Spider veins

The presence of spider veins on the legs is highly frequent. Spider veins make legs look ugly and moreover, in some cases, cause disproportionately intense symptoms concerning the severity of the problem.

What are spider veins?

Spider veins are enlarged veins on skin surface. Spider veins, in contrast to varicose veins, are small in diameter and appear on skin surface. More often than not, one may detect veins larger in diameter, which are located deep under the skin and end up at the spider veins feeding them with blood – reticular veins.

Spider veins are basically pathologically distended veins with damaged valves. This means that in spider veins the blood flows in a direction opposite to the normal blood flow and in larger volume, which leads to their dilatation. The presence of spider veins on the leg is a sign of first degree venous insufficiency; the circulation of the venous blood on the leg is disordered, even to a small degree.

Spider veins presence may be combined with the presence of varicose veins on the leg. A typical case is the development of quite intense spider veins around the ankle which is due to the presence of varicose veins and the increased venous pressure that, apart from the ugly looking leg, is a sign of severe blood circulation disorder.

What are the symptoms of spider veins?

In most cases, spider veins are asymptomatic. However, the unattractive look of a leg with spider veins is sufficient to have a negative effect on the self-esteem of the patient and consequently on the quality of his/her life. For example, it often happens that patients, especially women, with spider veins on their legs feel uncomfortably and have no choice but to cover their legs while being at the beach or wear trousers even the hotter summer days.

The symptoms of the spider veins, if there are any, are usually leg heaviness, itching, burning and more rarely pain and ankle swelling. Usually, the patient feels better on the morning. The symptoms appear later in the day and gradually get worse until the evening, while during the summer months they increase. A correlation has been detected between the presence of spider veins on the legs and anxiety, pain and cramps on the legs during night’s rest.

Diagnosis of spider veins

Spider veins are visible on the legs. Visible and enlarged veins on the skin that look red or more often blue are usually spider veins. Sometimes under the skin surface are visible veins larger in diameter, which end up in spider veins – they are called reticular veins and feed the spider veins with blood. Their extent and the detection of spider veins on the leg may vary. Some typical positions are the outer surface of the thigh and the shank, as well as the inner surface of the thigh, just over the knee.

Although spider veins are clearly obvious on the leg, the clinical examination by a vascular surgeon is important. The use of special LED lighting – Veinlite – allows the mapping of the reticulars which feed the spider veins with blood. Furthermore, the use of polarized light – Syris – allows the precise evaluation of the extent of spider veins.

The diagnosis of spider veins is completed by the Color Duplex scan. This is a painless and harmless examination which is performed at the doctor's examination room during the first visit. This examination is necessary because it allows the detailed evaluation of the function of the vein system of the leg and determines the selection of the appropriate treatment.

Treatment of spider veins

The treatment of spider veins is recommended for the symptoms relief, if patients display any, and certainly for the recovery of the legs appearance, which by itself is of great importance.

There is a great variety of techniques to be performed for the treatment of spider veins. Usually they may be combined, depending on the problem of each patient, a fact which highlights the importance of the right diagnosis before the application of the treatment.

For the treatment of spider veins are required some sessions, which are taking place at the doctor's examination room and their duration varies from 30 to 60 minutes. After the session the patient is able to return to his everyday activities. Usually, for every leg an individual treatment is required, except for the cases where spider veins are not extremely expanded. The session on the same leg can be repeated in 20 to 30 days, depending on the applied technique. The number of the required sessions is on average 3 to 4 for every leg and depends on the extent of the problem, as well as on the correspondence of the spider veins to the treatment. After every session it is expected that ecchymoses (bruising) may develop on the skin or you may observe sites with mild irritation, which disappear in 10 to 15 days.

A typical schedule for the treatment of spider veins on both legs with a clearance rate of 90-95% requires two sessions per month, every 15 days and lasts approximately 3 months.


Sclerotherapy (or microsclerotherapy) for the treatment of spider veins consists in the injection of a special medicine to the spider veins, which results in a controlled lesion at the venous wall, with consequent thrombosis and their final absorption.

