By Norman n Bein, MD, FACS, RVT
Spider veins and varicose veins affect millions of people throughout the world and their treatment has changed dramatically over the last decade. With the advent of the new Laser techniques and the efficacy of the current sclerosing solutions, most vein problems can be treated very efficiently in an office environment.
In my practice I see patients who can have either varicose or spider vein problems, but most commonly patients have a combination of both. This article will discuss not only the differences between spider and varicose veins, but also the variability in their treatments.
Varicose veins are those veins that can be described as rope-like in appearance. They are usually easily seen on the leg and are large almost grape-like in appearance. These veins tend to budge through the skin and are most prominent when someone is standing. Spider veins, on the other hand, are very fine veins that are seen in the skin. These can occur almost anywhere on the body but are certainly most prominent on the leg. They derive their name from the fact that they look like little spider legs through the skin surface. They can be red or blue or a combination of red or blue. They tend to occur in clusters and are usually most prominent in the thigh area. Both varicose veins and spider veins can occur in men and women, but generally men have more of a problem with varicose veins than spider veins.
There are many reasons for the formation of veins. By far the most common is heredity followed in women by pregnancies. The reason pregnancies can lead to varicose veins is that the pressure of the uterus on the pelvic veins during pregnancy leads to weakness of the vein valves which ultimately leads to varicosities. The single most important thing to remember about both varicose and spider veins is that it is usually due to a valve malfunction in the saphenous vein system.
The saphenous vein system consists of the greater saphenous vein which runs along the inner portion of the leg from the ankle to the thigh and the smaller saphenous vein which runs along the posterior portion of the calf from the ankle to the knee. These two veins, greater and lesser, make up the saphenous system which is the main venous superficial system of the lower extremity. These are the veins that have the valves. In simple terms, blood runs from the feet up through a series of valves. If the valves don?t close properly or malfunction then the blood goes in a reverse direction down the leg and is ultimately pushed through the skin to form varicose and spider veins. The absolute best way to determine if valves are functioning is to do an ultrasound of the venous system. In fact, it would be improper to treat varicose or spider veins without an extensive pretreatment ultrasonic evaluation.
In the past varicose veins were treated by a relatively radical surgical procedure called Ligation and Stripping which consisted of multiple incisions. This resulted in multiple stitches and the end result was the exchanging of a vein for a small scar. This was not usually a cosmetically acceptable procedure. Around ten years ago closure techniques consisting of Lasers were developed and have been perfected over the last decade. These procedures entail passing a Laser Catheter into the saphenous vein system to seal the leaking valves. This is the current state of the art treatment for valves that are malfunctioning. In doing this, incisions and sutures are avoided and the saphenous system is dissolved or ablated rather than stripped.
Spider veins, often times are due to valvular insufficiency primarily of the saphenous system. Again, a detailed ultrasound will determine that. If the ultrasound is normal and a person has significant spider veins then these veins are most likely due to other factors, including heredity, aging, over weight, wearing constricting garments, sun exposure and simply standing on ones feet for long periods of time. If the ultrasound shows valves to be abnormal and leaking then, even with spider veins only, the primary procedure should be to close the leaking valves. If the valves are not leaking then the spider veins can be treated with sclerotherapy techniques which consists of injecting specific solutions into the vein to eradicate them. The two most commonly used sclerosants are Asclera and Sotradecol. Asclera and Sotradecol are chemical irritants which cause the veins to collapse.? They can be used for surface and reticular veins in different dilutions. It should be noted that even with the best of treatments approximately ten percent of patients with spider veins will not respond to therapy.
Spider veins and varicose veins can now safely be treated in an office environment without the need for general anesthesia with excellent results. It is essential that a preliminary ultrasound be done prior to treatment. It should also be noted that, as far as varicose veins are concerned, if valves are proven to be incompetent and the source of the problem, this is covered by most insurance companies. Spider veins on the other hand are usually considered cosmetic and coverage for this is dependent on individual insurance companies.