“Spider veins” are a general term used for the thin hair-like veins that appear on the legs. The development of these veins is also primarily genetic, but they may be influenced by hormones, smoking and standing for long periods. They are very common with 80% of the population experiencing them.
There is a wonderfully vast and complex system of veins that are involved in transporting blood from our legs back to our heart. Spider veins arise from the subcutaneous and dermal system. They exist in vast numbers under the skin and are usually invisible to the human eye, but when they become dilated one sees the blood they are carrying and they appear as spider veins.
Spider Vein Types
Spider veins in general are less than 3mm. Veins that are 1-3 mm in diameter are known as reticular veins. These veins are usually blue in colour and are not found deeper than 5 mm. They often draw a blood supply from the superficial system or a small feeding vein. Telangiectasia’s are even more superficial, tiny veins, ranging from 0.1 mm - 1 mm in diameter.
There are four types:
Varicose veins are, by definition, larger than 3 mm in diameter and are linked to a deeper system– the saphenous system.
About 5% - 10% of patients with these types of veins will have a problem with the deeper saphenous veins, and this is why we always look at all the layers of veins. A brief scan will look for the major areas of where a feeding vein may be refluxing and causing the network of visible veins. This all depends on the location of the veins and other leg symptoms. If there are varicose veins or symptoms of chronic venous disease, a full venous scan and vein map will be necessary.
What is the treatment?
Treatment of these veins is called sclerotherapy.
There are many treatments for spider veins. Although these are veins mainly treated for cosmesis and not a health concern, they are notoriously hard to treat. There are many treatment options (laser, sclerotherapy with different chemicals, radiofrequency), meaning there is no single perfect treatment option.
At the OptiVein Centre, we use injection sclerotherapy for treating leg veins. We believe this is the best for leg veins as it is the strongest for veins that constantly have gravity applied against them.
We also use a special OptiVein Mix of two different sclerosants that we have had made up for us.
At the OVC, we have developed protocols to try and ensure the best outcomes. However, one does have to have realistic expectations, understand that getting rid of veins is a process and that maintenance is required as we cannot prevent new veins from forming.
We do believe, based on this understanding and our protocols we can achieve the desired results.
The treatment is called injection sclerotherapy. This involves injecting a sclerosant into the veins using tiny needles. The sclerosant essentially irritates the vein walls and causes them to stick to one another and prevent flow through the veins.
Veins do not disappear immediately. They will go red for 24 hours, and then if they start sealing off go dark and the body will resorb them over the next few weeks. Actual time frames of healing vary from individual to individual. In the same way, different individuals respond differently to sclerotherapy (and the different types of chemical). Some people require more than one treatment or a dose change.
Once the sclerosant is injected the area will be compressed. Graduated medical compression is placed immediately after the procedure.
Foam sclerotherapy may be used to treat larger veins. This involves mixing air bubbles with the sclerosant and allows more sclerosant to come into contact with the vein wall at a lower concentration.
How many treatments are necessary?
The number of treatments is individualised once your legs have been examined. There is a limit to the amount of injections and sclerosant that can be done per treatment. Usually more than one treatment session is required, but this depends on the extent and one’s response to treatment. There needs to be a 4 to 6 week treatment break of the same area. New areas can be treated within a week.
You need to have realistic expectations. When sclerosant is injected, the veins disappear (this is often shown on internet videos). However these veins refill with blood once the sclerosant is washed out (this is usually not shown on internet videos). Statistics recorded by the Mayo clinic state that you should expect to see results in 3 to 6 weeks. Larger veins may take up to 3 to 4 months . Studies have shown an overall success rate of 50 - 80 %. Despite the fact there is no 100% guarantee, if one perseveres and adheres to the post procedural management, excellent results can be achieved. Thereafter, maintenance becomes easy and one can have small sessions every year or second year or whenever some veins pop up again!
Side Effect of pigmentation
The chemical used to treat spider veins can sometimes leave pigmentation. We do not know who will get it and who won’t. Treating bigger veins does increase the risk. In most people this will go away but can take weeks to months or up to a year. It has shown to be permanent in 1% of people.
At the OVC we take precautions to try and prevent this – by using medical graduated compression and following a strict post procedural protocol.
Before / After Sclerotherapy Results
Left to right: Before and after treatment.