A 'good' sclerotherapy is the best solution for spider veins
Spider veins (capillary varices) are one of the most common indication for varicose vein treatment, especially in women. For spider veins, it is often said that they only compromise cosmetic appearance, do not cause health problems, and they may recur no matter how good the treatment is. However, in fact, spider veins are quite different from each other. In some cases, these veins are associated with medium-sized varices (reticular veins) and are named as Lateral Subdermic Venous Plexus (LSVP). LSVP is a network of blue-green vessels located on the outer side of the leg and easily visible when carefully viewed. This vascular network is actually the normal veins used by our legs before the birth, and they become a remnant shortly after birth. This remnant may be reactivated and grow in some individuals and forms the LSVP. The ideal treatment for spider veins associated with LSVP is microsclerotherapy, or more commonly known as foam sclerotherapy. Because the spider veins appearing on the surface are not isolated but a part of LSVP, not only the spider veins but the entire vascular network should be treated.
Spider veins can sometimes be isolated in several parts of the leg and not associated with other varices, especially in young women. In these cases, spider veins are very thin and few in number, but some people may still be uncomfortable with their appearance. In such persons, sclerotherapy may be difficult, whereas transdermal laser or similar treatments may be more appropriate.
Capillary varices, sometimes similar to blackberries, may be in the form of 1-2mm pink purple veins. These varices, which may occur in various parts of the leg, especially around the ankle, are often accompanied by medium-sized (reticular) varices and even larger varicose veins. This type of spider veins, called corona phlebectica, is usually associated with an underlying venous insufficiency which should be treated prior to spider veins.
As described above, there are different types of spider varices and some of them may have an underlying venous insufficiency. In my personal experience, I can say that approximately 40% of patients presenting with spider veins have an underlying venous insufficiency. Therefore, all the patients with spider veins should be examined in detail by color Doppler ultrasound, and if venous insufficiency is detected, this insufficiency should be treated first. If this is not done, either the treatment will fail or the spider varices will recur in a short time. Treatment of venous insufficiency should preferably be done with endovenous laser or radiofrequency ablation. If there are also large varices due to venous insufficiency, these varices should be treated with sclerotherapy and miniphlebectomy before the elimination of spider veins.
If there is no underlying venous insufficiency, or if it has been treated properly, spider veins can be treated directly. The main method of treatment for spider veins is a well-performed microsclerotherapy using liquid or foam sclerosants. In microsclerotherapy, the capillary varices are entered with fine needles as thin as a hair under a magnifying glass and a small amount of sclerosant is given. However, microsclerotherapy is a treatment method that is very dependent on the performing physician. During the procedure, at each injection, the sclerosant should be given at very low amounts and at low pressure, the drug should not leak outside the spider veins. It is frequently necessary to do more than one injection to each area. Microsclerotherapy is a difficult procedure that requires a lot of patience and care for the physician when it is done in this way, but it is an easy, painless treatment for the patient. When applied incorrectly or carelessly, it may cause some complications and make the cosmetic appearance even worse than before.