Removing the “web” of spider veins has long been a pursuit of humanity, first recorded in 400 BC. The first documented treatment of venous disease was referenced in historical annals in the form of offerings to the gods as supplication seeking relief. Soon after, Hippocrates wrote in 460 BC of introducing a “slender instrument of iron” through multiple punctures into veins to induce clotting. The idea of introducing a foreign substance into a vein for treatment is most likely the precursor to modern day sclerotherapy. Later in 1550 BC, the first historical documentation of treatment for these pesky superficial veins, is found on papyrus scrolls by the ancient physician Ebers.
The injection of medicine into these small veins began with Sigismund Eisholtz in the mid -1600 with the use of distilled plantain water. The advent of the lacrimal syringe in 1713 by Anel and the hypodermic syringe by Rynd in 1845 led to the trial of various substances to induce clotting including absolute alcohol, iodine, mercury salt solutions ( 1840-1946) and in 1966, polidocanol became popular and remains so.
What are Spider Veins?
Spider veins are superficial, tiny, dilated capillaries (1-2 mm) ranging in color from red to blue to purple. Spider veins are technically known as telengiectasias and lie close to the surface of the skin. Diagnosis is based on their superficial location. The three most common presentations include a spider shape with a central dark spot and outwardly radiating fine wiggly lines; individual tiny branch- like shapes and finally, thin separate lines. The most common location are the legs, followed by the face. Sometimes they are mistaken as a bruise.
All veins have one-way valves that move blood in one direction only. Deep veins have a layer of muscle which assists in directing the flow of blood by a squeezing action. Superficial veins to do not have muscle and for this reason are prone to dilation because of weakening of the vessel wall from back flow pressure.
What Causes Spider Veins?
There are many factors which contribute to the development of spider veins. The most common risk factors include underlying genetics, obesity, inactivity, pregnancy, increased age, prolonged sitting or standing, a history of prior blood clots, sun exposure and probably estrogen changes.
Risks of Spider Veins
Spider veins may start as a cosmetic annoyance but can be associated with varicose veins. Spider veins will not go away without treatment and usually progress over time. Although not all people with spider veins have varicose veins, most people with varicose veins also do have spider veins. Spider veins are easily diagnosed due to their superficial visibility. Varicose veins require additional steps. If there is associated leg fatigue, swelling, aching, and cramping, a diagnostic ultrasound to assess the status of the deeper veins is recommended to determine the status of the deep venous system and guide treatment.
Treatment of Spider Veins
There is no question that a healthy weight, physical activity, avoiding prolonged sitting and standing and using compression stockings for prolonged standing can help.
Compression therapy has been an important adjunct to treatment and not surprisingly, also dates to Hippocrates. Roman soldiers later used leather straps while today we apply mechanically engineered compression stockings. Such stockings are available at pharmacies and as well as custom fitted stockings ordered through a medical professional.
The gold standard of spider vein management is sclerotherapy:
Sklerosis: from the Greek, a hardening or induration of he a tissue or part
Therapeia: from the Greek, treatment of disease or disorder as by some remedial or restorative process
Sclerotherapy is a broad-based term to describe the medical technique of introducing medication into a vein for the purpose of shutting down and eliminating it. The agents that are used for spider veins, and some varicose veins, are chemical compounds that act as irritants and cause the inside of the vessels to collapse.
There are a variety of sclerosing agents but the two approved by the FDA include Polidocanol (brand name Asclera) and sodium tetradecyl sulfate (brand name Sotradecol), injected directly into a superficial vein . These agents remain the standard by which all other treatments are compared. Lasers can work with some of the smallest spider veins but usually at a slightly higher risk of complications (blister, scar, change in pigmentation, unsatisfactory result) and a higher cost. We like Asclera for it is the most pain free, has fewest side effects and best results.
Patients should expect 3-5 treatments to clear spider veins but depending on the size and severity, may take more sessions. These sessions can be 15-45 minutes each and are spaced about 4-6 weeks apart. Best results are achieved with the use of compression stockings for a minimum of 2 weeks after injection. The success rate is in the range of 80-90% and improvement, noted by fading, is usually noted in 3-4 weeks after the injections and can continue out to a year.
What to Expect from Sclerotherapy Treatment
Patients should expect 3-5 treatments to clear spider veins but depending on the size and severity, may take more sessions. These sessions can be 15-45 minutes each and are spaced about 4-6 weeks apart. Best results are achieved with the use of compression stockings for a minimum of 2 weeks after injection. The success rate is in the range of 80-90% and improvement, noted by fading, is usually noted in 3-4 weeks after the injections and can continue out to a year.
The veins treated by sclerotherapy can be successfully treated, reducing their prevalence and visibility. However, it is important to appreciate that the those which are treated can be replaced by new veins as well as the development of others in the same area. This can be a signal that the deeper vein system should be examined for underlying valve disorders which are contributing to the spider veins.
Many people with complaints of spider veins undergo sclerotherapy at least once annually to stay ahead of their growing visibility.
Preparing for Sclerotherapy
- Avoid aspirin or aspiring like medications (NSAIDS) for 2 weeks before treatment
- Avoid blood thinners
- Avoid smoking for 2 weeks before treatment
- Wash the area to be treated with antibacterial soap the morning of your procedure
- Stay hydrated
- Avoid lotion or shaving before treatment
- Wear loose fitting clothes
- Bring your compression stockings
Are there any risks to Sclerotherapy Treatment?
It is normal for the treated area to be slightly inflamed and itch. These issues usually resolve in a few hours. It is also possible to develop bruising, redness, superficial pain, inflammation, and discoloration.
Preventing Spider Veins
Although there is no sure way to prevent spider veins, making certain lifestyle changes may reduce the risk of developing them. Lifestyle changes include losing weight, exercising regularly, and wearing support stockings and comfortable, flat shoes. It is also important to move the legs frequently, especially during long periods of sitting or standing in one place. The presence of several clusters of spider veins is reason to investigate the possibility of a deeper vein problem as the origin of the issue. In this case, treating the deeper veins may reduce the future development of spider veins.
Schedule a Consultation
For more information, contact our office today by filling out our contact form or calling 203-221-0102.
