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I had sclerotherapy on several reticular veins for the 2nd time about 1 month ago. At times the veins bulge during the day, but other times look flat. Is this part of the healing process or does this mean that the sclerotherapy did not work? Thanks.
Generally if the vein is filling and collapsing they are still open, but possibly partially treated. Not all sclerotherapy treatment are 100% sucessful, and commonly repeat injections are required.
Michael D. Ingegno, MD
If the veins became large during the day it means there is active flow in those veins and need further treatment.
Have the treating physician re-evaluate them.
On average, veins can take 3 - 5 treatments for resolution. This is more realistic than two treatments. If they flatten and bulge then they probably still have flow. Treatments should be spaced about 4 weeks apart. Larger reticular veins are best treated with foamed solution (mixed with medical CO2, CO2/O2 mix) as it sticks in the vein and concentrates the solution against the vein wall. Solution type and strength may all have a part to play in the treatment of these veins and you should discuss this with your Sclerotherapist/Surgeon..
Norman N. Bein MD FACS RVT
A few questions regarding your evaluation. Did you have a thorough venous
insufficiency ultrasound before your sclerotherapy? It sounds like you
might have some underlying insufficiency in the deeper veins so if you have
not had an ultrasound this is the next step. If you have had an ultrasound
you might want to consider a second opinion and another ultrasound. Bulging
in the veins is a pretty good sign of underlying leaky veins connecting to
and causing the reticular veins to be pressurized (and bulge). If the veins
are tender and you can feel a "knot" where the vein was then this is likely
clot and should be drained.
It is impossible to answer this question without seeing you. Veins can be open and bulge when you stand or clotted from sclero and seem more prominent when you stand. You should follow up with your vein care specialist.