What are spider veins?

Spiders veins and telangiectasias are small veins and arteries that are visible on the skin. Telangiectasias are very small spider veins. They are common and affect more than half of women by the age of 50 years. They are unsightly but may also cause symptoms like throbbing, aching, itching, and burning. Bleeding can also occur, often from the ankles and feet. Men also get spider veins but unsightliness is often less of a concern.

For many women, spider veins may affect self-esteem, leading to increased self-consciousness with clothes and avoiding activities involving leg exposure. This affects self-confidence and may cause someone to feel older or less attractive.

The main methods of medical treatment are sclerotherapy and skin laser. Both are low risk and can achieve very good results (see below for more detail). Non-medical options include concealing creams.

 

 

 

 

What is my spider vein risk?

The risk factors are family history, varicose veins in the family, age, being female, prolonged sitting or standing, obesity, lack of activity and local trauma, including previous surgery. Sometimes the cause of spider veins is due to other medical conditions.

Having spider veins and varicose veins in the family is the main risk factor. There is also a strong connection with pregnancy, the contraceptive pill and hormone replacement therapy. Skin damage from sun exposure can also lead to telangiasias on the face. These are often called facial veins.

 

 

Facial veins are often bright red and can have a line or star-like appearance. Spider veins on the legs often have underlying varicose veins feeding them from multiple points. Star-like facial veins arise from a central feeding vessel.

 

 

In many people, the cause of spider veins is related to underlying varicose veins. Varicose veins cause increased pressure within the small skin veins, leading to gradual enlargement over time.

 

 

Spider veins and telangiectasias also commonly occur in the absence of varicose veins. In these cases, the cause relates to other factors, such as sun damage, trauma, including previous surgery, or female hormones.

 

 

What tests will I need for spider veins?

Investigation usually involves an ultrasound scan of the leg veins to determine whether there are underlying varicose veins, as these may need treatment first.

 

 

 

What are the treatments for spider veins?

Treatment involves sclerotherapy, usually followed by skin laser.  In sclerotherapy, a fine needle is introduced into the vein and a small amount of an irritant agent is injected into the spider veins, causing them to block off. Sclerotherapy is often performed with magnifying glasses and the use of ultrasound guidance (UGS).

Polidocanol and Sodium Tetradecyl Sulphate (STS) are common irritant agents. They act by damaging the wall of the vein, causing it to seal and eventually diminish over time. Both of these irritant agents are approved for use in New Zealand by Medsafe.

Following the procedure, patients need to wear compress stockings for 5-10 days, depending on the veins number and size and any other veins needing attention. The interval for skin laser is usually 6-8 weeks. For some people, skin laser may be the only treatment needed.

 

 

 

What about the results?

The aim of most treatments is to improve appearance, and it is important to understand the treatment will not eliminate all visible veins. Individual results also tend to vary. Sometimes people need several sessions of both sclerotherapy and skin laser to achieve an optimum result.

As with any procedure, there is always a risk of a complication or poor outcome afterwards. Allergic reactions can occur with sclerotherapy using Polidocanol and STS. Fortunately, these are very uncommon. When there is suspicion a person may be at higher risk of an allergic reaction, a test dose of the irritant agent can determine any risk.

Brownish discolouration of the skin relates to the accumulation of iron released from the blood in the treated veins. It is more likely to occur with bigger veins, lack of adequate compression after the procedure, sun exposure after the treatment and in patients with a history of discolouration. All skin types, colours and tones are susceptible. Fortunately, most cases will resolve after 3-12 months. About 1% to 2% of patients will have persistent discolouration, where it persists for more than a year. Skin creams such like Dermaka can useful to hasten fading.1

 

 

Compression Stockings and Post-thrombotic Syndrome (PTS)

Leg swelling, venous eczema, skin discolouration with thickening, and leg ulcers, occur in about 20-50% of patients who develop deep vein thrombosis (DVT). This cluster of changes, which often occurs gradually over several years, is called post-thrombotic syndrome (PTS). The cause of PTS is failure of blood to return efficiently to the heart after a DVT has blocked or damaged the deep veins of the legs. These vein valves keep blood flowing towards the heart, even while standing. Compression stockings play an essential role in maintaining blood flow towards the heart, and subsequently reducing the risk of PTS.

 

PTS symptoms caused by swelling, such as aching and heaviness, reduce a patient’s quality of life. Everyday activities, like walking and standing, become difficult and painful. As bending is difficult, simple actions like getting dressed and other everyday tasks take longer. Patients may withdraw from their normal social and family activities and may show signs of lowered mood as their condition deteriorates and their self-confidence deteriorates. If their condition worsens, some patients might need extra help to cope with their everyday activities, like showering, dressing and preparing food. This places a greater burden on health services and the economy as patients also seek care in the public health system.

 

 

There is controversy as to whether compression stockings can prevent the venous eczema, pigmentation and ulceration that may occur several years after a DVT 1. Recent studies have shown that wearing compression stockings regularly after a DVT can help to prevent these skin problems developing, and improve an individual’s quality of life 2.

 

Investigations

An ultrasound scan, performed by a technician called a sonographer, is the next step in confirming the diagnosis of DVT. This can also confirm blockage or failure of the deep vein valves, and subsequently determine firstly the risk of developing PTS, and secondly the usefulness of long term compression stockings. An ultrasound scan of the leg arteries is also often useful for compression stockings planning purposes.

 

 

 

 

 

 

Treatments

Treatment of DVT in the early stage usually involves blood thinners, such as Warfarin and Rivaroxaban. In some large DVTs affecting the leg and pelvic veins together, a clot-dissolving treatment called thrombolysis can be effective. The purpose of blood thinners is prevention of more blood clots, and detachment with travel to the lungs. This is a serious and sometimes life-threatening condition called pulmonary embolism.

 

 

Compression Stockings

 

 

Properly fitted compression stockings reduce leg swelling caused by DVT, and other causes such as varicose veins and lymphoedema. Compression stockings aid circulation and increase by controlling the build-up of swelling during the day.

People who work in standing occupations, particularly those who are prone to leg swelling will gain significant benefit from wearing well-fitted stockings. Even people who do not have any problems with leg swelling will get benefit from the regular use of compression stockings, as they support legs throughout the day.

 

Where can I get compression stockings?

 

Vascular specialists recommend that a vascular nurse or other allied health professional measures and fits the compression stockings. The correct fit is important for the best results in terms of comfort and effectiveness. Once wearing them in everyday life, a patient may find a pair of rubber gloves useful to apply the stockings. Custom made rubber gloves, with grips on the palms and fingers are also available. This is especially helpful for patients with poor strength in their fingers. Other aids include fixture glue, which helps to keep the stockings up. Medical fixture glue is specially formulated for use on sensitive skin, especially the skin on the thigh area, as this is where the stockings are most likely to sag.

Stockings fitting appointments are available in any of our clinics. Compression stockings (to the knee) are available in our online shop.