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Treatment of leg spider veins and thread veins

by – October 8, 2021

The treatment of leg spider veins and thread veins is a very specialised area. Results are often very poor when these veins are treated badly by non-experts.

Mark Whiteley presenting thread vein spider vein and telangiectasia treatments at the 25th IUA Meeting 2021

Mark Whiteley presenting thread vein spider vein and telangiectasia treatments at the 25th IUA Meeting 2021

Today Prof Whiteley explained this in an international lecture. This was a virtual presentation at the 25th IUA European Chapter Congress – International Union of Angiology.

The lecture was entitled “The treatment of telangiectasias”.

Telangiectasias is the medical name for spider veins or thread veins.

What are spider veins? What are thread veins? What are telangiectasias?

In the legs, telangiectasias (also called spider veins or thread veins) are very small branching veins that are usually blue or purple. In one major study, they were defined as veins that are less than 1 mm diameter. However, other studies define them as veins that are between 0.4 mm and 2 mm diameter.

Telangiectasia of the legs are very different from those on the face.

Those in the legs are below the heart. As such, the great majority are caused by underlying venous reflux. This might be “hidden varicose veins”, incompetent perforating veins or just incompetent feeding veins. Feeding veins are small local veins that have lost their valves and allow blood to reflux back into the thread veins.

What is the treatment of leg spider veins and thread veins (telangiectasia)?

Perforating vein at back of knee causing spider veins and thread veins – duplex needed to identify problem

Perforating vein at back of knee causing spider veins and thread veins – duplex needed to identify the problem

It has become clear that the most important part of the treatment is the planning. This means that it is essential to have a venous duplex ultrasound scan performed by an expert vascular technologist. It is not good enough to have a quick scan performed by the doctor or nurse who is going to do the treatment.

The reason for this is that although many people can learn to scan the major veins for hidden varicose veins, it takes a lot of training and practice to scan for perforating veins and small feeding veins.

This was illustrated in the talk by two patients who had previously had bad treatments and recurrent problems before they came to The Whiteley Clinic.

The first patient had increasingly bad thread veins behind her right knee which she had had treated many times at beauty and cosmetic clinics. When she came to The Whiteley Clinic, and had an expert venous duplex ultrasound scan by a vascular technologist, an underlying perforating vein was found to be the cause. Once this was treated, the thread veins were successfully removed by microsclerotherapy.

GSV reflux – hidden varicose veins – causing thread veins and telangiectatic matting – why duplex is essential before thread vein treatment

GSV reflux – hidden varicose veins – causing thread veins and telangiectatic matting – why duplex is essential before thread vein treatment

The second patient had previously been to a beauty clinic that claimed to specialise in thread veins of the legs. She had had some microsclerotherapy of the veins to her right lower thigh and initially they appeared to improve. However, as is often the case in such patients, they came back with a vengeance causing a severe increase in thread veins. This is called telangiectatic matting.

When this patient came to The Whiteley Clinic, venous duplex ultrasound scan showed that she had severe underlying varicose veins. The fact that these cannot be seen on the surface shows that she has “hidden varicose veins” – the sort that if left alone tend to deteriorate into swollen ankles, red and brown stains around the ankles and eventually leg ulcers.

By having this duplex scan and having the hidden varicose veins treated, not only can we treat have thread vein successfully but also prevent deterioration of the leg towards leg ulcers in later life.

Laser or sclerotherapy for the treatment of leg spider veins, thread veins and telangiectasia?

Huge amounts of experience worldwide have shown that the optimal treatment for leg telangiectasia (spider veins and thread veins), once any underlying cause has been treated, is microsclerotherapy.

Laser and intense pulsed light (IPL) not only have a high chance of damaging the overlying skin, but only treat the visible part of the veins and not the feeding part.

Therefore, unlike telangiectasia and thread veins on the face which are treated very well with laser and IPL, those on the legs should only be treated by microsclerotherapy.

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