Spider veins are blue, purple or red branching veins that can be found anywhere in the body but particularly in the legs, face and chest. They can appear as a connected network or as singular and separate.
In general, apart from their unsightly appearance, they cause no harm. The only exception is when they form around the ankle, usually on the inside of the ankle. There, the condition is called “corona phlebectatica”. This signifies a more significant disease, usually with incompetence of the larger veins including the main trunks of the superficial venous system of the leg. This is often associated with increased venous insufficiency, ankle swelling, skin colour changes and even skin ulcers. Accordingly, their presence requires careful assessment of the venous system of the leg including the Doppler Ultrasound Scan (also known as venous map). In order for treatment to be successful it is usually planned so that larger incompetent veins that are leading to these spider veins are treated first. This is likened to “turning off the tap” further upstream.
The ideal alternative for treatment of spider veins is by directly injecting them with a solution called “sclerosant” which leads to their sclerosis and eventual disappearance over weeks. Again, care should be taken with treating bigger blue/green lines of veins connected to them otherwise treatment will not be effective and will carry a high risk of recurrence.
The evidence for the success of this treatment is impressive. Recently during a guideline developing conference, the American and European Phlebological Societies concluded that based on the available randomised controlled studies, (RCT) sclerotherapy is a safe and effective method to treat telangiectasia (spider veins) and reticular veins (blue/green lines of veins). The highly respected British organisation – the National Institute for Health and Care Excellence (NICE) – also recommends sclerotherapy for the treatment for spider and reticular veins adhering to evidence based medicine in its interventional procedure guidance.