Can VNUS be performed if someone has very tiny veins?

My doctor tried but it was so painful trying to get the needle in the vein that he actually stopped trying. I am now turning to sclerotherapy for my veins.

Answers from doctors (7)


Hratch Karamanoukian, MD, FACS, RVT, RPVI, RPhS

Published on Sep 01, 2017

Refluxing veins should have a large diameter by definition. The vein refluxing segment enlarges over time. If it is small, it implies that there was no significant reflux in that segment and the symptoms wre/are not related to venous insufficiency. They may be caused by inflammation or phlebitis in that vein segment. In either case, sclerotherapy may be a better option of treatment.

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Answered by Hratch Karamanoukian, MD, FACS, RVT, RPVI, RPhS

Refluxing veins should have a large diameter by definition. The vein refluxing segment enlarges over time. If it is small, it implies that there was no significant reflux in that segment and the symptoms wre/are not related to venous insufficiency. They may be caused by inflammation or phlebitis in that vein segment. In either case, sclerotherapy may be a better option of treatment.

Published on Jul 11, 2012


Vein Specialties of St. Louis

Published on Aug 31, 2017

An experienced surgeon should be able to treat refluxing veins of any size. Typically however, they are larger if a saphenous vein. With appropriate local anesthetic and experience, you should not have any pain. Maybe get a second opinion before you proceed.

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Answered by Vein Specialties of St. Louis

An experienced surgeon should be able to treat refluxing veins of any size. Typically however, they are larger if a saphenous vein. With appropriate local anesthetic and experience, you should not have any pain. Maybe get a second opinion before you proceed.

Published on Jul 11, 2012


Vein Clinic of North Carolina

Published on Dec 19, 2012

Yes, VNUS can work on tiny veins, however, for it to be covered by insurance, the veins have to meet medical necessity (the size of the veins must meet guidelines per insurance policy). I am sorry you had so much pain. Sclerotherapy for the Great Saphenous vein is not covered nor recommended to treat Great saphenous vein reflux.

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Answered by Vein Clinic of North Carolina

Yes, VNUS can work on tiny veins, however, for it to be covered by insurance, the veins have to meet medical necessity (the size of the veins must meet guidelines per insurance policy). I am sorry you had so much pain. Sclerotherapy for the Great Saphenous vein is not covered nor recommended to treat Great saphenous vein reflux.

Published on Jul 11, 2012


Advanced Vein Center

Published on Dec 18, 2012

"Very tiny" veins are best treated by sclerotherapy.

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Answered by Advanced Vein Center

"Very tiny" veins are best treated by sclerotherapy.

Published on Jul 11, 2012


Vein Center of Orange County

Published on Dec 16, 2012

The ability to cannulate a smaller vein depends a lot on the practitioner's experience *and* ultrasonographer's imaging capabilities. Saphenous veins less than 3 mm in diameter can be challenging, whereas veins greater than 3.5 mm are usually treatable. Fortunately most abnormal saphenous veins
exhibiting reflux and requiring treatment are dilated > 4mm, making them easy targets. The decision when to use an alternate method such as duplex-guided sclerotherapy is up to the treating physician.

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Answered by Vein Center of Orange County

The ability to cannulate a smaller vein depends a lot on the practitioner's experience *and* ultrasonographer's imaging capabilities. Saphenous veins less than 3 mm in diameter can be challenging, whereas veins greater than 3.5 mm are usually treatable. Fortunately most abnormal saphenous veins
exhibiting reflux and requiring treatment are dilated > 4mm, making them easy targets. The decision when to use an alternate method such as duplex-guided sclerotherapy is up to the treating physician.

Published on Jul 11, 2012


Vanish Vein and Laser Center

Published on Dec 14, 2012

I am not sure what you mean by thin veins. Small diameter veins can be treated by VNUS depending on the size of the vein. Laser ablation can treat even smaller veins than VNUS. Another factor in treating small veins is the experience of the surgeon. More experienced surgeons can cannulate smaller veins than those less experienced. The bottom line is that the vein needs to be larger enough to accommodate the catheter.

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Answered by Vanish Vein and Laser Center

I am not sure what you mean by thin veins. Small diameter veins can be treated by VNUS depending on the size of the vein. Laser ablation can treat even smaller veins than VNUS. Another factor in treating small veins is the experience of the surgeon. More experienced surgeons can cannulate smaller veins than those less experienced. The bottom line is that the vein needs to be larger enough to accommodate the catheter.

Published on Jul 11, 2012


San Pedro Veins - Estea Laser & Cosmetic Center

Published on Dec 14, 2012

Small veins probably don't require closure as it's unlikely they have incompetent valves. Ask about the report of the US specifically the "reflux."

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Answered by San Pedro Veins - Estea Laser & Cosmetic Center

Small veins probably don't require closure as it's unlikely they have incompetent valves. Ask about the report of the US specifically the "reflux."

Published on Jul 11, 2012


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