If the GSV reflux is contributing to the varicose and spider veins, then you should have EVLT of the GSV before sclerotherapy to the smaller veins. Otherwise, there will be a high recurrence rate.

Published on Jul 11, 2012

If you have a negative experience with a vein care specialist, or any physician, then seek another opinion. There are many qualified physicians available, and you need to be able to trust your physician. If you do not trust your physician, find another one!

Published on Jul 11, 2012

Doesn't sound like the great saphenous vein (GSV) needs endovenous laser treatment. Never have I seen a GSV at 2.3 that leaks. A small saphenous vein at 6.1, however, is big and likely leaked badly.

Published on Jul 11, 2012

Your physician is correct, you have to correct the cause of the problem first.

Published on Jul 11, 2012

The saphenous vein has to be treated first, otherwise sclerotherapy can make the spider veins worse, not better. If given a good local anesthesia, and if performed properly, endovenous laser treatment should be rather painless. Most patients only take Tylenol or ibuprofen for post-procedural discomfort.

Published on Jul 11, 2012

Without seeing your venous map and knowing more about your history, I can't give you personal advice. However, there are a couple things I can say. First, if your GSV is no larger than 2.3 mm, it is unlikely to be the source of your problem. On the other hand, there are circumstances (e.g. cold temp) where the diameter of the vein can be greatly underestimated that might cause your vein to be in spasm. If the SSV was refluxing and has been treated, and all that remains abnormal are dilated, refluxing tributaries, and the GSV is normal, then indeed you could be treated with sclerotherapy without touching the GSV. If the GSV is abnormal, it should be treated before initiating sclerotherapy to reduce the risk of sclerosant escaping into the deep veins and the systemic circulation. Without treating abnormal proximal truncal veins first, there is a small but real risk of deep vein thrombosis, cardiopulmonary complications, or transient ischemic events in the brain from improperly conducted foam sclerotherapy. For this, your physician may be quite right to refuse sclerotherapy until the GSV is treated. Pain can arise even when performed by the best operator, but should be tolerable. Talk to your doctor about these issues.

Published on Jul 11, 2012

Your doctor has a point, as treating the saphenous first is the most efficient and probably the best way to treat your issues. With those aforementioned limitations understood, it is not unreasonable to perform sclerotherapy without doing an endovenous laser treatment. Also, you should know that most insurance will only cover sclerotherapy after an EVLT. But you can certainly proceed if you wish to pay with your own money.

Published on Jul 11, 2012