Spider veins, so called because the “arms” of these tiny dilated blood vessels appear to project outward from a central denser area like the legs of a spider from its torso, are also called sunburst varicosities, for a similar reason, or telangiectasias (“broken” blood vessels). In fact, they are simply diminutive, thick venules (literally: little veins) that lie close to the surface of the skin. And because they principally carry deoxygenated blood (blood that is not saturated with oxygen needed by the tissues) they actually serve no useful function. Even nutrition-wise, it is the function of the the blood vessels hidden below the surface, within the dermis, that carry nutrients to the skin. In short, spider veins are just a plain, disfiguring nuisance.
The precise cause of these unwanted vessels is still the subject of investigation. However, we believe that they develop as a result of a complex interplay of genetic, hormonal and environmental factors. There is often a strong family history for their formation. You might find, for example, a mother, daughter and sister suffering the same problem. Elevated estrogen levels appear also to aggravate the problem. You might find that the condition worsens, for example, during pregnancy or while on birth control pills. It is also more common in people whose jobs require them to be on their feet a great deal, in overweight individuals, and in those who have sustained some kind of injury to the area, including blunt trauma, cuts, lacerations, or even surgical procedures.
Whatever they are called and however they come about, countless numbers of women and men want them gone. Despite the advent of lasers, sclerotherapy is still considered the gold standard treatment and the commonest method for getting rid of them. Sclero, literally means “scar,” and sclerotherapy works by irritating the lining of the unwanted blood vessels to such an extent that they collapse upon themselves and eventually scar over and disappear from view entirely. For this purpose, your doctor can choose from a number of different sclerosing agents, including super concentrated salt solution (hypertonic saline).
Very tiny, dense “mats” or conglomerations of red blood vessels, known as telangiectatic matting is difficult to treat with sclerotherapy and may respond better to laser therapy. On the other extreme, larger varicose blood vessels are best treated by such procedures as venous stripping and ligation, ambulatory phlebectomy and the newer radiofrequency surgical technique.
One of the major advantages of sclerotherapy is that it is fast and simple. A typical treatment session may take only about fifteen to thirty minutes depending upon the size of the area to be treated. A very tiny needle, smaller than most sewing needles, is inserted into the venule and the sclerosing material is then injected until it and the vessels in the region immediately surrounding it fade from view as the solution courses through. Each subsequent site is injected in a similar fashion until the entire area to be treated is completed. No anesthetic is typically required, although occasionally a topical anesthetic cream, such as EMLA or ELA-MAX may be applied. Some pricking, stinging or burning may accompany the injection. Doctors frequently cover the sites with compression bandages consisting of cotton balls that are taped in place and left for three days. Others also recommend that support hosiery be worn for several days or weeks afterward. A soothing anesthetic, moisturizing cream, such as Lida Mantle cream, may also be prescribed.
While some patients obtain satisfactory overall improvement after one treatment session, it is more common to require two or more treatments, spaced at four to six week intervals, to the same area in order to obtain a satisfactory cosmetic result. Each session can be expected to yield a 50 percent improvement in appearance, but of course the results are highly individual. And, unfortunately, eliminating existing blood vessels does nothing to prevent new ones from developing at a later date requiring additional treatment sessions. Individuals with diabetes, heart disease or circulatory problems are not considered good candidates for the procedure.
Some mild leg cramping, bruising or redness may occur following treatment, but patients typically return to work or social activities right away (ie. no “down time”). Clots that may need to be drained and temporary coffee-colored skin staining also sometimes occurs. Rare, but more severe reactions include the formation of clots, local or systemic allergic reactions, to the sclerosing solution, skin ulcerations and scarring. Thankfully, the latter complications are uncommon.