Spider Veins

What:

Spider veins are fine, dilated veins in, or just below, the skin surface. They may appear reddish in color (telangectasias) or bluish (venulectasias). They are often associated with larger abnormal veins beneath the surface. Ultrasound evaluation is frequently indicated to rule out underlying abnormal veins that would require treatment first to allow later effective treatment of the spider veins. Spider veins most commonly appear on the legs, but can also develop on the face and in other areas.

Why:

Heredity and hormones. Spider and varicose veins have a strong relationship to heredity—to the point that if both your parents have varicose veins, the likelihood that you will develop similar problems is about 80%. Pregnancy, hormone medication and normal hormonal cycles of estrogen and progesterone appear to increase the incidence of spiders—thus, they are much more common in women than men.

Symptoms:

Spider veins may cause complaints of burning, itching and local discomfort. Support stocking and exercise are helpful for symptoms but do not affect the appearance or development of spider veins. Spider veins are generally not considered a health hazard and as a result are considered primarily a cosmetic problem.

Treatment Options:

Injection sclerotherapy is a long established and still the most effective treatment for spider varicosities, especially in the legs. Laser treatments are often quite effective for facial spiders, as well as small areas of “red” spiders on the legs. Because of anatomic variations (such as variable sizes, skin depth, underlying larger veins), laser treatment is generally not as effective for leg spiders.

Sclerotherapy:

Sclerotherapy uses injection of a FDA-approved medication (sclerosing agent) directly into the abnormal veins. The medication has an irritant effect on the lining of the veins causing the walls to stick together. Small clots develop and are naturally absorbed by the body over a period of months. Blood is directed back to deeper veins.

Bruising can last two weeks to six months depending on the size of the vein treated. Due to bruising following the sclerotherapy, the treated areas usually look worse before they look better—so that patience is essential awaiting a good result.

Each treatment session is 15-20 minutes. It will be performed either by a physician or a registered nurse specially trained in the technique. The treatments involve minimal discomfort—basically the insertion of a very fine needle into the vein. The medication itself is NOT painful.

Initial treatments usually focus on underlying larger reticular veins. The average patient will require four to six treatments, although this can vary widely dependent on the extent of the varicose vein problem. Support stocking or Ace wrap may be used for forty-eight hours after the treatment. Physical activity is encouraged. Sun exposure or tanning beds are discouraged for two weeks after treatments.

What Result Can I Expect:

No treatment will eliminate 100% of spider veins. Most patients can expect 70-80% improvement. It is important to realize that the veins typically look worse before they look better. Significant cosmetic appearance will take several months and the ultimate result is achieved only after ten to twelve months. Accordingly, many patients like to begin therapy in the fall/winter months.

What are possible complications?

Sclerotherapy is generally a very safe and effective therapy. Significant blood clot problems or allergic reactions to the medications are rare. Local skin irritation is not uncommon, but usually transient and mild. Mild bruising in the area of the injection is expected and will resolve. A small percentage of patients can develop permanent blemishes along the treated veins. Neovascularization (development of fine blood vessels) in the area of injection can occur, but is usually transient and will disappear over a period of time.

Longterm:

Sclerotherapy typically resolves 70-80% of treated veins, but because of the underlying tendency toward spider veins patients typically note other spider veins appear as time goes on. Optimal control of spider veins often requires repeat sclerotherapy every one to two years.