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Leg Spider Veins | Not Just Skin Deep


Leg Spider Veins are very common and for many people they are just a cosmetic annoyance. So if you simply do not like the look of these blemishes, how can you get rid of them?

Firstly, although these vein are actually in the skin, they are not a simple skin condition or just a cosmetic problem. These veins become larger and visually prominent because they are under abnormal pressure as a result of back flow from deeper veins below the skin. Over the years, they “stretch” and balloon and then they can be seen through the skin surface. These deeper veins, which are the cause of the back flow and pressure build up, are called reticular veins or “feeder veins and they are always near the spider veins in the skin. Sometimes they can be seen as large blue veins, but usually they are deeper and “hidden” and they can only be seen with a medical device.

This is important because if treatment is directed only at the skin spider veins, the injection will not be effective, or worst still, it might actually make the spider veins worse.

I (and most other vein specialists) make a special effort to identify and locate these “feeder” reticular veins during my assessment of leg spider veins and I make sure that I treat these as well as the spider veins themselves. So let’s look at an example.

Before Treatment

This lady in her 60’s had a string of spider veins by her knee and down the side of her left calf. Looking at them, they seem minor and some people might think it would be an easy task to inject them by Microsclerotherapy.  Indeed, it is fair to say that with proper training and skill, the procedure of injecting the spider veins is relatively straight forward. In fact I and my colleague Miss McGuinness run training courses in Microsclerotherapy. With detailed instruction, skill and hands-on training and practice, Microsclerotherapy is easy to learn. However, a very important part of the treatment of leg spider veins that we teach on our courses – and which is sometimes overlooked – is the identification of the feeder veins that also need to be injected. We also teach our delegates when Microsclerotherapy is not an option and when to refer patients for detailed assessments.


Infra-red-imaging of leg veins
Near Infra-Red Imaging

With Near Infra-Red Imaging, we see that the spider veins are actually connected to a network of deeper veins. These veins transmit back pressure from the deeper veins and it is this back pressure which causes the spider veins in the first place. These feeder veins should be injected as well as the spider veins themselves.

If the feeder veins are not injected, the treatment is either ineffective or may cause complications.

Not all specialists agree, but I believe that if feeder veins are carefully sought and injected, the results of Microsclerotherapy are much better and that the risks of making the spider veins worse are greatly reduced. Unless the feeder veins are injected properly, problems such as telangiectatic mattting (the appearance of very fine vessels near the injection site – often confused with persistent bruising), staining of the skin (excessive brown discolouration) and early recurrence of the spider vein soon after injections are comon problems.

After Treatment

I treated this lady by sclerotherapy and she was so pleased, she gave me permission to share her clinical photographs. As you can see, she has an unsightly cluster of spider veins on the outer part of her left calf. I injected the deeper feeder veins first and then I injected the spider veins themselves. I injected both sets of veins at the same appointment. As you can see, the results are very satisfactory and as you can imagine, she is very pleased indeed.

She had had these veins for nearly 20 years. She wasn’t expecting “miracles” but she was “over the moon” with the transformation.

Near Infra-Red Imaging equipment is expensive and it is not available in all clinics. Fortunately, it is not absolutely necessary to have this equipment to get good results. I show the images here to make important points about feeder veins.

Reticular _Feeder Vein_ Injections_Veinlite
Feeder Veins With Veinlite®

On the Microsclerotherapy Training Courses that we run at The VeinCare Centre, we teach delegates how to identify feeder veins using transillumination devices which are highly effective and very affordable. I regard transillumination devices as a “must have” tool in the treatment of leg spider veins. Other aids to visualisation are cross-polarised illumination and magnification.



If you would like more information about leg spider veins, or if you like to know about our Microsclerotherapy Course, please get in contact and one of our advisors will be happy to help you.