What Are Spider Veins?

Millions of women and men 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's estimated that at least half of the adult female population is plagued with this common cosmetic problem.

Today, physicians of the Advance Vein are treating spider veins with sclerotherapy. In this rather simple procedure, veins are injected with a sclerosing solution, which causes them to collapse and fade from view. The procedure may also remedy the bothersome symptoms associated with spider veins, including aching, burning, swelling and night cramps.

Although this procedure has been used in Europe for more than 50 years, it has only become popular in the United States during the past decade. The introduction of sclerosing agents that are mild enough to be used in small veins has made sclerotherapy predictable and relatively painless.

If you're considering sclerotherapy to improve the appearance of your legs, this brochure will give you a basic understanding of the procedure - when it can help, how it's performed and what results you can expect. It won't answer all of your questions, since a lot depends on your individual circumstances. Please ask your doctor if there is anything about the procedure you don't understand.

Spider veins - known in the medical world as telangiectasias or sunburst varicosities - 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.

A number of factors contribute to the development of spider veins, including heredity, pregnancy and other events that cause hormonal shifts, weight gain, occupations or activities that require prolonged sitting or standing, and the use of certain medications.

Spider veins usually take on one of three basic patterns. They may appear in a true spider shape with a group of veins radiating outward from a dark central point; they may be arborizing and will resemble tiny branch-like shapes; or they may be simple linear and 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 be related to more serious vein disorders. For some patients, sclerotherapy can be used to treat spider veins. However, often surgical spider vein treatment is necessary for this condition.

The best candidates for sclerotherapy
Women of any age may be good candidates for sclerotherapy, but most fall in the 30-to-60 category. In some women, spider veins may become noticeable very early on - in the teen years. For others, the veins may not become obvious until they reach their 40s.

If you are pregnant or breastfeeding, you may be advised to postpone sclerotherapy spider vein treatment. In most cases, spider veins that surface during pregnancy will disappear on their own within three months after the baby is born. Also, because it's not known how sclerosing solutions may affect breast milk, nursing mothers are usually advised to wait until after they have stopped breastfeeding.

Spider veins in men aren't nearly as common as they are in women. Men who do have spider veins often don't consider them to be a cosmetic problem because the veins are usually concealed by hair growth on the leg. However, sclerotherapy is just as effective for men who seek spider vein treatment.

What to expect from sclerotherapy
Sclerotherapy can enhance your appearance and your self confidence, but it's unrealistic to believe that every affected vein will disappear completely as a result of spider vein treatment. After each sclerotherapy session, the veins will appear lighter. Two or more sessions are usually required to achieve optimal results.

You should also be aware that the procedure treats only those veins that are currently visible; it does nothing to permanently alter the venous system or prevent new veins from surfacing in the future.

Before you decide to have sclerotherapy, think carefully about your expectations and discuss them with your doctor.

Risks related to treatment
Serious medical complications from sclerotherapy are extremely rare when the procedure is performed by a qualified practitioner. However, they may occur. Risks include the formation of blood clots in the veins, severe inflammation, adverse allergic reactions to the sclerosing solution and skin injury that could leave a small but permanent scar.

A common cosmetic complication is pigmentation irregularity - brownish splotches on the affected skin that may take months to fade, sometimes up to a year. Another problem that can occur is "telangiectatic matting," in which fine reddish blood vessels appear around the treated area, requiring further injections.

You can reduce the risks associated with spider vein treatment by choosing a doctor who has adequate training in sclerotherapy and is well versed in the different types of sclerosing agents available. A qualified doctor can help you select which type of sclerosing medication is most appropriate for your needs.

Planning your treatment
During your initial consultation, your legs will be examined. Your doctor may draw a simple sketch of your legs, mapping out the areas affected by spider veins or other problems. During the examination, you will be checked for signs of more serious "deep vein" problems, often indicated by swelling, sores, or skin changes at the ankle. A hand-held Doppler ultrasound device is sometimes used to detect any backflow within the venous system.

