Spider Veins and Varicose Veins on the Legs
If you are bothered by persistent, increasing, symptomatic or unsightly blood vessels on your legs, it is important that you know that these can be successfully treated in a minimally invasive way with a variety of treatment modalities.
Spider veins, or telangiectasia, are small, dilated, bluish blood vessels (carrying deoxygenated blood) that appear close to the skin’s surface, mostly on the legs and face. The term spider vein refers to small vessels, regardless of the colour, or type of blood within them (ie 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 of these are usually only found on the lower extremities (at least as far as the skin is concerned).
Patients with dilated reticular or varicose veins may be troubled by leg heaviness, pain – usually dull or throbbing type-, and swelling or fatigue of the legs, especially with prolonged standing. These types of vein problems, if not treated, can worsen over time and lead to more problems, such as skin redness and irritation (known as stasis dermatitis), breakdown of the skin, ulceration, poor wound healing, and increased risk of infection. Varicose veins may also lead to deep vein thrombosis (DVT), a serious medical condition that requires 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 available.
The treatment of 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 a variety of 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.
Why Treat Spider Veins or Varicose Veins on the Legs?
Patients with blood vessels on the lower extremities can treat them for cosmetic or medical reasons (oftentimes for both reasons). Blood vessels can be unsightly, to the point of disfiguring in some cases, and can make a patient feel self-conscious, resulting in low sense of self-esteem. From a medical perspective, damaged veins causing pain or fatigue can significantly decrease the quality of life of the patient.
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 (such as crossing one’s legs, or prolonged standing on a hard floor). Some vessels are associated with pregnancy while others can be associated with a variety of systemic conditions (venous hypertension). Of course, some can develop for no apparent reason at all.
It is important that patients with increasing, persistent or symptomatic veins of the lower extremities have a vascular assessment completed of the lower extremities that includes doppler ultrasound and, possibly, duplex ultrasound to determine the degree of backflow of blood that is present in the damaged vessels. This assessment will help determine the degree of damage caused to the superficial vessels, in addition to the underlying, deeper vessels that if left untreated, can lead to more serious consequences, such as infection and clot formation. A proper assessment will also provide the patient the opportunity to discuss potential treatment options available for their vein condition.
Vein treatments should ideally be directed at the underlying root cause as to why the veins become dilated and damaged. Treatment will be determined based on your vein assessment.
Treatment options include:
- Conservative management with compression stockings
- 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
Fortunately, with recent advances, in most cases, large and symptomatic varicose veins do not require vein stripping and can be safely and effectively removed through the use of alternative methods, such as ultrasound guided foam sclerotherapy and EVLA.
Vascular / vein assessment and treatment should ideally be completed by a vein 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 more than 15 years.
Laser Treatment for Spider Veins/Telangiectasia of the Legs
In many cases, blood vessels can now be treated in by laser therapy for those patients wanting to avoid sclerotherapy, or when sclerotherapy is contraindicated. Most spider veins and telangiectasia on the legs can be easily treated with excellent results using laser therapy.
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, both 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 2 different lasers or light sources, ie the Alexandrite (755 nm) and the YAG (1064 nm) or the PDL and the YAG, for optimal results.
Laser Vein Therapy for Reticular Veins of the Legs
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 veins or varicose veins (greater than 3 mm) usually have more effective results with either 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 some sort of anesthesia and is associated with more complications and downtime as compared with the alternatives available now.
At Art of SKIN Dermatology, Laser and Cosmetic Surgery, we have the medical and cosmetic expertise as well as 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.