Large Arm Veins- Dr. Rich Mueller has similar patient & has questions

Last Updated: 3/8/2011

Responses

Regarding your patient with arm veins, I would not do foam sclerotherapy due to the fact that a long-standing visible fibrous cord will be present. There could also be discoloration. Again, EVLT would give you a long visible cord. I think phlebectomy would give you the best cosmetic result. However, you could do laser if you decide to do so. Make sure you use copious amounts of tumescent around the vein. Make sure the vein is 1-2 cm away from the skin surface. If you do laser, please email us an image pre- and post-op. This would be an interesting case. Eventually the cosmetic result should be fairly good. Submitted by Ron Bush MD, FACS - 3/8/2011

saw a young main with similar. problems. doppler is pending to rule out TOS, obstruction. is foam sclero an option? if so, what strength? there is literature as you know from dr. shamma on evlt of hand veins (no burns with tumescent despite a tight anatomic space and very superficial veins), and extensive literature from dr. schulman and mitch goldman on hand vein sclero. i assume no one has done evlt of arm veins.... many thanks, rich Richard l. Mueller, Md, FACC, FACP, FAHA Clinical Assistant Professor of Medicine Weill Cornell Medical College Cornell University Medical Associates of New York / Cardiovascular Diagnostics, pc Cosmetic Vein Solutions of New York 401 e. 55 Street New York, NY 10022-4103   212.593.9800 tel 212.593.5757 fax   www.medicalassociatesny.com www.cosmetic-vein-solutions.com Submitted by rich mueller, md - 3/7/2011

I agree with Dr. Sudheendra. Excellent points to consider. Submitted by Ron Bush, MD, FACS - 2/23/2011

It would be a good idea also to exclude a scalenus anticus syndrome or TOS. A clinical exam along with US done with arm abducted at shoulder might shed some light also. R. Sudheendra MD Vein Center of Northeast Ohio 4100 Youngstown Road SE Warren, OH 44484 330-306-0300 Google Maps | Visit Website   Submitted by R.Sudheendra MD,FACS - 2/23/2011

These can be removed easily with phlebectomy or possibility invagination stripping from elbow to wrist. Two simple tests I would do: 1) The vein must empty rapidly when elevated. 2) I would also do an US to examine the axillary vein. Is there obstruction when the patient’s arm is dependent? 3) If any of these tests are abnormal, then further investigation should be carried out. Since this now becomes a pathologic phenomenon rather than a physiologic occurrence. Submitted by Ron Bush MD, FACS - 2/17/2011

24 year old female with large arm veins. These are asymptomatic but is embarrassed of them and wishes to have them removed. She did have a tendon repair in her left wrist years ago and no significant medical history. Does any one have any thoughts or experience with this type of problem.