Spider veins : a word from the experts

 

More than 80 million people in the United States suffer from spider veins or varicose veins. The American Society of Plastic Surgeons (ASPS) estimates that 50% of women over 21 in the United States have spider veins.

Spider veins (Telangiectasias) are small, red, blue or purple superficial veins commonly appearing as thin lines on the thighs, legs and ankles. Spider veins occur in the general population much more commonly than varicose veins. In fact, most people who have spider veins do not have varicose veins.

However, once venous reflux occurs and varicose (bulging) veins form, the pressure in these veins leads to accelerated and often uncontrolled growth of spider vein clusters.

In the absence of venous reflux , spider veins occur spontaneously and independently due to the inherent weakness of the one-way valve system of the smaller veins of the legs. These veins subsequently dilate, expand and recruit even smaller network of thinner surface veins that are visible to the naked eye. This is why these dysfunctional smaller veins are also known as "feeder veins".

Spider veins usually take on one of three basic patterns: they may appear in a true spider shape with a group of veins radiating outward from a dark central point (A); they may be arbored and take branch-like shapes (B); or they appear as separate lines, each about the size of a large hair (C). Linear spider veins are commonly seen on the inner knee, whereas the arbored pattern often appears on the outer thigh in a sunburst or cartwheel distribution.

Some people are at greater risk for developing spider veins. These risk factors include:

• Sex. Females in any age group are more likely than males to develop spider veins.
• Genetic factors. Some people have veins with abnormally weak walls or valves. They may develop spider veins even without a rise in blood pressure in the superficial veins.
• Pregnancy. A woman's total blood volume increases during pregnancy, which increases the blood pressure in the venous system. In addition, the hormonal changes of pregnancy cause the walls and valves in the veins to soften.
• Using birth control pills.
• Obesity. Excess body weight increases pressure on the veins.
• Occupational factors. People whose jobs require standing or sitting for long periods of time without the opportunity to walk or move around are more likely to develop spider veins than people whose jobs allow more movement.

Sclerotherapy is considered the gold standard treatment for reticular (blue 1-3mm veins) and spider vein removal.

The purpose of sclerotherapy is to produce endothelial damage that results in permanent

endofibrosis and clinical obliteration of the vessel. The ideal sclerosant would have a
highly specific mechanism of action, would be free of adverse effects when used for this
purpose, and would not produce allergic reactions. Although many agents have been
used in treating varicose veins and telangiectasias.

Sodium tetradecyl sulphate

STS is a versatile sclerosant that can be effectively used for

the treatment of a wide range of varicose veins and telangiectasias. The essential concept
in using STS successfully is to use the appropriate concentration for the given vein
diameter. This will result in minimisation of adverse effects. Although STS has a
predictable and constant effect within the same caliber and type of vein at the same level
or area of the leg, there can be variation in sensitivity among patients.

  

Is contraindicated in previous hypersensitivity reactions to the drug; in acute superficial thrombophlebitis; valvular or deep vein incompetence; huge superficial veins with wide open communications to deeper veins; phlebitis migrans; acute cellulitis; allergic conditions; acute infections; varicosities caused by abdominal and pelvic tumors unless the tumor has been removed; bedridden patients; such uncontrolled systemic diseases as diabetes, toxic hyperthyroidism, tuberculosis, asthma, neoplasm, sepsis, blood dyscrasias and acute respiratory or skin diseases.

Dr. Roxana Kerns is a board certified anesthesiologist and a vein specialist doctor, with a long surgical operating room experience.

Dr. Roxana Kerns is an expert in sclerotherapy and cosmetic lasers treatments for spider veins.

Until a decade ago, compression therapy involving bandaging or wearing of compression stockings was the only option available to vein patients preferring a non-surgical solution to their vein problems. Although compression stockings offer some relief to patients with aching and heavy legs and are beneficial to those with existing blood clots in the deep and superficial veins, or in healing ulcers; these stockings can't eliminate varicose and spider veins, and do not cure chronic venous insufficiency, the underlying cause of vein disease, also known as venous reflux.