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Treatment of spider veins

Would you like to learn more about spider veins and the possibilities of treatment?

In our two vascular medicine practices in Munich you will find a competent team with many years of experience with spider veins and their treatment. We use all forms of sclerotherapy. Preference is given to sclerotherapy with ethoxysclerol, which has been used for decades. Occasionally, we also perform laser therapy.

What are spider veins?

Spider veins are dilated, superficially located veins in the skin. They are usually harmless. Only in rare cases is there a disease of the deeper veins. They often appear as a blue or reddish spot. On closer inspection, one can see spider-web-like, fine hair vessels in the skin. Feather- to fan-shaped or only sporadically arranged, finest veins also frequently appear. The term spider veins is due to the way the tiny vessels are arranged and configured. Since one could also think of brushwood brooms here, the term spider veins came into popular use.


What is the difference between spider veins and varicose veins?

Medically, spider veins correspond to the smallest, mildest form of varicose veins. In most cases, they have no medical significance, in contrast to truncal varicosis (valve weakness of the large and small rose veins, i.e. great or small saphenous vein) or large caliber side branch varicosis (valve weakness of the perforating veins or connecting veins from the musculature to the subcutaneous tissue). However, they are usually a cosmetic problem for those affected.


How dangerous are spider veins?

There is no risk of thrombosis or superficial phlebitis in spider vein varicosis. Also, spider veins that lie in the skin or small-lumen varicose veins that lie just under the skin are not responsible for leg swelling.

These are found preferentially in the case of venous valve weakness in the area of the deep venous system after thrombosis has taken place or in the case of truncal varicosis. Treatment for venous thrombosis must be initiated immediately if venous thrombosis is detected.

Only in rare cases do larger spider veins/reticular nests or tender varicose veins cause discomfort such as a feeling of pressure or itching.

In older age, a rhexis hemorrhage can occur, especially in fragile vessels. This can usually be stopped without any problems by compression and should then be sclerosed in any case in order to prevent a new bleeding.

Why do you get spider veins?

The reason for the formation of spider veins is weak connective tissue, which causes the veins to dilate.

In many women, the changes already appear during puberty or pregnancy. Their occurrence is thus also favored by a hormonal change. Statistically, women are affected by spider vein varicose veins significantly more often than men.

A genetic predisposition is also known as a cause. If both father and mother are affected, the risk for the offspring is above average. Spider veins are most frequently found on the outer or inner thigh, but also in the hollow of the knee, on the lower leg and in the ankle area. Less frequently, they are also found on the foot.

Spider vein-like skin changes on the face are called telangiectasias. These are tiny, usually reddish veins in the skin that become visible. Strong sun exposure promotes the development of these skin changes.

Smoking and increased alcohol consumption also lead to vascular damage and promote the development of both spider veins and other vascular diseases.

A frequently asked question is whether spider vein varicosis can be prevented. It is not really possible to prevent the formation of spider veins in the case of genetically caused connective tissue weakness/cellulitis. However, there are a number of possible spider vein treatments that have a positive influence on the tightening of the connective tissue and thus also slow down or reduce the formation of spider veins.

In the first place of a possible spider veins treatment is a healthy lifestyle with regular sports activities, whereby regular swimming and aqua gymnastics are often particularly effective. A healthy diet and avoidance of excess weight and nicotine are advised.

Daily alternating showers with cold and warm water promote blood circulation and thus tighten the connective tissue. This also improves the elasticity of the veins and relieves pain caused by spider veins. Regular skin massages that promote circulation can also be helpful.

Those who have a sedentary job should regularly activate their calf muscle pump by repeatedly moving their toes and feet, thus preventing spider veins on the legs. Static activities should be interrupted again and again.

Another effective treatment against spider veins is an adequate fluid intake of drinking 2 liters per day. Wearing compression stockings supports the muscle vein pump and can thus slow down the development of varicose changes.

How is spider vein varicosis treated?

Unfortunately, there is currently no drug that can be taken and which – as proven by serious studies – stops or sustainably improves spider vein varicosis.

Horse chestnut and vine leaf extract are believed to have a positive effect on toning the connective tissue.
In any case, they subjectively relieve possible feelings of heaviness and tension in the legs.

To improve the cosmetic appearance, sclerotherapy (sclerotherapy) or laser therapy in the area of spider veins can be preferred in the legs today.

Polidocanol (ethoxysclerol) is used in sclerotherapy. This is a substance that has been approved for varicose vein treatment in Germany for over 50 years (since 1966) and leads to the destruction of the vein wall. It can be used for all types of varicose veins. For spider veins, 0.5% ethoxysclerol is usually injected in liquid form and with a short, very thin needle into the finest hair vessels. In the case of reticular spider veins with a central feeder (nutrient vessel), it is recommended to inject 0.25 % foam into the nutrient vessel, which ideally eliminates the entire nest of spider veins. For this purpose, the liquid substance is mixed with room air, which creates a viscous foam that improves the effectiveness of sclerotherapy. Large lumen varicose veins can be persistently sclerosed with 0.5-1% foam, venous vascular malformations e.g. circumscribed vein ectasias with 1-2%.

Within several weeks, the sclerosed veins are transformed into connective tissue so that they are no longer visible or palpable. Following spider vein treatment, consistent compression must be applied during the day for about 1 to 2 weeks in the case of spider vein varicosis.

As a rule, after injection of the sclerosing agent, an eccentric compression bandage with ball swabs or absorbent cotton as well as compression bandages is applied in the practice, which should remain on overnight and can be removed independently on the morning of the following day.

However, sauna sessions, hot tub baths, solarium visits or sun exposure should be avoided for the period of about 4-6 weeks.

Sclerotherapy is a form of treatment that can be repeated as often as desired, but there are dose restrictions within 24 hours each time.

Laser therapy has been an alternative to the treatment of spider veins for several years. Here, the veins are obliterated by heat applied to the skin by a focused laser beam. Only laser beams that do not penetrate into the depth of the tissue may be used. The device is accompanied by a cooling technique to reduce the pain caused by the heat generated by the laser beam and to avoid hyperpigmentation.

The advantage of laser treatment of spider veins is the lack of need for compression therapy. Only eccentric compression may be applied for 24 hours following the treatment. Wearing a compression stocking is not necessary after that.

What do I have to consider before the spider veins treatment?

On the day of the sclerotherapy or laser therapy for spider veins treatment, the affected skin areas should not be creamed. Beyond that, there are no restrictions on daily habits.

Immediately after the treatment, a walk of about 20 minutes is recommended, as well as a sufficient drinking quantity of about 2 liters throughout the day. In the evening, a second, smaller walk should be taken.

Sports activities are not recommended directly after sclerotherapy and in the following days. Everyday activities are possible without restrictions from the following day under consistent compression therapy.

When are the results of spider vein treatment visible?

The success of the treatment can be seen after 8-12 weeks at the earliest. The sclerosed spider veins must shrink and be broken down by the immune system (macrophages).

In any case, every patient should be informed about rare side effects of the treatment. Both liquid and foam sclerotherapy, as well as laser procedures, may cause hyperpigmentation (brown discoloration) of the skin, which usually disappears over time. It is particularly important to apply adequate sun protection to the treated skin areas after treatment.

Matting can also occur in rare cases – this is the appearance of a new spider vein nest in the immediate vicinity of the treated spider veins.

In a large number of patients, spider veins appear more frequently with advancing age due to increasing weakness of the connective tissue.

Is spider vein treatment covered by health insurance? And what does it cost?

Cosmetic treatments in general are not covered by health insurance. Private health insurance companies, on the other hand, may cover the cost of sclerotherapy.”

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