Spider and Varicose Veins
If you are bothered by persistent, increasing, symptomatic or unsightly veins on your legs, it is important that you know that these can be successfully treated in a minimally invasive way using various treatments.
Spider Veins
Spider veins, or telangiectasia, are small, dilated, bluish blood vessels (carrying deoxygenated blood) that appear close to the skin’s surface, mainly on the legs and face. The term spider vein refers to small vessels, regardless of the colour or type of blood within them (i.e., red or blue, venous or oxygenated blood). Larger blue veins are called reticular veins, and the larger still, blue or purple, ropey, bulging veins are called varicose veins. Both are usually only visible on the lower extremities.
Patients with dilated reticular or varicose veins may be troubled by leg heaviness, pain – usually dull or throbbing – and swelling or fatigue of the legs, especially with prolonged standing. If not treated, these types of vein problems can worsen over time and lead to more problems, such as skin redness and irritation (known as stasis dermatitis), skin breakdown, ulceration, poor wound healing, and increased risk of infection. Varicose veins may also lead to deep vein thrombosis (DVT), a serious medical condition requiring immediate medical attention.
Diagnosis and Treatment of Spider Veins
Patients with dilated or discernable blood vessels, particularly when located on the face and legs, would benefit from examination by a dermatologist. A dermatologist can help to determine the correct diagnosis and discuss the appropriate treatment options.
Treating increasing or unsightly blood vessels on the face or body is often done for cosmetic reasons. These small blood vessels are most commonly treated with laser or light energy devices. The choice of one laser over another depends on several factors, including size, pressure, location, and depth of the vessel being treated.
Patients with blood vessels on the lower extremities can treat them for cosmetic or medical reasons, often for both. Blood vessels can be unsightly, to the point of disfiguring in some cases, and can make a patient feel self-conscious, resulting in low self-esteem. From a medical perspective, damaged veins causing pain or fatigue can significantly decrease the quality of the patient’s life.
Patients may develop different types of blood vessels on the legs of different sizes and for different reasons. Some patients will develop increasing leg veins for genetic reasons or due to lifestyle or work-related habits, including crossing one’s legs or prolonged standing on a hard floor. Some vessels are associated with pregnancy, while others can be associated with various systemic conditions, such as venous hypertension. Of course, some can develop for no apparent reason at all.
Patients with increasing, persistent or symptomatic veins in the lower extremities must have a vascular assessment completed that includes a doppler ultrasound and, possibly, a duplex ultrasound, which will help to determine the degree of blood backflow present in the damaged vessels. Further, the assessment will establish the degree of damage caused to the superficial vessels and the underlying, deeper vessels that, if left untreated, can lead to more severe consequences, such as infection and clot formation. A proper assessment will also allow the patient to discuss potential treatment options for their vein condition.
Vein treatments should be directed at the underlying root cause of why the veins became dilated and damaged. Treatment will be determined based on your vein assessment.
Treatment options include:
- Conservative management with compression stockings
- Sclerotherapy
- Ultrasound-guided foam injections (UGF)
- Laser therapy
- Ambulatory phlebectomy
- Endovenous Laser Ablation (EVLT)
- Vein stripping – an older surgical treatment still used to remove the larger varicose veins particularly located in the groin
In most cases, with recent advances, large and symptomatic varicose veins do not require vein stripping. They can be safely and effectively removed using alternative methods, such as ultrasound-guided foam sclerotherapy and EVLA.
Vascular/vein assessment and treatment should be completed by a specialist who is specially trained in vein disease and advanced vein treatment, such as a dermatologist. Dr. Lubitz is an accredited dermatologist who has been providing advanced vein assessment and treatment for over 15 years.
In many cases, laser therapy can now treat blood vessels for patients wanting to avoid sclerotherapy or when sclerotherapy is contraindicated. Laser therapy can easily treat most spider veins on the legs with excellent results.
Patients with only a few small vessels on the legs wanting a cosmetic improvement will often choose laser therapy. We use the Elite MPX 1064 nm Nd:YAG laser, the Alexandrite 755 nm, the Cynergy PDL, and the Cynergy 1064 nm YAG, which are systems with mulitplex technology to quickly and effectively treat spider vessels in the legs. Multiplex technology allows for synchronous treatment of a target blood vessel with two different lasers or light sources, i.e. the Alexandrite (755 nm) and the YAG (1064 nm) or the PDL and the YAG, for optimal results.
Laser vein therapy is a minimally invasive treatment that uses a laser to seal off larger reticular veins, diverting blood flow to healthy veins. For leg vessels of 2 -3 mm, we use either the Elite MPX 1064 nm Nd:YAG laser or the Cynergy 1064 nm Nd:YAG laser. The procedure can be done quickly, usually in under an hour.
Patients with larger reticular or varicose veins (greater than 3 mm) usually have more effective results with sclerotherapy (including foam). Severe varicose veins can be treated with EVLA. Vein stripping is still done, but much less often, and involves physically pulling the damaged vessel out of the skin. This procedure requires anesthesia and is associated with more complications and downtime compared to the current alternatives.
At Art of SKIN Dermatology, Laser and Cosmetic Surgery, we have the medical and cosmetic expertise and the technology to safely and effectively treat any problems you may be experiencing with your veins. If you are concerned about your veins, please schedule a visit with us.
Note that new patients not previously seen at our centre and wishing to have a medical assessment of their veins by Dr. Lubitz (complete vascular assessment) will require a referral from their physician.