Modern sclerotherapy is highly effective and is almost always necessary in a phase of the treatment of spider veins. The medicine used nowadays is administered painlessly and without complications. Its administration is done with special, very thin needles, which do not provoke pain. After the sclerotherapy the patient has to wear elastic compression stockings for 5 to 10 days, depending on the case. The injection is performed with optical aids, such as LED lighting (Veinlite) or polarized lighting (Syris).

Sclerotherapy is a rather safe technique, although this depends to a great extent on the doctor’s technique and the use of elastic compression stockings. In the contrary case, mostly esthetic complications are possible to happen.

Foam sclerotherapy

Foam sclerotherapy is the evolution of sclerotherapy and applies mainly at the initial phase of the spider veins treatment. At the foam sclerotherapy the medicine is converted into foam by a special technique before its injection. It applies in spider veins larger in diameter and especially in the larger in diameter reticular veins that are located under the skin and feed the spider veins.

In some cases the puncture of the vein-target by ultrasound guidance is required.

The medicine used is the most indicated. The medicine administration is performed by tiny needles and is painless. In almost every case the assistance by LED lighting (Veinlite) is necessary.

Concerning the instructions the patient has to follow after the session and the possible complications, applies the same as at the simple sclerotherapy. In any case, the two techniques are combined at the overwhelming majority of the cases during the same session.

Dermal Laser for the treatment of spider veins

The use of Laser for the treatment of spider veins is particularly effective provided that it will be applied on the correct spots.

The larger in diameter reticular veins, which feed the spider veins with blood, are located under the skin. Starting the treatment from these veins is of strategic importance, because in this way the feeding of the most superficial spider veins is interrupted. It should be noted that, starting the treatment directly from the spider veins, without a prior intervention to the reticular veins which feed them, is a critical error and will lead in adverse results. Since reticular veins are located under the skin, it is far more difficult for the Laser to reach them because its energy is absorbed in the skin. This is one of the main reasons why sclerotherapy shows better results compared to the individual use of Laser for the treatment of spider veins.

Nevertheless, when the dermal Laser is used into the thinner and more superficial spider veins, even more in combination with sclerotherapy, is highly effective.

Dermal Laser and thermocoagulation are the only techniques that may be used for the treatment of facial spider veins. After the treatment with dermal Laser the patient has to wear elastic compression stockings for several days.

The Laser used at the doctor's examination room is 980nm diode Laser, usually in combination with sclerotherapy, with very good results.


Thermocoagulation is a method used mainly for the treatment of spider veins and was developed during the last ten years.

This method’s operating principle is based on the production of high frequency waves (4 ΜΗz) and their transmission through a very thin needle. These waves deliver pulsing thermal energy to the vein with great accuracy. In this way, the vein shrinks, while simultaneously the surrounding tissues are protected. The distance between each puncture is one to two millimeters. At the end of the treatment, the vein is totally erased and in its place develops a skin reaction, which is more intense around the puncture spots and lasts one to two weeks.

The method is painless and well-tolerated by the patient. The treatment is very quick and typically 15 to 20 minutes are required to cover veins with total length more than one meter.

Thermocoagulation can be applied individually or in combination with sclerotherapy to spider veins very small in diameter with excellent results.

It can be applied to every part of the body, including on the face. If applied individually, not in combination with sclerotherapy, the use of elastic compression stockings after the treatment is not necessary.

Finally, we should bear in mind that....

Everyone who suffers from spider veins and visits the doctor is a totally individual case, which requires the combination of the suitable techniques. The right diagnosis and the use of a proper treatment are of great importance. The improvement is gradual and is accomplished in the long run. The vascular surgeon should be devoted to his job and tolerant, while the patient should trust his doctor and adhere strictly to his instructions.

The presence of spider veins on the legs is a sign of venous insufficiency, although on a mild degree, and blood circulation disorder. Furthermore, it is a sign that the patient suffers from a genetically predetermined vessel walls weakness, which certainly is irreversible. However, this means that it should be checked on annual basis, in order to detect and recover early enough potential changes in the venous system of the lower limbs. Prevention is better than cure.

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