My doctor said my vein is too large to have sclerotherapy performed first, is this true?

I have a few visible spider veins on my lower leg that I want treated with foam sclerotherapy. However, the doctor wants me to do endovenous laser treatment before the sclerotherapy. According to him, my vein is way too large and if I do the sclerotherapy first, they will reappear. Is this true?

Answers from doctors (16)


Vein Center of Orange County

Published on Sep 24, 2013

If unwanted surface veins are being fed by a larger vein below the surface, the latter vein must first be treated for durable results. If the surface veins are unrelated to any deeper diseased veins, then it is acceptable to perform sclerotherapy first.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/1015_1408044084.jpg
Answered by Vein Center of Orange County

If unwanted surface veins are being fed by a larger vein below the surface, the latter vein must first be treated for durable results. If the surface veins are unrelated to any deeper diseased veins, then it is acceptable to perform sclerotherapy first.

Published on Jul 11, 2012


Cosmetic Vein Centers of Texas

Published on Sep 24, 2013

Yes, that is usually true.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/554_1447800116.jpg
Answered by Cosmetic Vein Centers of Texas

Yes, that is usually true.

Published on Jul 11, 2012


Arizona Vein Specialists

Published on Sep 23, 2013

You should be aware that most leg vein blood exits the leg via the saphenous vein. If that vein is incompetent, blood can't efficiently be removed from the leg. Size may or may not be an issue, but symptoms like swelling, pain, and heaviness usually are. Most spider veins in the drainage zone from that saphenous vein will experience impaired drainage and higher venous pressure, and be resistant to sclerotherapy. By the way, spider veins should not be treated with foam, as the side effects are increased, and there is no advantage using foam in veins less that 4 mm diameter. It sounds like you need to obtain more info before leaping.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/1365_1408044094.jpg
Answered by Arizona Vein Specialists

You should be aware that most leg vein blood exits the leg via the saphenous vein. If that vein is incompetent, blood can't efficiently be removed from the leg. Size may or may not be an issue, but symptoms like swelling, pain, and heaviness usually are. Most spider veins in the drainage zone from that saphenous vein will experience impaired drainage and higher venous pressure, and be resistant to sclerotherapy. By the way, spider veins should not be treated with foam, as the side effects are increased, and there is no advantage using foam in veins less that 4 mm diameter. It sounds like you need to obtain more info before leaping.

Published on Jul 11, 2012


Aluna Vein Centers

Published on Sep 23, 2013

Whether sclerotherapy or endovenous laser ablation is performed first, depends on your history. Do you have leg pain? Have you had an ultrasound to map out your veins? If you have large veins with reflux, it means you have venous insufficiency. In this case, it is better to do endovenous laser treatment first to close the source of faculty veins, then close the smaller vein. You will have better results when done in this order. Not only will your legs look better, but your leg discomfort will improve.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/1162_1408044089.jpg
Answered by Aluna Vein Centers

Whether sclerotherapy or endovenous laser ablation is performed first, depends on your history. Do you have leg pain? Have you had an ultrasound to map out your veins? If you have large veins with reflux, it means you have venous insufficiency. In this case, it is better to do endovenous laser treatment first to close the source of faculty veins, then close the smaller vein. You will have better results when done in this order. Not only will your legs look better, but your leg discomfort will improve.

Published on Jul 11, 2012


Vein Clinic of North Carolina

Published on Sep 23, 2013

I need a little more information. Do you have reflux in the veins? I can't advise more until I get more details.


//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/1172_1408044089.jpg
Answered by Vein Clinic of North Carolina

I need a little more information. Do you have reflux in the veins? I can't advise more until I get more details.


Published on Jul 11, 2012


Milford Vascular Institute

Published on Sep 23, 2013

Yes, this is true. The sclerotherapy either won't work, or the veins will recur within weeks to months. In some cases, the sclerotherapy can even worsen the appearance of your spider veins if the larger "feeder" vein is not treated first.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/1373_1445876067.jpg
Answered by Milford Vascular Institute

Yes, this is true. The sclerotherapy either won't work, or the veins will recur within weeks to months. In some cases, the sclerotherapy can even worsen the appearance of your spider veins if the larger "feeder" vein is not treated first.

