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Tiny veins in the skin which measure less than 1 mm in diameter are called spider veins, referred to as telangiectasia in medical terms. These veins are very superficial and appear to be red because of the blood in the very superficial veins. They are distinct from slightly larger veins measuring 1-3 mm in diameter, called reticular veins, which are slightly deeper under the skin and appear to be bluer in appearance than spider veins.

Spider veins may be very isolated problems due to progressive enlargement of tiny veins in the skin. Frequently, however, they develop because of abnormal underlying veins which are under high pressure and feed blood into the spider veins. The “feeder veins” usually are reticular veins in which the one-way valves have failed over time allowing gravity to pull blood downwards into the spider veins.

Some of our patients actually have more significant underlying problems with larger veins resulting in pain, tenderness, or swelling of the ankles. If the larger abnormal veins are not treated before treating the spider veins, treatment of the spider veins alone will not be successful for long, since the underlying problems will still be forcing venous blood into the skin, causing more spider veins to form soon. This is a common problem for patients who receive surface LASER treatments or sclerotherapy for spider veins without first assessing the larger veins in the legs with color duplex ultrasound.

Treatment of spider veins through sclerotherapy can be very effective. Some patients may need only one treatment while others may need a number of treatments depending on the number of spider veins and the variation in individual response to treatment.

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