Diagnosis of Spider Veins
Most of the time diagnosis of spider veins is straightforward. There they
are on your legs. But it is important to identify associated vein disease.
Are there also varicose veins present? We have many patients come in asking
to have spider veins treated, yet ignore their varicose veins. In general,
this will not produce a satisfactory outcome. The underlying factors causing
the varicose veins usually relate to the spider veins as well. Usually, one
must treat the varicose veins first before treating the spider veins. If the
spider veins are very extensive, or form dark purple clusters, an underlying
vein abnormality must be sought, and, if identified, treated prior to spider
vein treatment. So, sometimes a patient interested in having spider vein
treatment may need to have an ultrasound examination to evaluate these special
situations.
It is also important to identify other factors which may influence spider vein
treatment. Has there been prior vein treatment, and, if so, any complication
from it? Was there a significant injury or major surgery of that leg that could
have disrupted normal vein patterns? Does the patient have other chronic conditions,
blood disorders, autoimmune diseases, diabetes, arterial disease, obesity, skin
conditions, etc.? Is the patient taking any medications that could influence
treatment, such as blood thinners, steroids, antibiotics, etc.? So, even though
treatment of spider veins seems simple, it is important that is supervised by a
physician specialist in vein disease.
How are spider veins treated?
Sclerotherapy involves the injection of solutions into the veins that cause them
to shut down by a process similar to scarring. The needle used is very tiny, and
even people with a history of fear of needles tolerate the procedure well. The
solutions do not harm other organs in the body, and have longstanding safety records.
Highly concentrated saline has been used by many physicians, but is very painful.
Most experts use solutions that are chemically similar to detergents. These cause
only minor discomfort, and generally give better results. Severe allergic reactions
to these solutions have been reported, but are very rare. At an international
meeting of vein experts last winter, physicians were asked if they had ever seen a
serious allergic reaction with use of any of these solutions. Not one hand was
raised. If there is a risk from allergic reaction, it must be very, very small.
In over 20 years experience with sclerotherapy, I have never had a patient have a
severe allergic reaction.
Prior to treating the spider veins directly, any associated vein abnormalities must
be addressed. At a minimum, this usually involves injection of the reticular veins,
and we consider this the first step in treating spider veins. Omitting this is the
most common reason we see for poor results in patients treated elsewhere for their
spider veins. After a minimum of three weeks following treating the reticular veins,
the spider veins themselves can be treated. We usually check the results of this
after another three weeks, and do touch up injection of any spider veins that do not
appear to have been treated. So, the first spider vein treatment usually takes two
or three steps. After each injection session a compression stocking is worn for a
week.
