I've had 5 sclerotherapy treatments for my chest and shoulder veins with minimal results. Next steps?

Sclerotherapy is the most effective method to treat these prominent reticular veins on the chest. If veins persist after treatment - whether on the chest or elsewhere - then there was not sufficient alteration by the solution to the vein wall for the body to initiate its absorption and ultimate removal. Veins should require just one treatment for their removal by sclerotherapy.

This is a common problem, and I have successfully treated dozens of patients with the same pattern. It requires foam sclerotherapy with 0.5- 1 % Polidocanol of its equivalent (STS 0.25-.5%). The foam should be made with carbon dioxide and not air. I believe if TOS was at all related and obstructing a vein, it would dilate veins in the arms and not veins on the upper chest. See Destin Vein Center under gallery photos to see similar case that we have treated.

Sclerotherapy is the gold standard for these types of veins. If you have TOS, you need to prove that there is no vein compression leading to dilation of the chest wall veins. If no compression then sclerotherapy should improve these veins. You do have a lot of veins and much more than is usually seen for veins in this location. Ct of the chest and CTA of the thoracic and axillary veins should be done.