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I want to inject some minor veins/spiders, they are branches of a great sph. vein that is now closed; but doctor won't inject ANY veins before closing sph. vein on the calf first,but I prefer not to touch it as it's not symptomatic. Any 2nd opinions?
I agree with your doctor however it won't hurt to try sclerotherapy in the
presence of truncal reflux. The concern is that the sclerotherapy won't be
successful. If the patient understands this I will go ahead and treat them.
Having done this, some patients are happy and the spiders go away and in
others they have come back. I think some sclerotherapy treatment failures
are due to unrecognized underlying reflux.
If the saphenous is closed I will generally inject spider veins unless there is another incompetent source (i.e. perforator) causeing reflux in the remaining saphenous segment.
If there is higher pressure in the underlying veins it may be better to close the vein first. If the main problem was the upper saphenous and that is now closed, however, I will usually inject the lower veins without issues.
Ask your provider.
Michael D. Ingegno, MD
They will come back unless GSV is closed first.
If you have doubts about your course of treatment is advisable to seek a second opinion from a board certified vascular surgeon who specializes in vein treatment.
In our practice we will treat spider veins on an affected leg after sealing the cause (in your case GSV). Unless you have severe symptomatic reflux in the Short Saphenous then it should be treated.
If asymptomatic and not causing skin changes, varicosites etc, it can be left untreated. We would advise you wear some sort of compression routinely.
I hope this helps
Norman N. Bein MD FACS RVT
One would need to know exaxt details of clinical and ultrasound findings to make specific recommendations and this can only be done by a physician who has examined you. However, we usually do not treat an incompetent great saphenous vein below the upper calf. On occasion, we believe the remaining great saphenous vein in the calf needs to be treated and we would do it before proceeding with sclerotherapy.
Stephen F. Daugherty, MD, FACS, RVT, RPhS
This is a very good question and one that I frequently deal with. Patients are often more concerned about their spider veins than their saphenous veins, particularly when they are not symptomatic. Your situation will therefore frequently come up. As long as the large incompetent veins that feed your spider veins are closed, you can treat the spider veins with sclerotherapy.
In defense of your doctor, like me he probably wants to follow the typical progression of treating the larger truncal veins with laser, and then the large tributary branches with ultrasound guided sclerotherapy prior to treating the smaller reticular branches and spider veins.
David G. Smith, MD
If you are not having pain or swelling and you accept the risk of failure of
the injections due to residual leakiness in the saphenous vein remnant below
the knee, I would not have a problem injecting your spider veins.
Think of your veins like a tree. The trunk is the saphenous vein which is feeding the branches(spider and varicose veins). You can treat the branches but if the problem is in the trunk(reflux), then the chances of being successful is less. If you have only a few spider veins then sclerotherapy alone can be done. However, if you have recurrences or increasing veins after the treatment, then you should consider treating the saphenous vein.
You certainly can have spider vein injections without closing your saphenous vein, even if it is leaking. We treat many patients with spider veins this way, and in the absence of varicose (bulging) veins, the treatment works well as an initial therapy for cosmetic improvement. However, varicose veins should not be treated with sclerotherapy as they will leave you with hardened lumps that can take months to resolve.