If such problems are identified, your surgeon may refer you to a different specialist for further evaluation. Problems with the larger veins must be treated first, or sclerotherapy of the surface veins will be unsuccessful.

Your doctor will ask you about any other problems you may have with your legs, such as pain, aching, itching or tenderness. You will also be asked about your medical history, medications you take, or conditions that would preclude you from having spider vein treatment. Individuals with hepatitis, AIDS or other blood-borne diseases may not be candidates for sclerotherapy. Patients with circulatory problems, heart conditions, or diabetes may also be advised against spider vein treatment.

It's important to be open in discussing your history and spider vein treatment goals with your doctor. Don't hesitate to ask any questions or express any concerns you may have. Your doctor should explain the procedure in detail, along with its risks and benefits, the recovery period and the costs. (Medical insurance usually doesn't cover cosmetic procedures.)

Preparing for the procedure
ou will receive specific instructions from your physician on how to prepare for your spider vein treatment. Carefully following these instructions will help the procedure go more smoothly.

You'll be instructed not to apply any type of moisturizer, sunblock or oil to your legs on the day of your procedure. You may want to bring shorts to wear during the injections, as well as your physician-prescribed support hose, and slacks to wear home.

When scheduling your procedure, keep in mind that your legs may be bruised or slightly discolored for some weeks afterward. You probably won't be comfortable wearing shorts, a swimsuit or a mini skirt until after your legs have cleared up a bit.

Where your treatment will be performed
Sclerotherapy of spider veins is a relatively simple procedure that requires no anesthesia, so it will be performed in an outpatient setting, most likely in our office.

The procedure
A typical sclerotherapy session is relatively quick, lasting only about 15 to 45 minutes. After changing into shorts, your legs may be photographed for your medical records. You will be asked to lie down on the examination table and the skin over your spider veins will be cleaned with an antiseptic solution. Using one hand to stretch the skin taut, your doctor or nurse will begin injecting the sclerosing agent into the affected veins. Bright, indirect light and magnification help ensure that the process is completed with maximum precision.

Approximately one injection is administered for every inch of spider vein - anywhere from five to 40 injections per spider vein treatment session. A cotton ball and compression tape is applied to each area of the leg as it is finished.

During the procedure, you may listen to music, read, or just talk to your practitioner. You will be asked to shift positions a few times during the process. As the procedure continues, you will feel small needle sticks and possibly a mild burning sensation. However, the needle used is so thin and the sclerosing solution is so mild that pain is usually minimal.

After your treatment
In addition to the compression tape applied during the procedure, tight-fitting support hose may be prescribed to guard against blood clots and to promote healing. The tape and cotton balls can be removed after 48 hours. However, you may be instructed to wear the support hose for 72 hours or more.

It's not uncommon to experience some cramping in the legs for the first day or two after the injections. This temporary problem usually doesn't require medication.

You should be aware that your treated veins will look worse before they begin to look better. When the compression dressings are removed, you will notice bruising and reddish areas at the injection sites. The bruises will diminish within one month. In many cases, there may be some residual brownish pigmentation which may take up to a year to completely fade.

One month after the first spider vein treatment, spider veins are distinctly lighter, yet still somewhat visible.

Getting back to normal
Although you probably won't want to wear any leg-baring fashions for about two weeks, your activity will not be significantly limited in any other way from sclerotherapy spider vein treatment.

You will be encouraged to walk to prevent clots from forming in the deep veins of the legs. However, during the period of time to complete your spider vein treatment program, prolonged sitting and standing should be avoided, as should squatting, heavy weight lifting and "pounding" type exercises, including jogging.

A one-month healing interval must pass before you may have your second series of injections in the same site. After each spider vein treatment, you will notice further improvement of your legs' appearance.

Your new look
Most patients are pleased with the difference sclerotherapy makes. The skin of your legs will appear younger, clearer and more healthy-looking. If you've been wearing long skirts and slacks to hide your spider veins, you'll now be able to broaden your fashion horizons. Often, patients are surprised at the dramatic difference in appearance between a treated leg and an untreated one.

