Should I Get Venous Doppler Studies Before 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.

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.

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.  

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

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.

Cheers

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.

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.

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.

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.