Spider veins refer to small veins close to the surface of the skin that usually appear as small groups of red, blue or purple veins. They are usually located on the thighs, calves, and ankles. Spider veins may appear as a few isolated sites, or they may be extensive covering large surface areas. In addition to spider veins, there are reticular veins, blue or green veins beneath the surface of the skin. These are larger than spider veins ranging from one to three millimeters in diameter. Both spider veins and reticular veins can be effectively treated with sclerotherapy. The prominence of spider and/or reticular veins can mar the appearance of otherwise attractive toned, shapely legs.

Sclerotherapy entails injecting a mild chemical into spider veins or reticular veins. The chemical irritates the walls of the blood vessels causing the vessels to collapse eliminating or minimize the appearance of spider or reticular veins.

There are a variety of chemical solutions that can be used to treat both spider and reticular veins. These include Polidoncano, Sodium Tetradecyl Sulfate, and Hypertonic Saline. Treatment sessions may last between 15 minutes and 45 minutes depending on the number of veins treated. Most patients describe the discomfort as minimal. When the treatment session is completed, the patient’s legs are wrapped with a compressive elastic bandage for several hours to 24 to 48 hours post treatment depending on physician protocol. Compression stockings may also be prescribed to be worn for one to three days. Patients can return to their usual activities immediately after their treatment session. However, patients are advised not to stand or sit with their legs in a dependent position for a prolonged period of time.

What factors contribute to the development of spider veins in the legs?

• Heredity
• Pregnancy
• Weight fluctuation
• Prolonged standing or sitting
• Gender—females are more likely to develop prominent leg veins secondary to hormonal changes associated with puberty, pregnancy, or menopause
• Birth control medications can increase the risk of developing prominent leg veins

Are there any contraindications to sclerotherapy?

• Allergy to Polidoncanol
• Breast-feeding
• Pregnancy
• Patients with blood clotting diseases
• Patients taking blood thinner may experience excessive bruising

What can be expected immediately after treatment?

• There may be bruising which gradually resolves within two to four weeks. Occasionally bruising may last longer.

• Gradual lightening of spider veins occurs over the course of a month.

• Occasionally there may be brown pigmentation which may appear several weeks after the procedure. This is referred to as postinflammatory hyperpigmentation (PIHP). Often this will resolve over time. It can be treated with topical medications (Retin-A, hydroquinone) which can facilitate the resolution of PIHP.

Can lasers be used to treat spider and reticular veins?

While lasers can be used to treat spider and reticular leg veins, sclerotherapy is the gold standard for treating leg veins. Sometimes lasers may be used to treat blush areas where there is a confluence of tiny spider veins, too small to inject. In some instances, lasers may be used in conjunction with sclerotherapy.

Do the veins come back after treatment?

The veins do not come back, but new ones can develop. For individuals who have occupations that require long periods of standing or sitting gradient compression support hose can help prevent the development of new veins.