Definition and Overview

Spider veins, also known as varicose veins, are swollen blood vessels that are raised just beneath the surface of the skin. They come in twisting lines of red, purple, and blue, some smaller, and some bigger. They are most commonly found on the legs but can also appear on other parts of the body, including the face. Treatment for varicose veins ranges from home remedies to laser therapy. Some cases may also require surgical procedures.

Who should undergo and expected results

Spider veins do not always require treatment, especially if they are not causing any pain or discomfort. However, there are some cases where treatment should be considered, such as in cases where you:

  • Experience symptoms such as pain and discomfort
  • Experience complications, which may include swelling, skin discolorations, and leg ulcers
  • Develop a painful blood clot due to the inflamed vein, a condition known as thrombophlebitis
  • Are bothered by the appearance of your spider veins


You should also seek treatment if you experience the following symptoms:

  • Leg pain
  • Cramping
  • Tiredness
  • Restlessness
  • Burning sensation
  • Throbbing
  • Tingling
  • Heavy legs


Spider vein treatment is also commonly sought by those who have a higher risk of developing this condition, such as those who:

  • Have a family history or genetic predisposition to it
  • Are working in an occupation that requires standing for extended periods of time, such as teachers
  • Are obese or overweight
  • Are using oral contraceptives
  • Are undergoing hormonal replacement therapy
  • Have a history of blood clots
  • Have an underlying condition, such as pregnancy or a tumour
  • Are used to wearing tight-fitting garments such as girdles

How the procedure works

The primary form of treatment for spider veins is using compression stockings, changing one's lifestyle to avoid standing for an extended period or to lose weight, and getting more exercise, such as walking or jogging. If these do not help, it is best to seek medical care. Available treatment includes:

  • Sclerotherapy – This is a procedure wherein a saline solution is injected directly into the inflamed vein. This causes varicose veins to disappear after just three to six weeks. It is becoming a very popular spider vein treatment because it is not just effective but is also affordable. It is also convenient, not just because it can get rid of spider veins in just weeks, but also because the procedure itself takes a single outpatient visit to the doctor.
  • Endovenous laser treatment – This procedure involves inserting a tiny laser fiber into the affected vein and delivering laser light pulses through it. Once the laser light reaches the veins, the latter collapses. Similar to sclerotherapy, this minimally invasive procedure can be performed on an outpatient basis and requires only local anesthesia.
  • Surface laser treatments – While laser light can be sent directly into the veins to shrink them, it can also help get rid of spider veins when applied to the skin surface. Such treatments are called PhotoDerm or Vasculight, both of which use heat energy to destroy abnormal veins without having to use needles or sclerosing solutions. However, this is not widely recommended as it can cause some discomfort, discoloration, and blistering.
  • Radiofrequency occlusion – Another minimally invasive spider vein treatment, radiofrequency occlusion uses a small catheter to deliver radiofrequency energy to the walls of the affected veins. The energy brings about some heat, which then causes the veins to collapse and eventually be sealed shut. Without any blood going through, the vein will slowly shrink and disappear. This is also performed under local anesthesia in an outpatient setting.
  • Surgical removal. Depending on the severity of the condition, surgical removal such as stripping, ligation, or ambulatory phlebectomy may be considered. Ligation refers to tying off a vein to stop the blood flow while stripping refers to the surgical removal of spider veins. However, the latter does not work for large surface veins, which are instead removed using ambulatory phlebectomy where the veins are removed through small incisions. The choice of anesthesia will depend on the doctor's discretion and the patient's preference, but local, spinal, or general anaesthesia may be used. Even with surgical spider vein treatment, patients rarely have to stay in the hospital overnight.

Possible risks and complications

The possible complications and risks of spider vein treatment depend on the exact type of treatment performed.

Radiofrequency ablation poses the risk of paraesthesia, or a pins and needles sensation, although this is only a short-term side effect. Endovenous laser treatments, on the other hand, puts the patient at risk of some bruising and pain as well as some tightness in the legs especially immediately after the procedure, although these are temporary as well.

As for sclerotherapy, the lack of information about this relatively new treatment option is a risk in itself. With no information as to its long-term effectiveness, sclerotherapy may not prevent a spider vein from reappearing. Studies also show that it has only an 84% chance of effectiveness and more than 50% chance of recurrence. This procedure also causes side effects such as blood clots in other veins, lower back pain, fainting, headaches, and vision problems, all of which are temporary.

References:

  • Freischlag JA, Heller JA. Venous disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 65.
  • Goldman MP, Guex JJ, Weiss RA. Sclerotherapy: Treatment of Varicose and Telangiectatic Leg Veins. 5th ed. Philadelphia, PA: Elsevier Saunders; 2011.
  • Nijsten T, van den Bos RR, Goldman MP, et al. Minimally invasive techniques in the treatment of saphenous varicose veins. J Am Acad Dermatol. 2009;60:110-119.
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