Although sclerotherapy will obliterate the noticeable veins for good, it's important to remember that spider vein treatment will not prevent new spider veins from emerging in the future. As time passes, you may find that you need "touch-ups" or full treatments for new veins that surface. But even if you choose not to have further sclerotherapy, your legs will look better than if you never had spider vein treatment at all.

Different Types of Vein Terms/Names

Deep Veins are are located deep in the leg between muscle and fascia (tough fibrous tissue). They are responsible for returning 90-95% of the venous blood back to the heart.

Perforating Veins link the deep and superficial veins together.

Superficial Veins are usually affected by varicosities because they have little external support like the deep veins. These veins are visible from the skin when varicose. They drain the blood from the skin and are also responsible for blood storage. When these veins become varicose they can appear engorged and distended. This group also includes reticular veins and 'spider' veins. Reticular veins are small blue veins often seen through the skin. These are often the cause of 'spider veins, which are the tiniest blue purple veins seen in the skin.

When and How Are Veins Treated?

The most commonly asked questions are: Do veins require treatment and What treatment is best? Veins that are cosmetically unappealing or cause pain or other symptoms are prime candidates for spider vein treatment. There are two general treatment options: conservative measures, such as compression stockings, and "corrective" methods such as sclerotherapy, surgery and light source/laser treatment. In some cases, a combination of treatment methods works best.

Sclerotherapy

Sclerotherapy can be used to treat both varicose and spider veins. A tiny needle is used to inject the veins with a medication that irritates the lining of the vein. In response, the veins collapse and are reabsorbed. The surface veins are no longer visible. Sclerotherapy relieves symptoms due to varicose and spider veins in most patients. With this procedure, veins can be dealt with at an early stage, helping to prevent further complications.

You may need anywhere from one to several sclerotherapy sessions for any vein region. Depending on the type and number of veins being treated you may have one to many injections per session. Generally, normal activities can be resumed after sclerotherapy. Medically prescribed support hose and/or bandages may need to be worn for several days to several weeks to assist in resolution of the veins. The procedure, performed in the doctor's office, usually causes only minimal discomfort. Bruising and pigmentation may occur after sclerotherapy. Bruising typically disappears within 1-2 weeks. Although pigmentation almost always fades, it can last for several months. Scarring and other complications are rare.

Varicose veins before and after sclerotherapy.
Individual results can vary.
(Photos courtesy of S. Zimmet, MD)

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Ultrasound-Guided Sclerotherapy

This is an in-office treatment alternative to surgical stripping. With this technique, sclerotherapy is done while the doctor visually monitors the vein on an ultrasound screen. This enables treatment of veins that can't be seen because they are below the surface of the skin and would otherwise require surgical removal.

Laser Closure Procedure Called LES-Vein©

LES-Vein© (Laser Endovenous Saphenous Vein) Procedure is a treatment alternative to surgical stripping of the greater saphenous vein. A small laser fiber is inserted, usually through a needle stick in the skin, into the damaged vein. Pulses of laser light are delivered inside the vein, which causes the vein to collapse and seal shut. The procedure is done in-office under local anesthesia. Following the procedure a bandage or compression hose is placed on the treated leg. LES-Vein© treatment performed with a Dornier laser is FDA-approved for the treatment of the greater saphenous vein.

The Advanced Vein Care Center is one of the very few medical offices in the country specializing in LES-Vein© (Laser Endovenous Saphenous Vein) Procedure. We do all therapy in our office on an outpatient basis with the patient awake and able to resume normal activity immediately. LES-Vein© is a revolutionary treatment that almost eliminates the need for older surgical treatments for spider veins and has a 97% success rate. Our advanced techniques enable patients to achieve the best medical and cosmetic outcome.

Surgery

Surgical techniques to treat varicose veins include ligation (tying off of a vein), stripping (removal of a long segment of vein by pulling it out with a special instrument), and ambulatory phlebectomy (removal of veins through tiny incisions, SEE SECTION BELOW). Surgery may be performed using local, spinal or general anesthesia. Most patients return home the same day as the procedure. Surgery is generally used to treat large varicose veins.

