|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
Medical Associates of New York / Cardiovascular Diagnostics, pc
Cosmetic Vein Solutions of New York
401 e. 55 Street
New York, NY 10022-4103
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
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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 patientís 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.