Along Came A Spider

You may not notice them every day. But there they are, first forming at the ankles and then suddenly becoming noticeable as they form little groups and climb up the legs. Spider veins. Where do they come from? What can we do about them?

The skin has a network of tiny capillaries everywhere on its surface. These vessels allow for nutrients to be brought to the skin cells, and waste to be removed. The blood then flows into tiny veins, which join together with other veins to gradually form ever-larger veins, draining finally into the very large veins in the legs. Over time, some of these tiny veins which receive blood from the capillaries begin to expand. The reasons for this vary, but the result is the same: the previously tiny invisible vein is now large enough, and close enough to the skin surface, to become visible.

Sometimes these veins occur in isolation, and develop sporadically due to stretching of the vein wall. In other cases, there are localized or widespread patches of spider veins, which could indicate a problem with the larger, deeper veins in the legs. If those larger veins aren’t draining properly, pressure builds up and causes the smaller veins to stretch. Usually, there will be a prominent vein (called a reticular vein) which feeds these patches of spider veins. Over time, as spider veins further expand, they too can develop into reticular veins. Very rarely do they develop into true varicose veins (which measure over 3 mm in size). The good news is that spider veins on their own are totally harmless. In exceptionally rare instances, they can bleed (often when nicked by a razor while shaving), but the bleeding usually stops very quickly, and is not a danger to the patient. 

So how do we treat them? The first step is to determine if the spider veins developed due to a problem with the deeper veins. If so, the best treatment is to close the malfunctioning deeper vein, and then target the spiders. An ultrasound will quickly determine if this is the case. Once the deeper vein is treated, or if the deeper veins are functioning normally, we can successfully target the spider veins with a procedure known as “sclerotherapy”. This is a general term for a treatment where an irritant is injected into a space in the body to cause the space to close. In the case of veins, sclerotherapy is best accomplished with a medication called Sotradecol.

Some doctors use a medication called saline, but this is not the best sclerotherapy agent, as it is less effective, is painful on injection and has a higher risk of darkening the skin. Sotradecol has the fewest risks, has been in use for decades, and is FDA-approved to treat veins of all sizes. Using a minuscule, tiny needle (the smallest available in the world), the Sotradecol is injected directly into the problem vein. This irritates the vein lining, and the body tries to heal the irritation by closing the vein. The injection itself is often painless. A mild tingling sensation may be felt at the injection site, followed by a slight itchiness.  

If there is a larger reticular vein feeding the spider veins, I try to inject that vein, so that the Sotradecol flows into all the little spiders that come off of the reticular vein. Sometimes the reticular vein is a little too deep to be seen with the naked eye, so I use a special light to highlight the reticular vein and guide the injection. A cream to reduce irritation and break up any blood that leaks out of the vein is then applied. Compression is applied to the leg for 24 hours after the injection to squeeze the blood out of the vein and allow the vein walls to touch and close up permanently. 

Usually, a series of injections is necessary to effectively treat the veins. Of course, the exact number of sessions needed varies from patient to patient and an estimate will be provided after an initial consultation. This initial visit - which includes an ultrasound to rule out a problem with the deeper veins - is provided at no charge. Subsequent sessions will usually last about a half hour, and all the visible veins on the leg are treated per session. There is no downtime, and many patients come on their lunch break and return right to work. As the treatment of spider veins is considered a purely cosmetic procedure, it is never covered by insurance, but is surprisingly affordable.

Spider veins can occur on other parts of the body as well, namely the face and the trunk. Special care must be taken when treating facial veins, as some of the veins of the face drain into spaces around the brain, and the development of a clot in that area could be very dangerous. It is important to seek out a board-certified phlebologist (vein doctor) who can evaluate and treat these and other veins with the utmost care and expertise. There are many doctors who perform sclerotherapy, but very few certified by the American Board of Venous and Lymphatic Medicine. 

While you may not be thinking about the appearance of your legs during these cold winter months, now is actually the best time to have them treated, as there is a period of several weeks between injection sessions. By the time warm weather comes around again, significant progress can be made toward eliminating or vastly improving the appearance of these troublesome veins. So make an appointment today to squash those pesky spiders!