Spider Veins: Less Sinister Than They Sound

With FPG Endovascular Surgeon James Shepherd, MD

It’s not unusual to be able to see your blood vessels through the skin. On our wrists, in our elbows, and elsewhere, evidence of our circulatory system is apparent and healthy and normal. However, sometimes the tiny blood vessels just beneath the skin are damaged, turning red, blue or purple and appearing in clusters on the skin like spiderwebs or scraggly tree branches. These are called spider veins. Usually a cosmetic concern, accompanying symptoms are rare and effective treatment is available. But, in rare occasions, spider veins can also be a sign of a serious underlying issue like chronic venous insufficiency. “As long as spider veins are small, it’s purely cosmetic,” says Dr. James Shepherd, an endovascular surgeon with First Physicians Group. “But if you start noticing bulging veins, like varicose veins, there’s more going on.”

What are spider veins?

Spider veins are tiny, damaged blood vessels right below the skin. Unlike varicose veins, they are not actually veins, but rather damaged capillaries, venules and arterioles. These are the teeny-tiny blood vessels that branch off the larger veins and arteries and are present in much larger numbers. Because spider veins are not major arteries or veins, their presence does not typically cause or indicate immediate health concerns and can be easily treatable.

What causes spider veins?

It is not always known why spider veins form, but causes can include genetic factors, hormonal changes such as those experienced during pregnancy, and injury or trauma. And there are risk factors that could put you at higher risk of developing spider veins. Risk factors for developing spider veins include:

• Sitting for long periods
• Hereditary predisposition
• Obesity
• Pregnancy
• Hormonal birth control
• Prolonged sun exposure
• Smoking

How are spider veins diagnosed?

A visual inspection. Spider veins are, by definition, visible under the skin, so the doctor will perform a simple physical check and confirm the presence of spider veins. However, if spider veins are present alongside signs of chronic venous insufficiency, such as tiredness or heaviness in the legs or cramping in the legs, the doctor may order an ultrasound to further examine circulatory health.

What is the treatment for spider veins?

Though spider veins are not life-threatening, many decide to seek treatment for cosmetic reasons. And because the effected blood vessels are superficial and non-essential, treatment is quick and leaves no long-term side effects. Called sclerotherapy and performed as an outpatient procedure, treatment involves a small injection of a chemical solution directly into the spider vein. This causes the spider vein to seal shut, eventually turning into a tiny bit of scar tissue that fades away. There may be some mild inflammation or redness for a couple days, says Dr. Shepherd. “But once the inflammatory reaction goes down, the spider veins disappear.”