Why haven't certain patches of my spider veins responded to Sclerotherapy?

In almost all cases, spider veins can be treated with either sclerotherapy or lasers. As a pioneer of sclerotherapy treatment, I would suggest visiting a board certified dermatologist who is highly specialized in the treatment of leg veins, as they will have the highest level of knowledge for bringing you a successful and effective treatment. When treating spider veins with sclerotherapy injections, many doctors simply treat the visible veins instead of locating the root problem. When I perform the treatment for my patients, I carefully locate the cause of the spider veins, which brings the best results as the root source is being treated instead of the after effect veins.

Thank you for your question.

Persistent pooled venules (bluish spider veins) are normally due to back flow in the 'feeding '  larger vein which sometimes itself is not visible.

Doppler ultrasonography is required to establish that. Solution might be to strip out that vessel surgically or use a foam sclerosant. Look for a doctor experienced in vascular treatments.

When spider veins persist in spite of treatments, there is usually an underlying cause, leaky valves, that has not yet been treated.  Ultrasound by an experienced technologist or physician is important to look for that.  Heredity can be a major factor as well.  Switching sclerosing solutions, the concentration of the solution, making sure that compression stockings are worn, consideration of laser, are all important.  Whether the spiders are pink, red, or bluish-purple makes a difference as well.  If your physician isn't able to address these questions, I would consider another physician.  There are a lot of technique aspects in this type of treatment.

When veins are resistant to treatment there is usually a reason.  The first thing that I would suggest would be to repeat the venous ultrasound to see if there is any feeding source for the spider veins such as valves that have not closed or other veins with leaking valves.  If there are no leaking valves, then I would next recommend looking for feeding veins to the spiders with special lights which we call Vein Lites.  Thirdly, I would then increase the concentration of the sclerosing solution or change the sclerosing solution. There are times when the treatment of spider veins could be challenging,but usually with persistence we can solve the problem.

Once the 'underlying problem' is fixed, namely venous insufficiency, the focus should be to treat the spider veins (telangiectasias), reticular veins and varicose veins (smaill and large). It should be remembered that one needs expertise to treat venous insufficiency, as most doctors just treat truncal venous insufficiency (at the groin - saphenofemoral junction) or at the level of the knee (saphenoopliteal junction) - they have no expertise in treating perforator venous insufficiency that is so often the reason why sclerotherapy fails or cosmetic laser work fails. It may be that you have perforator vein refux (sometimes called feeder veins) and these have to be treated with special laser devices such as perforator EVLT procedures or ultrasound guided sclerotherapy before cosmetic sclerotherapy or topical laser work is reattempted.