialist should be.  The only doctors which receive board-certification in vascular & vein diseases that is recognized by the American Board of Medical Specialties (ABMS) are vascular surgeons.  This is because this is the only specialty that completes a formal residency and fellowship in vascular and vein disease management and surgery.  Other doctors that perform vein treatments, including dermatologists and radiologists, are not board-certified in vascular surgery. Rather, they are board-certified in dermatology and radiology.  Their residency training are therefore typically in skin conditions and x-ray interpretation rather than vascular surgery.  Other certifcations in phlebology or vein disease are not recognized by the American Board of Medical Specialties, as their is no formal university residency or fellowship available for phlebology.   The most highly university trained vein doctors (in terms of number of years of formal medical university training in a formal residency and fellowship in vascular and vein diseases) are vascular surgeons.  Sclerotherapy itself is a fairly straight-forward vein procedure and can be performed by any qualified physician with experience in the procedure.  Although vascular surgeons typically have alot of experience in sclerotherapy, other types of doctors at various types of vein clinics often have adequate experience as well.  Maybe ask your primary care doctor for their recommendation, as it will vary based on the local medical community.

Hratch Karamanoukian, MD, FACS · Answer

It is important that you were evaluated for venous insufficiency and that the leaky vein will be treated using a laser (in your case). EVLT or endovenous laser therapy treats venous insufficiency by ablating (closing) a vein segment that is leaky or leaking backwards, supplying varicose veins, reticular veins and spider veins. The American Board of Venous and Lymphatic Medicine certifies physicians who have additional knowledge in the field of venous and lympphatic medicine. Those physicians are called Diplomates of the American Board of Venous and Lymphatic Medicine. Choose a physician who has obtained this certificate status from the ABVLM for the EVLT and sclerotherapy.

John Landi, MD · Answer

There are many physicians performing vein treatments across multiple speciality groups including vascular surgery, general surgery, plastic surgery and dermatology.  There is now an American Board of Venous and Lymphatic Medicine which certifies physicians in vein care as Diplomates. It would be wise to go to a physician who is certified as a Diplomate of the American Board of Venous and Lymphatic Medicine to do your complete vein treatment.You can get a list of these physicians by going to the website for the American Board of Phlebology, American College of Phlebology or the American Board of Venous and Lymphatic Medicine.

Bryan K. Chen, MD · Answer

If you have large, tortuous vessels in your other leg, it would be very beneficial to have a practitioner with the ability to perform ultrasound-guided sclerotherapy.  I would stick with your interventional radiologist.  While some dermatologists and plastic surgeons are very skilled at sclerotherapy, larger, symptomatic vessels of clinical significance are best treated by someone who can fully evaluate the vascular system of the legs/thighs such as an interventional radiologist or vascular specialist.
Good luck.

Robert Swanson, MD (retired) · Answer

It sounds like you have significant venous disease. Not that it is dangerous, but it is more than a cosmetic issue. This requires the attention of a doctor who understands the pathophysiology of the venous system. That means either a phlebologist, vascular surgeon or a well versed interventional radiologist. It sounds like you have found a doctor that understands your problem. Stick with him/her.

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