Stubborn Spider Veins
Written by Dallas Vein Specialists on January 21, 2013
Every now and then I come up against stubborn spider veins, those that refuse to fade away as I would expect. I see patients not infrequently who have had multiple treatments for their spider veins with little if any success. This may be a stubborn cluster in one location on the thigh, leg, ankle, or foot or a recalcitrant array of spider veins throughout a patient’s legs. For whatever reason these fail to respond by gradually clearing over the ensuing weeks after usual treatment. Fortunately this situation is uncommon but when it occurs, is frustrating to me, the doctor, and to the patient.
There are certain considerations when I come upon such stubborn spider vein cases. Firstly, I make certain that there is no venous insufficiency such as saphenous vein incompetence (poorly functioning or non-functioning valves within the veins). I know that riding the skin of spider veins is especially difficult when there is incompetence of larger superficial veins such as the great saphenous vein. (Superficial veins course in the leg superficial to the muscle, i.e. in the fat layer or the skin.) This can be easily ruled out by a careful ultrasound examination. Certainly, if the deep venous system (veins that course in the muscle layer of the leg) is incompetent (veins with valve dysfunction in the leg deep to the skin and fat layer), spider veins are usually not amenable to treatment, and if some are eliminated, others soon develop. The appearance of legs with deep vein incompetence is not easily missed by informed physicians and thus is rarely a consideration in the puzzle.
Secondly, a likely finding is that there has been a missed “feeder” vein, a reticular vein that supplies the spider cluster. These are larger veins that course nearby or beneath the spider veins and are in the top of the fat layer or bottom of the skin. Such veins may also have poor function and appear as tortuous, dark, and enlarged. If these veins are not treated, the spider veins will not respond, or if there is some improvement, others will soon reappear.
When the above possibilities have been ruled out, I am left with trying different solutions for the sclerotherapy (injection of a chemical agent that damages the inside wall of the spider vein leading to its disappearance). Fortunately there are several good agents that are safe and widely used. For some unknown reason one may work when another will not.
If sclerotherapy fails after trying different chemical agents, I may go to the application of external energy or heat to the spider veins. These techniques include laser and radiofrequency. I favor radiofrequency and have had success using the VeinGogh device, which carries less chance of skin injury than the laser. Now the VeinGogh treatment can extend to the larger spider veins of the leg using a newly designed tip, whereas until recently it was only effective for the tiny spider veins of the face. The treatment is usually only slightly uncomfortable, and if needed, topical local anesthetic may be applied prior to the treatment.
Thus there is a logical progression to treating resistant spider veins of the legs. With the approach outlined above most stubborn spider vein problems can be solved to the benefit of the patient.