Spider veins

Spider veins are small, widened veins in the top layers of the skin. Doctors call them telangiectasias. They are usually less than 1 millimeter wide and look like fine red or purple lines, starbursts or a spider's web. Slightly larger blue-green veins, 1 to 3 millimeters wide, are called reticular veins. They often feed clusters of spider veins.

They are most common on the thighs, calves and ankles, and can also appear on the face. They are a mild form of the same vein weakness that causes varicose veins: tiny valves let blood slip backward, and small veins stretch.

For most people, spider veins are a cosmetic concern and cause no symptoms. Some people feel mild burning, itching or aching over them, especially after long days on their feet.

If you also have aching, heavy or swollen legs, bulging veins, skin darkening near the ankles or spider veins clustered around the ankle, there may be a larger leaky vein underneath. In that case, we check with a duplex ultrasound first. Treating that deeper leak comes before treating the surface veins, or the spider veins tend to come back quickly.

On a duplex ultrasound, the technologist looks at the larger veins below the skin. If blood flows backward in them when the calf is squeezed, that deeper leak may be feeding the spider veins you see.

Sclerotherapy is the standard treatment for spider and reticular veins on the legs. A medicine called a sclerosant is injected into the vein with a very fine needle. It irritates the inner lining so the vein walls stick together and close. Over the next weeks, your body absorbs the closed vein and it fades.

1. 1
   Get ready

   Wear shorts or bring them, and skip lotion on your legs that day. Bring your compression stockings if we asked you to buy them. We photograph the veins so we can track progress.

2. 2
   Injections

   You lie on a table. Using a very fine needle, we inject small amounts of sclerosant into many veins, sometimes as a foam for slightly larger ones. Most people feel tiny pricks and, with some medicines, a brief sting or cramp.

3. 3
   Compression

   Cotton balls or pads may be taped over the injection spots. You put on compression stockings before you leave.

4. 4
   Walk

   You walk out of the room and take a 10 to 20 minute walk. A session takes about 15 to 30 minutes.

No sedation is needed. You can drive yourself home and go back to work the same day.

1. First 48 hours
   Wear stockings as instructed. Walk every day. Avoid hot baths, hot tubs, saunas and hard workouts. Regular walking and light activity are encouraged.
2. First 1–2 weeks
   Keep wearing stockings during the day, usually for 1 to 2 weeks. Protect treated skin from strong sun or tanning. Treated veins may look darker and bruised at first.
3. 3–6 weeks
   Small spider veins fade noticeably. Larger reticular veins take longer.
4. 3–6 months
   Full result. A touch-up session can treat veins that did not fully fade.

Most people see clear improvement after a few sessions, but it is rare for every vein to disappear. Sclerotherapy does not stop new spider veins from forming later, because the tendency runs in families. Many people come back for a touch-up every few years.

Before I inject a single spider vein, I want to know whether something bigger is feeding it. If there is a leak underneath, I fix that first, because otherwise we are painting over a water stain. I also tell patients to plan on more than one visit and to judge the result at three months, not three days, because veins often look worse before they look better.

Fabio Komlos, MD, interventional radiologist · About Dr. Fabio Komlos