They are varicose blood vessels that have a blue appearance and are typically visible on the thighs, legs and ankles. Those who have them, often feel very self-conscious.
These "spider veins" are small vessels whose walls have lost their elasticity. They are then left carrying slow moving deoxygenated blood. In other words, they're serving no useful function for the skin or any other tissues in your legs.
The causes for these vessels are many, and in any given person, more than one factor may be playing a role in causing "spider veins." The major factors causing "spider veins" on the legs are:
In these cases, there is usually a family history.
There is frequently a worsening during times of heightened estrogen levels, as during pregnancy, during adolescence, or while taking some estrogen-containing medication (such as birth control pills).
There is usually a history of a well remembered blow, or fall, or cut, or surgical procedure at or near the affected sight. Other factors are known to cause "spider veins ", but are much less commonly associated with the veins than the three factors listed above.
Because these vessels are such so unsightly many different techniques have been developed through the years in order to eliminate them. The major techniques tried on the legs have been electrosurgery and laser surgery, and injection of sclerosing solutions (sclerotherapy). While electrosurgery and lasers work nicely on facial vessels, sclerotherapy has proven to be the best treatment for "spider veins " on the legs.
We use hypertonic saline (23.4sodium chloride, containing no preservatives and no heparin) because of its safety and effectiveness. Allergic reactions cannot occur and it does not cause permanent staining of the skin at the injection sight. Hypertonic saline does cause stinging and short-term (minutes) discomfort in some persons, but it is very safe and very effective. We also use Sotradecol which is a detergent type of sclerosing agent.
Vessels from less than 1/2 mm to as large as 2 mm can be treated. Pressure over the larger vessels after sclerotherapy causes them to respond better to treatment. Larger vessels can also be treated, but may need surgery, and vascular studies prior to treatment.
Side effects are uncommon. They include brown spots or small crusts or ulcerations at the injection sights. If a brown streak occurs along the course of the treated vessel, it will fade without treatment. Some vessels may require two to four treatments before responding completely. Ankles frequently swell for a few days after they are treated. Thrombophlebitis of the treated vessel occasionally occurs. It's superficial and responds well to aspirin (or other similar anti-inflammatory drugs), heat, and antibiotics (infrequently needed). Infrequently, tiny new vessels develop at treatment sights. They are treated the same way the original vessels were. Rarely, an ulcer may need to be excised in order to speed-up healing.
The frequency of treatments is determined by the severity of the problem. Treatments are usually done at four to six week intervals. Most patients achieve about a 50% clearing with each treatment.
We expect our patients to get a 75-80% improvement with two treatments. Most do better than that. Sclerotherapy is a very pleasing answer to a nuisance-type problem that will not go away by itself.
Generally patients go directly back to work. No work should be missed.
Those spider veins can also be treated with very good results with a pulsed-dye laser.