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What are spider veins?
Spider veins, known in the medical world as telangiectasias, are small, thin veins that lie close to the surface of the skin. Although these super-fine veins are connected with the larger venous system, they are not an essential part of it.
Spider veins usually take on one of three basic patterns. They may appear in a true spider-like shape with a group of veins radiating outward from a dark central point; they may be arborizing and resemble tiny branch-like shapes; or they may be simple, linear vessels that appear as thin separate lines. Linear spider veins are commonly seen on the inner knee whereas the arborizing pattern often appears on the outer thigh in a sunburst or cartwheel distribution.
Varicose veins differ from spider veins in a number of ways. Varicose veins are larger, usually more than a quarter-inch in diameter, darker in color, and tend to bulge. Varicose veins are also more likely to cause pain and are related to more serious vein disorders. For some patients, sclerotherapy can be used to treat varicose veins, although surgical treatment is often necessary for this condition.
Why do spider veins occur?
The cause of spider veins is not known. In many cases, they seem to run in families. Identical twins can be affected in the same areas of the body and to the same extent. The condition can occasionally occur as part of an internal disease.
Spider veins appear in both men and women, but more frequently in women. The hormones estrogen and progesterone may play a role in their development. Puberty, birth control pills, pregnancy, or hormone replacement therapy often seem to bring them out. They may appear after an injury, or as a result of tight girdles or hosiery held up with tight rubber bands.
What treatments are available?
At this time, sclerotherapy is considered the treatment of choice for spider veins on the legs. The advantages of this procedure are that it is safe, quick, essentially painless, relatively inexpensive, and very effective in the vast majority of patients. Recently, there is been interest in using lasers for treatment of leg veins, but this is only helpful when treating very tiny spider veins that are too small to be injected. On the other hand, laser treatment is extremely effective for spider veins on the face and is now the preferred treatment for this condition. Sclerotherapy may be combined with compression for treating some small varicose leg veins, but many of these larger vessels are better treated by a vascular surgeon in a procedure known as surgical phlebectomy.
How does sclerotherapy work?
Sclerotherapy is a simple procedure in which a solution (called a sclerosing agent) is injected into the unwanted veins with a very tiny needle. The needle used is so small that the sensation is barely noticeable, typically no worse than a mosquito bite. The most commonly used sclerosing agents are hypertonic saline and Polidocanol. These solutions make the insides of the vein’s walls stick together like a drinking straw being pinched between your fingers. Over a few weeks, the veins close up, shrink away, and are absorbed by the body so that they are no longer visible.
What is the procedure like?
A typical sclerotherapy session is relatively quick, lasting approximately 20-30 minutes. Prior to treatment, the veins are photographed and the skin is cleansed with an antiseptic. Approximately one injection is administered for every inch of spider vein - anywhere from 5-40 injections is typical. The needle used is so small and the sclerosing solution is so mild that discomfort is minimal. Dressings are not usually required following treatment, but cotton balls and compression tape may be applied for a short period of time following treatment of larger veins.
How many treatments will be needed?
The number of treatments needed is determined by the severity of the problem. Usually two or more sessions performed at 4-6 week intervals are required to achieve optimal results.
What results can be expected?
After 2-3 treatments most patients can expect 70-90% improvement. Fading is gradual, with most veins slowly disappearing over several weeks. Sclerotherapy only works on those veins that are visible at the time of treatment; it does not prevent new veins from surfacing in the future. If necessary, touch-up treatments can be performed.
What about recovery?
Patients are generally encouraged to resume normal activities immediately. Walking is encouraged because it increases blood flow through other vessels. Depending upon certain factors such as the size of the blood vessels injected, some patients may need to “compress” the treated vessels by wearing support hose. This may help heal the treated vessels, keep the blood from collecting under the skin, and reduce the development of dark spots. It may also reduce the number of treatments necessary and the possibility of recurrence. Between treatments, some patients may benefit from wearing support hose, particularly if they spend a lot of time on their feet.
Are there side effects to sclerotherapy?
Serious medical complications from sclerotherapy are extremely rare, however, as with any medical procedure, side effects may occur. Possible complications include the following:
Aching or soreness may occur during the first day or two following treatment. This is usually relieved by walking.
Red, raised areas may occur at the sites
Brown lines or spots on the skin (pigmentation) may occur at the sites of the treated blood vessels. These pigmented areas are mainly composed of hemosiderin (a form of iron stored in the blood) and may result when blood escapes from treated veins. This pigmentation is more likely to occur in patients who have larger veins treated. In most cases, this resolves within a year, but may persist longer in some cases. Persistent pigmentation may respond to laser treatment.
Development of groups of fine, red blood vessels near the sites of larger vessels (telangiectatic matting) may occur, especially on the thighs. Most disappear by themselves, some go away with injection treatment or laser therapy, and a few persist.
Rarely, small, painful ulcers may occur at the sites within two weeks of injection. These occur when some of the solution escapes into the surrounding skin. They appear to occur more frequently in patients who smoke cigarettes. These ulcers often heal slowly and may leave a small scar.
Bruising occasionally occurs at the injection sites. These disappear within a few weeks and are probably related to the fragility of blood vessel walls. Blood trapped in the sclerosed vein may cause the vein to be more noticeable in the first few weeks following treatment, and is an early sign that the treatment has been successful.
Although very rare, allergic reactions to certain sclerosing solutions may occur sometimes requiring an immediate injection of adrenaline. Less serious reactions may be treated with antihistamines.
Phlebitis, an inflammation of the treated blood vessels, may occasionally be seen. When it occurs, it is treated with anti-inflammatory medication, compression, antibiotics, and hot packs.
Tender lumps may occasionally develop in the injected vessels, particularly if larger vessels are being treated. These are areas where blood has been trapped in the sclerosed vein. The blood may be drained out of these lumps a few weeks after injection if necessary.
Some people who have a history of migraines may develop symptoms of migraine within a few minutes of the treatment session. The headache goes away on its own, but may be treated with medications if needed.
Deep vein thrombosis (clot in a deep leg vein) can occur, but is extremely rare if postoperative instructions are strictly followed.
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Millions of women are bothered by spider veins - those small yet unsightly clusters of red, blue, or purple veins that most commonly appear on the thighs, calves, and ankles. In fact, it is estimated that at least half of the adult female population is plagued with this common cosmetic problem.
