What are spider veins?
“Spider veins” is the common term for the relatively small red, blue, purple or greenish veins on the surface of the skin. The medical terms for these veins are telangiectasia, if the vein is less than one millimeter in diameter, and reticular veins, if they are greater than one millimeter in diameter.
These small dilated veins are very near the surface of the skin and can appear anywhere on the body, but are mainly found on the legs and face. Even though these veins are small, they can cause a significant amount of pain, itching, and burning, as well as the other symptoms of vein disease.
“Spider veins” are sometimes a sign of significant vein disease within the leg. If a patient with “spider veins” is having any of the symptoms of vein disease such as aching, heaviness, tiredness, burning, itching, restless legs, etc. they should have a venous ultrasound to evaluate the underlying veins of the legs.
If a patient has “spider veins” with no symptoms, they can be treated immediately with visual sclerotherapy without undergoing an ultrasound study. If a patient without symptoms has sclerotherapy and does not get good clearance of the “spider veins” or if the “spider veins” return relatively soon, they should have an ultrasound study because there may be underlying disease.
The treatment of choice for “spider veins” on the legs is visual sclerotherapy. An injection sends the sclerosing fluid along the vein no matter which way the vein twists or turns. Hypertonic saline was used in the past for sclerotherapy but it is no longer used in advanced vein centers. Modern sclerosants are not painful like hypertonic saline injections are, have much fewer side effects, and are much more effective. At ERVC we use Asclera® (http://www.asclera.com) for visual sclerotherapy of “spider veins.”
Many surface lasers have been developed to treat “spider veins” over the years and none is as effective as visual sclerotherapy. It has not proven safe or effective to use an external laser for anything more than the tiniest “spider veins” and the lasers have a risk of blistering or discoloring the skin.
On the other hand, lasers, intense pulsed light and ohmic devices are preferred over sclerotherapy for the treatment of facial veins. At ERVC we have all three of these options available and we will use the device or combination of devices most likely to help eliminate an individual’s facial veins. We employ the Sciton® ClearScan™ 1064 YAG laser (http://www.sciton.com/products/clearscan-yag), the Sciton® BBL™ intense pulsed light system (http://www.sciton.com/products/bbl.html) and the VeinGogh XP® ohmic system (http://www.veingogh.com).
Clovis E. Manley, MD
Evansville Regional Vein Center