Spider veins (telangiectases) are dilated blood vessels visible as blue or red streaks, webs, or clumps located in the skin itself. They are different than varicose veins which are bulging lumps underneath the skin. Spiders occur anywhere but are most frequent on the thigh and calf of the lower extremities. They are permanent once they appear and tend to increase in number over time, but do not grow at a predictable rate. Spider veins drain into collecting veins at the base of the skin called reticular veins which are larger and usually of a greenish or bluish tint; reticular veins may be visible or non-visible to the naked eye. Identification and treatment of the reticular veins is an important part of success in controlling spider veins.

These veins are a frequent cause of cosmetic discomfort in areas where the weather is warm and the legs are exposed. They usually are not a cause of symptoms beyond the cosmetic discomfort, but in some instances they are attended by itching, burning, heaviness, or fatigue in the legs. Spider veins are often the beginning signs of more advanced venous disease.

Occasionally superficial spider veins rupture and cause spontaneous bleeding (hemorrhage) that surprises and shocks the individual. These hemorrhages occur at sites where particularly delicate thin skin covers the spiders; this usually happens in the ankle or foot but can occur on the calf or even the thigh.  The bleeding can be quite profuse and is treated by holding pressure on the bleeding vein and elevating the extremity. In most instances except hemorrhage spiders are considered a cosmetic problem and are not covered by insurance policies, including Medicare.

The exact cause of spider veins is unknown. They are so common that nearly everyone knows someone in the family who has them. They are more prevalent in women but happen in men as well. They can appear locally after trauma or after superficial surgery, even after vein surgery. We do not know how to prevent them from forming. The advice to avoid crossing the legs or wearing constricting clothing or garters to prevent them has no established basis. The hope that support stockings and dietary supplements are of help is unsubstantiated. Spider veins may be associated with larger diseased veins underneath. This possibility warrants the use of ultrasound to check for underlying venous disease because treatment should be directed first at the deeper veins.

Treatment options for spider veins in the legs are by injection treatments called ‘sclerotherapy’ or by superficial Laser obliteration. The Laser provides a superior cosmetic result in conjunction with reticular vein sclerotherapy in the lower extremities where the veins tend to be larger and the pressure is higher than on the face or trunk. Laser methods alone are preferable for the face and trunk.

The approach to treatment requires an initial visit to define the problem. Examination often includes ultrasound evaluation of the underlying veins to identify and recommend treatment of underlying vein disease before working on the spider veins. If this is not done, early recurrence or increased failure of the initial treatment is more likely to occur.

Dr. Kaplan's treatment is usually directed at the whole extremity because spiders occur in multiple sites. We have found our best results come from a two stage treatment plan in which the first stage is directed at both the spider veins and the reticular veins, and the second stage about 4 weeks later cleans up residual veins, usually just spiders. The availability of a special instrument called the Veinlite—which projects an angled light that identifies reticular veins not visible to the naked eye—allows simultaneous treatment of spider and reticular veins. This provides a more thorough treatment with better cosmetic results than just injecting the spider veins.

It is very important that the person who decides to have spider veins treated understands the benefits and the limitations of the treatment. This is to prevent disappointment when the healing process seems prolonged or the results are less than ideal. The basic understanding we suggest is that the two stage treatment will clear about 2/3 of the visible veins in the average case. This means that half will be better than this, and half will not be that good. Recurrent treatments often are safe and are effective in clearing up residual veins. There are some individuals who continue to form veins and need to have interval treatments to maintain a satisfactory appearance in their legs.

The injections should not be expected to achieve immediate disappearance of the spiders on the day of treatment. This is because the method is based upon a controlled injury to the vein wall that causes the inner lining of the vein to dissolve. This is followed by an automatic healing process that causes the vein to ‘dry’ up, and time is required for healing to occur.
The vein ultimately becomes scar tissue and is an invisible part of the normal tissue under the skin. In some cases this happens within a few weeks; in others 3-18 months may be required before the final result is achieved. Unfortunately, it is not possible to predict which persons will get an immediate or a delayed response.

After treatment, bluish bruising of the tissue occurs and requires 2-3 weeks to clear up. In the process of healing the blood cells in the tissue can leave traces of a brownish iron pigment called hemosiderin in the skin. This appears as a brownish streak that is usually more acceptable than the bluish vein color, but is not the desired cosmetic result. This brownish staining automatically clears over a variable period of time but it can take months to do so, and in occasional instances requires a year or two. It is very unusual for these spots to persist permanently.

Spider veins resemble cavities in the teeth because they tend to recur after intervals of time. It is important for those who decide to treat their spider veins to realize the chronic recurrent nature of this problem to avoid excessive disappointment if it happens to them. For these people there can be reassurance in the knowledge that recurrent treatments have been found to give good long-term control of the cosmetic problem in many instances.

Dr. Kaplan has been on several TV shows. Here's one of his most popular appearances.