Ambulatory Phlebectomy

Ambulatory phlebectomy is a method of surgical removal of surface varicose veins. This is usually done in the office using local anesthesia. Incisions are tiny (stitches are generally not necessary) and typically leave nearly imperceptible puncture mark scars. After the vein has been removed by phlebectomy, a bandage and/or compression stocking is worn for a short period.

Laser/Light Source Treatments

A variety of laser/light source treatments are available today. A light beam is pulsed onto the veins in order to seal them off and cause them to dissolve. Light-based treatment is generally used only to treat small veins. Treatments may be combined with sclerotherapy. Multiple treatments are usually required.

What Results Can You Expect From Vein Treatment?

With the evaluation and treatment methods available today, spider and varicose veins can be treated at a level of effectiveness and safety previously unattainable. Regardless which treatment method is used, its success depends in part on careful assessment of the problem by a knowledgeable phlebologist.

How Veins Work

To understand why the different lifestyle factors make such an impact, it's important to have a basic understanding of how veins work. The main purpose of leg veins is to return blood up the legs to the heart. The blood is pumped up the legs by muscle contraction and breathing. So, when you walk or move, the venous blood moves. And when you stand still, so does the blood.

The weight of all the blood in your legs is very heavy - so heavy, in fact, you would think it would drain down to your feet when you stand still. The veins prevent this from happening. Hundreds of small valves within the leg veins shut when you stand still. These valves keep the blood in place and stop it from running back down to your feet. When you start to walk again, the valves open up and the blood is pumped toward the heart.

Varicose Veins Result from Expanded Vein Walls and Damaged Valves

Although the exact cause of varicose veins is unknown, we do know that the walls of the veins can expand and valves can be damaged. This damage can happen when the blood is prevented from moving out of the legs as it should. Since the weight of the blood is so heavy, the valves are able to hold back the downward flow of blood for only a limited time. Then the vein wall gradually starts to expand. The valves no longer have a nice, tight fit, and blood starts to move down the leg. As more valves become damaged, more blood is allowed to pool in the vein, and it starts to become visible to the human eye. This is what we call a "varicose vein." When you have this type of vein you may also have symptoms of tiredness and "heaviness."

Heredity is the number one contributing factor causing varicose and spider veins. Women are more likely to suffer from abnormal leg veins. Up to 50% of American women may be affected. Hormonal factors including puberty, pregnancy, menopause, the use of birth control pills, estrogen, and progesterone affect the disease. It is very common for pregnant women to develop varicose veins during the first trimester. Pregnancy causes increases in hormone levels and blood volume which in turn cause veins to enlarge. In addition, the enlarged uterus causes increased pressure on the veins. Varicose veins due to pregnancy often improve within 3 months after delivery. However, with successive pregnancies, abnormal veins are more likely to remain. Other predisposing factors include aging, standing occupations, obesity and leg injury.

If you suffer from problems related to varicose and spider veins, you are not alone. It is estimated that more than 80 million Americans suffer from some form of venous disorder. While some people seek treatment for cosmetic improvement, many seek relief from pain.

What Are Varicose Veins?

Arteries bring blood from the heart to the extremities, veins, which have one-way valves, channel blood back to the heart. If the valves don't function well, blood doesn't flow efficiently. The veins become enlarged because they are congested with blood. These enlarged veins are commonly called spider veins or varicose veins. Spider veins are small red, blue or purple veins on the surface of the skin. Varicose veins are larger distended veins that are located somewhat deeper than spider veins.

Pain in the legs is frequently related to abnormal leg veins. Symptoms, often made worse by prolonged standing, include feelings of fatigue, heaviness, aching, burning, throbbing, itching, cramping, and restLESness of the legs. Leg swelling can occur. Severe varicose veins can compromise the nutrition of the skin and lead to eczema, inflammation or even ulceration of the lower leg.

Vein disorders are not always visible; diagnostic techniques are important tools in determining the cause and severity of the problem. In addition to a physical examination, non-invasive ultrasound is often used.

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