Should I Get Venous Doppler Studies Before Sclerotherapy?

Doctor Answers 9


My recommendation to do a venous reflux doppler exam prior to sclerotherapy depends on several factors including amount of spider veins, location of spiders, family history, pregnancy history and response to prior sclerotherapy treatments.  If I am suspicious of reflux then I would recommend a pre treatment full venous evaluation.  This exam gives a lot of useful information as far as ability to respond to treatment and risk of future vein formation.  

Naples General Surgeon
5.0 out of 5 stars 5 reviews

Ultrasound is helpful but not necessary in all cases

While an ultrasound is helpful to determine your vein anatomy, it is not always necessary if you have mostly spider veins.  In my office, I perform the full range of vein procedures-- including endovenous ablation, microphlebectomy, and sclerotherapy.  While I always do an ultrasound on patients I suspect with larger vein issues, I do not perform ultrasound on all my patients with just spider veins.  

A thorough clinical exam and history will tell me whether an ultrasound is necessary.  For the most part, scattered spider veins (without any signs of larger vein disease) can be treated with sclerotherapy alone.  On the other hand, if my patient has significant symptoms, prominent spider veins around the ankles, or have had previous unsuccessful treatment with sclerotherapy, I may recommend an ultrasound even if they only have spider veins on exam.

Bottomline is you should seek an experienced vein specialist who can determine if an ultrasound is necessary.

Good luck!

-Dr Mann

Margaret Mann, MD
Cleveland Dermatologic Surgeon
5.0 out of 5 stars 1 review


otherwise how will the treating physician really know the true story behind your veins?

duplex ultrasound is very simple to do and yields a great amount of information.  i know it can be expensive depending on where you live but i use it on every patient who walks in the door for vein treatments and i am regularly treated to much more information than i would have otherwise seen from observation alone.


Craig Crippen, MD
Kelowna Physician

Venous Doppler before Sclerotherapy a great idea

Most vein specialists would recommend venous doppler or Duplex Ultrasound Scanning prior to sclerotherapy. The exception would be for a person who only has small spider veins on the outer thigh. If you have leaky veins (reflux) and do not treat the underlying leaky or refluxing veins then the sclerotherapy is less likely to be effective. The advances in Duplex Ultrasound Technology and Endovenous Procedures has revolutionized the treatment of leg veins over the past 15 years.

Jerome Potozkin, MD
Danville Dermatologic Surgeon
4.2 out of 5 stars 5 reviews

Checklist before undergoing Sclerotherapy

Important considerations in sclerotherapy include the proper use of sclerosant solutions, but more importantly, the technique used for injection. Larger veins should be addressed prior to smaller end branches. As a fellow of the American College of Phlebology and a double board certified surgeon who is a Diplomate of the American Board of Phlebology and the American Board of Plastic Surgery, it is important for me to evaluate these venous patterns in a logical and comprehensive fashion prior to having treatment. Do not focus on the sclerosant as much as the surgical planning and knowledge of the treating physician.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

It depends

The experienced vein specialist should be able to detect during the first consultation if you need additional study before proceeding with the sclerotherapy. In some cases it might be necessary to get an ultrasound to make sure there is not a problem with a blood flow in the main vein. If such occurs it must get resolved first for the sclerotherapy to be effective.

Gregory Turowski, MD, PhD, FACS
Chicago Plastic Surgeon
4.5 out of 5 stars 58 reviews

Important to get Doppler studies before vein treatment

Yes. Before elective vein procedures it is important to get Doppler studies to make sure that you don't have venous insufficiency, also called venous reflux disease. This ensures better success when this condition is excluded as it is less likely for you to have recurrence of spider veins, reticular veins, feeder veins and varicose veins once the venous reflux is treated and sclerotherapy is performed. Venous reflux is treated with VNUS Closure or EVLT.

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

Venous doppler studies before Sclerotherapy depends

If you only have small spider veins in the absence of signs/symptoms of venous insufficiency, it would be hard to justify obtaining a study that would likely show normal results. Most doctors who perform sclerotherapy do not obtain any studies for spider veins or small reticular veins in the absence of clinical evidence of venous insufficiency.

Bryan K. Chen, MD
San Diego Dermatologist
5.0 out of 5 stars 5 reviews

I don't

In my practice, for just spider veins without signs and symptoms of venous insufficiency, I don't get the studies.  In cases where I suspect that venous insufficiency exists, I would refer to a vascular surgeon who may order that work up.

Scott E. Kasden, MD, FACS
Dallas Plastic Surgeon
4.7 out of 5 stars 101 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.