Vein Facts:

Spider veins are more common in women than in men. They usually occur
on the legs or face…
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Spider Veins

What are Spider Veins?

Spider veins are well-defined small veins measuring from 0.1mm to 1mm in diameter and appear on the surface layer of the skin. They may appear as scattered irregular veins but commonly occur in clusters of varying density. They are seen to some extent in most people as they age.

Spider veins, also called telangiectasias, are of cosmetic concern to many patients because of their appearance and location, which may be at any site on the thigh, leg, ankle, and foot. But spider veins also may cause symptoms.
Patients often complain of:

  • Pain
  • Burning
  • Fatigue that increase with prolonged standing or sitting

It is not uncommon for patients to change their lifestyles because of the appearance or the symptoms of spider veins of the legs. Women, especially, often change their way of dressing and their activities.

Spider veins occur in most people as a consequence of heredity, as often there is a strong family history of spider veins in parents or grandparents. But sometimes spider veins by their distribution and density will raise the possibility of venous hypertension from failed valves (incompetence) of superficial or deep veins of the leg. This may range from incompetent reticular veins to incompetent superficial veins such as the great saphenous vein, which courses deep in the fat and nearthe muscle of the leg. Reticular veins are the larger bluish veins just beneath the skin surface, the so-called “feeder veins”, that often can be seen to lead into the spider vein clusters. Reticular veins often feed prominent spider veins on the outside area of the thigh, the so-called lateral subdermic venous plexus, which is not uncommonly first noticed in young women even in the teenage years. Dense clusters of spider veins along the inside of the ankle and foot should alert the physician to the possibility of incompetence of the great saphenous vein and, when seen at the lateral ankle and foot, the small saphenous vein. Patients with chronic swelling of the lower leg, ankle, and foot from incompetence of the deep veins of the leg will usually have prominent spider veins as well.

Principles of Treatment of Spider Veins of the Leg

At Dallas Vein Specialists the principles of successful treatment of spider veins includes the following:

  • Identify a treatable cause if present
  • Produce an irreversible injury to the spider vein
  • Compression after the treatment

Identify a treatable cause if present – Reticular veins or other superficial veins, such as the great saphenous vein that have failing valves and are causing venous high pressure, should be treated before the spider veins are treated, otherwise the results of spider vein treatment will be disappointing.

Produce an irreversible injury to the inside lining cells of the spider vein – This can be done by injecting chemical solutions or by delivering heat energy to the spider vein. Chemical injection (sclerotherapy) through a small caliber needle in sufficient amount and concentration achieves an irreversible injury, which is followed by formation of small clots in the treated veins. Subsequent to this the body’s inflammatory process removes the vessel and the clot. This may take weeks to months depending on the size of the blood vessels and their location. Larger sized spider veins may take months to totally resolve, and this is especially true if they are located low on the ankle or on the foot. Of course the appearance will look much better after only a few weeks, but if one looks closely, residual clot may be seen well beyond most of the disappearance of the spider vein complex. These clots within the small spider veins do not migrate and are not a threat for breaking loose within the circulation and causing illness. Other modes of achieving an injury to the spider vein include laser and radiofrequency.

At Dallas Vein Specialists we use chemical injection (sclerotherapy) for most spider veins and, when indicated, for reticular veins as well. The sclerosing chemicals used are gentle and well tolerated. Patients usually feel little if any discomfort during the treatment. There is usually minimal or no discomfort afterwards.

Laser treatment of spider veins is less predictable in results than injection (sclerotherapy), and takes much more time. The laser usually is more painful and more likely to cause skin damage.

At Dallas Vein Specialists we have been impressed with the benefits of treatment of spider veins using the VeinGogh device. The VeinGogh uses radiofrequency energy to produce “ohmic thermolysis”, a process that eliminates the vein using heat energy delivered at the point of a small needle probe that is placed against the vein wall. This treatment is best for the small hair-like veins that are too small for injections. The treatment causes only some mild discomfort.

Compression after the treatment – At DVS we urge our patients to use compression on the treated leg for at least 1 week post treatment. There is some evidence that conscientious use of compression wraps or hosiery daily for at least 1 week improves the results of treatment. Our usual practice is to place the compression stockings at the conclusion of the treatment session. The patient is instructed to wear the stocking until the following evening so that the night of the treatment the patient sleeps with the stocking in place. Then the patient wears the stocking daily when not in the bed or bath. Hot showers are avoided for the first 48 hours. Usual activities may resume immediately, and vigorous exercise may be resumed in 48 hours.

Spider Veins of the Face

Facial telangiectasias or fine spider veins are common cosmetic concerns in both men and women. Again heredity plays an important role in most patients. These small hair-like veins may occur anywhere on the face but are commonly seen about and on the nose, around the nostrils, along the fold between the nose and the cheek, and on the prominence of the cheek. They are often resistant to treatment by laser or intense pulsed light (IPL). They are too small for injection but are ideal for the VeinGogh device. Using radiofrequency the VeinGogh delivers heat energy at the point of a small needle-like probe to the facial spider veins, which immediately disappear. Patient satisfaction has been high at Dallas Vein Specialists.