Sclerotherapy for Large Veins?

Can sclerotherapy be used to treat large varicose veins?

Doctor Answers 9

Sclerotherapy for large Spider Veins--size does matter

Regarding: " Sclerotherapy for Large Veins? Sclerotherapy is usually best for small reticular [blue] veins and threadlike spider [red] veins. Sclerotherapy can be used on veins up to 3mm in diameter. However, review and closure of larger deeper incompetent veins needs to be completed prior to sclerotherapy. I think this is why patients do not get the desired results from sclerotherapy alone.

Reticular varicose veins at the surface maybe the result of reverse vein flow from larger deeper veins in the legs. only ultrasound review can determine if a more invasive approach is needed. In my office, new patients with extensive spider or reticular veins undergo screening ultrasound review [complimentary]. A plan is formed. If the deeper veins are normal and the varicose veins are less than 3mm in diameter--then by all means Sclerotherapy is a viable options.

For Sclerotherapy to work, a caustic / highly irritating substance is injected in a vein to bring about inflammation of its walls followed by collapse and obstruction. Large veins have faster blood flow which moves this medication along faster, with less damage to the walls. If the deeper veins demonstrate significant increase in size with demonstrated reflux [reverse flow]--then more invasive procedures maybe necessary for desired effects.

I see patients in my office each day with the same story; "I had sclerotherapy for my spider veins and they did not go away". After ultrasound review, it was found that these patients had underlying problems with the larger veins. No amount of sclerotherapy would have resulted in the desired effect.

Chattanooga General Surgeon
4.5 out of 5 stars 3 reviews

Treating large veins with Sclerotherapy or Laser or Removal?

Larger "ropey" veins can indeed be treated with Sclerotherapy.  There is a caveat to this however in that after treatment those treated veins will become tender, firm and likely discolor the overlying skin for many months or even years. 

For those larger veins i like to perform an Ambulatory Phlebectomy which is a treatment where we make 1-2mm size incisions in the skin and take out the vein.  Healing is quick with excellent cosmetic results.

Craig Crippen, MD
Kelowna Physician

Medium sized varicose veins can still be treated with foam sclerotherapy.

Large varicose veins usually require endovenous laser treatments while medium ones do good with foam sclerotherapy for $350 per session and need usually 2-3 sessions at a month apart.  Sincerely,

David Hansen,MD

David Hansen, MD
Beverly Hills Dermatologic Surgeon
4.7 out of 5 stars 43 reviews

Sclerotherapy is NOT recommended for large Veins

Regarding: " Sclerotherapy for Large Veins?  Can Sclerotherapy be used to treat large varicose veins?"

It depends what you mean by "large" veins. For Sclerotherapy to work, a caustic / highly irritating substance is injected in a vein to bring about inflammation of its walls followed by collapse and obstruction. Large veins have faster blood flow which moves this medication along faster, with less damage to the walls but with potential distribution to other areas where we would not want the medication to go. In addition, the farther the walls are apart, the less they can be brought together so they can adhere to one another and block the flow.

Dr. Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 109 reviews

Is sclerotherapy used for varicose veins? Buffalo Niagara, NY

Sclerotherapy is commonly used to treat small tributary veins (varicose veins) of the great and lesser saphenous veins and for spider veins (telangiectasias) and reticular veins. 

Spider veins are < 1 mm in size. They are called telangiectasias or thread veins.

Reticular veins are 1-3 mm in size and intradermal and bluish/purple in color.

Varicose veins are larger than 3 mm and can be as large as 4 cm in size. 

Very large varicose veins (> 1.5 cm) are best treated with microphlebectomy with or without ultrasound guided sclerotherapy. 

Hratch Karamanoukian, MD, FACS
Buffalo Phlebologist
4.8 out of 5 stars 41 reviews

Better options.

Sclerotherapy can be used to treat varicose veins but it works much better on smaller spider and reticular veins. If you have varicose veins then you should first have a venous reflux ultrasound to look for malfunctioning (refluxing) of the saphenous vein system which is usually the cause of the varicose veins. If this is the case, then the leaking valves should be closed first with either a laser or radio frequency catheter. Following this the varicose veins could be treated with sclerotherapy or small micro incisions. You should get an opinion from a vein specialist.

John Landi, MD
Naples General Surgeon
5.0 out of 5 stars 5 reviews


Sclerotherapy is typically best for small reticular veins and spider veins.  If you have large varicose veins, it may be best to have imaging done and be evaluated by a vascular surgeon.   

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Large varicose veins

Stripping is rarely done these days. Large varicose veins can be treated by ambulatory phlebectomy, small incisions, or laser energy delivered into the vein via a catheter (endovenous) or sclerosant foam. You should have an ultrasound examination by an experienced physician prior to the injections or other treatement.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

Sclerotherapy and varicose veins

Sclerotherapy can be used for large veins and certain techniques such as "foaming" the sclerosant may enhance the effect. However, if the flow is too great, it may benefit more from endovenous laser treatment, or ligation.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 82 reviews

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.