Spider veins are tiny superficial blood vessels appearing on the skin in "sunburst" patterns. They often appear in clusters on the lower extremities, face and other parts of your body. It is estimated that at least 50% of women suffer from spider veins. It is common in men but not as noticeable secondary to hair and clothing. Women often avoid wearing clothes that show their legs due to the embarrassment of having spider veins.
Most patients with spider veins remain asymptomatic while others may complain of burning, itching, throbbing, heaviness or pain. Occasionally they may spontaneously bleed. The exact cause of spider veins is unknown; however, heredity seems to play a critical role. Spider veins are more common in woman secondary to pregnancy, hormones, birth control pills or hormone replacement therapy. Occupations requiring prolonged sitting, standing or working on hard concrete floors may increase the risk of developing spider veins. A history of blood clots or venous valvular insufficiency may increase the risk too.
Treatment options for spider veins should be individualized. Many people are simply not bothered by them and do not seek medical treatment. Additionally, the treatment of spider veins is rarely covered by insurance, especially if the treatment is for cosmetic reasons. If there is an underlying condition of venous valvular insufficiency or larger varicose veins, then these underlying conditions are often covered by insurance.
There are several conservative treatments for spider veins, which have marginal positive effects. These include support stockings, elevation of the legs and lifestyle changes such as weight loss, avoidance of sun and walking. The two mainstay forms of treatment include sclerotherapy and topical skin laser therapy.
Sclerotherapy treatments involve the injection of a sclerosing agent into the spider vein. Various solutions work by different mechanisms but most commonly irritate the lining of the vessel, which causes it to close, fibrose and become reabsorbed by the body. The vessel fades and becomes barely noticeable. Most patients receive multiple injections with very small needles. Special bright lights and magnification aid the doctor while injecting these veins. The procedure is relatively simple and is performed in an outpatient setting. It may take more than one sclerotherapy session to obliterate all of the spider veins but most specialists wait three or four weeks between treatments for best results. Most patients can achieve 80%-90% improvement.
There are several safety and risk factors to be aware of prior to sclerotherapy. Temporary or limited complications include pain and reddened areas at the site of injection and temporary bruising. More severe complications include possible allergic reactions and skin ulcerations at treatment sites. Small areas of hyper pigmentation or brown staining at the site of injection may occur up to 30% of the time. Matting or new spider veins may also arise at the injection site.
An extremely rare but reported complication is a major neurological event (TIA/Stroke) following foam sclerotherapy of spider veins. Your vein specialist should be well versed in the treatment of this complication. Make sure you tell your doctor if you have a known patent foramen ovale of the heart, an atrial septal defect or a history of migraine headaches. This should alert your physician of the increased risk of embolization occurring through a right to left shunt within the heart at the atrial level. This mechanism of injury is the blocking blood flow in the brain and local neurological tissue secondary to ischemia that is caused by a cerebral artery air embolis.
Although extremely rare, these risks do exist and you need to discuss this with your vein doctor. While sclerotherapy is still the most commonly used and is considered the gold standard for treatment of spider veins, advances have been made with the use of topical skin lasers for the treatment of spider veins.
The laser energy is wavelengths of light, which are absorbed by the hemoglobin in the spider vein, which destroys them. There are various types of skin lasers with varying wavelengths (depth of penetration). The advantage of lasers for the treatment of spider veins is the lack of use of needles (less invasive) and the speed of the treatment. Not all lasers can be used on different skin types. It is best to discuss which laser is best for you with your vein doctor. Side effects of lasers include discomfort during the procedure and hypo or hyper pigmentation of the skin.
Spider veins can give doctors a bad reputation. Even with the treatment of spider veins with either sclerotherapy or laser therapy, these little veins have a tendency to reoccur or often-new veins develop. One’s expectation should be realistic knowing that these veins may be a lifelong problem although treatment markedly improves their appearance.