Published on Jul 11, 2012


Intermountain Vein Center

Published on Sep 23, 2013

There is a very good chance they will reappear since those spider veins have a source and that source is probably those bigger saphenous veins or other deeper varicose veins that are big enough to ablate. The ablation is more effective than the sclerotherapy.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/1153_1408044089.jpg
Answered by Intermountain Vein Center

There is a very good chance they will reappear since those spider veins have a source and that source is probably those bigger saphenous veins or other deeper varicose veins that are big enough to ablate. The ablation is more effective than the sclerotherapy.

Published on Jul 11, 2012


Advanced Vein Center

Published on Mar 27, 2012

They may reappear but if cost is a factor I will do the sclerotherapy first.
For some patients this is an acceptable way to go if they understand the
sclerotherapy may not be as successful. Not everyone needs to have an EVLT
if they are not symptomatic.



//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/464_1408044069.jpg
Answered by Advanced Vein Center

They may reappear but if cost is a factor I will do the sclerotherapy first.
For some patients this is an acceptable way to go if they understand the
sclerotherapy may not be as successful. Not everyone needs to have an EVLT
if they are not symptomatic.



Published on Jul 11, 2012


Bella MD Laser Vein and Aesthetic Center

Published on Mar 22, 2012

Definitely get a second opinion. Only need to close the GSV if there is significant reflux and dilation of the vein. This may be the case but an independent ultrasound could confirm this.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/772_1408044077.jpg
Answered by Bella MD Laser Vein and Aesthetic Center

Definitely get a second opinion. Only need to close the GSV if there is significant reflux and dilation of the vein. This may be the case but an independent ultrasound could confirm this.

Published on Jul 11, 2012


Miller Vein

Published on Mar 22, 2012

It is difficult to answer that question without assessing the type and size
of the veins that you need treated and if you have an underlying condition
of venous insufficiency. We encourage you to make an appointment for a
consultation with a board certified vein specialist.


//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/1175_1500663995.jpg
Answered by Miller Vein

It is difficult to answer that question without assessing the type and size
of the veins that you need treated and if you have an underlying condition
of venous insufficiency. We encourage you to make an appointment for a
consultation with a board certified vein specialist.


Published on Jul 11, 2012


Angelo N. Makris MD

Published on Mar 22, 2012

If you have underlying insufficiency, sclerotherapy alone will have a high recurrence rate.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/977_1408044083.jpg
Answered by Angelo N. Makris MD

If you have underlying insufficiency, sclerotherapy alone will have a high recurrence rate.

Published on Jul 11, 2012


VeinCare Centers of Tennessee

Published on Mar 21, 2012

An important concept in vein treatment is to treat the larger abnormal veins first. If there is a saphenous vein with reflux in the region where the spider veins are located, the saphenous vein should be treated first.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/755_1499906765.jpg
Answered by VeinCare Centers of Tennessee

An important concept in vein treatment is to treat the larger abnormal veins first. If there is a saphenous vein with reflux in the region where the spider veins are located, the saphenous vein should be treated first.

Published on Jul 11, 2012


General Vascular Surgery Group

Published on Mar 21, 2012

Very possible. Sometimes a bad underlying vein needs to be treated first to prevent reverent veins.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/922_1408044082.jpg
Answered by General Vascular Surgery Group

Very possible. Sometimes a bad underlying vein needs to be treated first to prevent reverent veins.

Published on Jul 11, 2012


Vein Specialties of St. Louis

Published on Mar 21, 2012

Your surgeon is correct that in the presence of a large refluxing saphenous vein spider veins can reappear. Sclerotherapy is usually limited to more superficial spider and "feeding" reticular veins or deeper perforator veins.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/623_1499902138.jpg
Answered by Vein Specialties of St. Louis

Your surgeon is correct that in the presence of a large refluxing saphenous vein spider veins can reappear. Sclerotherapy is usually limited to more superficial spider and "feeding" reticular veins or deeper perforator veins.

Published on Jul 11, 2012


Vanish Vein and Laser Center

Published on Mar 21, 2012

Evlt could be indicated is you have underlying severe reflux. If the reflux is sealed, then sclerotherapy is more successful. However, if you only have a few spiders then an attempt at sclero treatment is indicated realizing that if sclerotherapy fails, then EVLT should be considered.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/1053_1499982262.jpg
Answered by Vanish Vein and Laser Center

Evlt could be indicated is you have underlying severe reflux. If the reflux is sealed, then sclerotherapy is more successful. However, if you only have a few spiders then an attempt at sclero treatment is indicated realizing that if sclerotherapy fails, then EVLT should be considered.

Published on Jul 11, 2012


Heart and Vein Center

Published on Mar 21, 2012

If your doctor has properly diagnosed with an ultrasound of your leg veins that you have venous reflux/venous insufficiency, then will be much better to do EVLT of the abnormal refluxing veins first and then sclerotherapy of your spiders. The results will be better and? longer lasting.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/923_1408044082.jpg
Answered by Heart and Vein Center

If your doctor has properly diagnosed with an ultrasound of your leg veins that you have venous reflux/venous insufficiency, then will be much better to do EVLT of the abnormal refluxing veins first and then sclerotherapy of your spiders. The results will be better and? longer lasting.

Published on Jul 11, 2012


Related Questions for Endovenous Laser Ablation

Endovenous Laser Ablation -10 answers
I had EVLT about 10 days ago , now I have a big knot on my inner thigh and when I touch it, it still hurts , I had a lot of pain the day after the surgery and I couldn't bend my leg. Is this normal?
See More
Endovenous Laser Ablation -8 answers
If I have had large vessels such as the saphenous closed, is there chance of circulatory problems later on?
See More
Endovenous Laser Ablation -9 answers
Can you please detail some of the restrictions after EVLT?
See More
Endovenous Laser Ablation -10 answers
I am just over 2 weeks post EVLT and still have pain. As long as I take an anti-inflammatory the pain subsides. Visually the inner thigh looks good. How much longer will the pain last?
See More
Endovenous Laser Ablation -8 answers
It has been a week since my EVLT procedure, and I am wondering if I should continue wearing the compression stocking?
See More
Endovenous Laser Ablation -11 answers
I had swelling in my left foot and my doctor confirmed that the valves in two of my veins were not working properly. I had these veins closed with endovenous laser ablation, but four weeks later I still have swelling in my foot that doesn't go away. Is this normal?
See More
Endovenous Laser Ablation -10 answers
I have burning pain at my incision site 3 weeks after endovenous laser ablation. It isn't constant, just when it is touched or rubbed. Could this be nerve damage or a hair follicle that is irritated from the incision?
See More
Endovenous Laser Ablation -6 answers
Or does the treatment permanently remove them?
See More
Get answers from our experienced doctors.
How it works
Endovenous Laser Ablation -5 answers
I had EVLT done about three months ago..right after the EVLT procedure i started feeling weird sensations in my ankle and now the pain seems to get worse every day? Could this pain be associated with the procedure?
See More
Endovenous Laser Ablation -6 answers
I had endovenous laser treatment and sclerotherapy performed on both the greater and lessor saphenous veins of my legs. It was done on the same day. After a couple of weeks I started feeling numbness and tingling in my legs, mostly below the knee and through my feet. Will the feelings ever go away?
See More
Endovenous Laser Ablation -6 answers
I am about two months into treatment for chronic venous insufficiency? I have had laser ablation and foam sclerotherapy with very little results. Can anything be done to treat lipodermatosclerosis after the veins are treated. I wear compression hose.
See More
Endovenous Laser Ablation -13 answers
I had my GSV ablation done 13 days ago and still have intense pain in a segment on the inner thigh just above the knee. Is this level of pain normal and, if so, for how long? I have to take Advil for relief, but my stomach is sensitive to NSAIDS.
See More
Endovenous Laser Ablation -9 answers
I've heard that ELA can result in deep vein thrombosis. Is this true, and how common is this complication? Is there any way to prevent it?
See More
Endovenous Laser Ablation -7 answers
EVLT 5 days ago GSV. No serious pain yet. Compression stocking to come off tomorrow, but bruising seems excessive with dark patches and tenderness to touch. I was told to use heating pad, and now I'm reading not to do that. What should I do?
See More
Endovenous Laser Ablation -4 answers
I have sharp stabbing pains in my leg. It's very painful and the Motrin did not help. I was in tears! This went on for a couple of days. The pain is on my right leg and my left leg isn't painful at all. What could this be?
See More
Endovenous Laser Ablation -5 answers
What are the side effects of drinking alcohol after my evla?
See More
Endovenous Laser Ablation -12 answers
Does this procedure hurt?
See More
Endovenous Laser Ablation -6 answers
I've heard that endovenous laser treatments actually remove or destroy the saphenous vein in the leg. Is this true, and will I still get enough blood circulation to the legs if this large vessel is removed?
See More
Get answers from our experienced doctors.
How it works

Related Articles

Have specific questions?
ASK A DOCTOR