Spider Veins (Telangiectasia)

Spider Veins (Telangiectasia) – Symptoms and Treatment

Definition and Causes
Spider veins (telangiectasia) are abnormally dilated tiny blood vessels that become visible on the skin’s surface. They resemble red or purple dots, lines, and a “web-like” pattern. The appearance of spider veins is often accompanied by itching and pain at the site.

Spider veins are completely harmless to health on their own. Patients are usually only bothered by the outward appearance of the affected skin. However, the appearance of spider veins can be a result of more serious conditions.

Spider veins typically appear in men with chronic venous insufficiency. Women, on the other hand, have several potential causes for their appearance:

• Varicose veins.
• Connective tissue disorders.
• Interruption of small blood circulation.
• Hormonal disorders (including oral contraceptive use and corticosteroid medications).
• Miscarriage, pregnancy, childbirth, and menopause.
• Reproductive system disorders: ovarian cysts, uterine fibroids, among others.
• Spider veins can also appear due to deficiencies in vitamins and minerals, especially vitamin C, which controls the permeability and strength of capillary walls.

Spider veins can appear after mechanical injuries to the skin, such as during cosmetic facial cleansing. Often, vascular spots become apparent after exposure to different types of radiation on the skin, such as ultraviolet and X-rays. Some patients report their appearance after visiting tanning beds.

The presence of spider veins on the legs is not necessarily associated with varicose veins: even with the presence of varicose veins and severe symptoms of venous insufficiency, spider veins may not appear, while the appearance of “stars” is more common against a background of simple venous insufficiency.

Symptoms of Spider Veins (Telangiectasia)

The main complaint of patients suffering from spider veins is cosmetic defect. Telangiectasia appears on the face, legs, and back, with various colors and shapes. If the telangiectasia vessels are filled with venous blood, they appear blue, and if arterial blood, they appear red. Over time, their appearance may change. For example, red telangiectasia may turn blue, and vice versa, which is associated with blood flow to them from small veins at the beginning of varicose veins.

The presence of spider veins may be accompanied by symptoms of the underlying condition that caused their appearance. Often, these symptoms result from varicose veins:

• Heaviness and swelling at the end of the working day.
• Fatigue and nighttime leg cramps.
• Presence of larger varicose veins.
• In some cases: venous ulcers and skin discoloration in the leg area.
• In other cases, patients associate the presence of spider veins with oral contraceptive use, childbirth, menopause, or other diseases.

Spider veins appear in typical locations, and an expert relying on their appearance and location may suspect the presence of a specific disease. For example, the “sea anemone head” syndrome can be detected in patients with fluid in the abdominal cavity, and varicose veins appear on the abdomen, which may indicate the presence of portal hypertension syndrome.

In some cases, the predisposition to the appearance of telangiectasia is a sign of connective tissue weakness. In this case, the patient may notice, in addition to other symptoms, such as joint laxity, high skin elasticity, easy bruising, and the presence of bursts in blood vessel walls.

Spider veins (telangiectasia) are classified according to their external appearance and shape. There are four main types, according to the classification of W. Redisch, R. Pelzer:

1. Simple (sinusoidal, linear).
2. Arborized.
3. Branched (spider-like).
4. Patchy (pantyhose-like).

• Linear red telangiectasia commonly expands on the face, especially around the nose and cheeks. Red and blue linear and arborized telangiectasia mainly expand on the legs, which may indicate their association with varicose veins or hormonal disorders.
• Branched types often appear red, consisting of a central feeding artery, from which many dilated tiny arteries branch out radially.
• Intermittent telangiectasia (patch-like) often occurs with systemic connective tissue diseases and some other diseases.
• Regardless of the origin, the clinical picture and main symptoms of any type of telangiectasia are cosmetic defects.

Complications of Spider Veins

Spider veins rarely have serious complications on their own. Continuous expansion of the vascular pattern and increased diameter may occur, and bleeding from telangiectasia may occur.

Diagnosis of spider veins

Diagnosing telangiectasia (spider veins) is not difficult: it is sufficient for a vascular specialist to conduct an examination and perform ultrasound waves on the veins to establish a correct diagnosis.

In case of suspicion of accompanying diseases that may have caused the appearance of spider veins, the vascular specialist refers the patient to consult with a specialized physician – such as a gynecologist, endocrinologist, rheumatologist, or cardiologist. For example, if the patient claims during the consultation that spider veins appeared on her body after taking oral contraceptive pills to treat a functional ovarian cyst, she will be referred to a gynecologist to reassess the risks of using contraceptive pills and conduct hormone tests. A skilled vascular surgeon seeks to identify and treat the cause of telangiectasia appearance, then begins treatment. In case of unsuccessful treatment, spider veins may reappear after successful treatment.

Treatment:

• It depends on the form of the disease, the surgeon’s experience, and the patient’s preferences. If the patient suffers from an external appearance of the affected skin, methods of removing spider veins are used.
• Sclerotherapy: One of the most common and effective methods of removing spider veins. Special substances – sclerosing agents – are injected into the spider veins, which affect the vessel wall from the inside, leading to gradual adhesion of the vessels. After some time, there is no trace of the disease left on the skin.
  Sclerotherapy can be used on very tiny spider veins, and even on large veins and even on the large vein trunk under the skin. One of the most common areas of using sclerotherapy is the lower limbs. Usually, a solution called Laurence-Moon or Laurikosclerol is used. When used properly, the sclerosing agent causes only a local effect and does not have a toxic effect on the body. Immediately after the effect of the sclerosing agent in the vein lumen, a special assembly (thrombosis sclerosis) forms, and the vessels become rigid, then the process of vein absorption begins, which may take up to half a year.
  Similar drugs such as Ethoxyclerol (Germany) or Fibro-Vein (Great Britain) have almost the same effect.
• Sometimes a mixture of oxygen ozone is used as a sclerosing agent. In this case, the procedure is called ozone therapy. Cold sclerotherapy is another common method, where the skin at the injection site is cooled using ice or cold air.
• Cryo Laser Ablation (CLaCS) therapy is popular – this method combines cold therapy, sclerotherapy, and laser coagulation of blood vessels. The affected vein is affected by a transdermal laser, which causes vein spasm. Sclerosing solution is injected into the vein lumen. All interventions are performed under the influence of cold therapy, which reduces pain in the patient.

We should also mention the possible complications of sclerotherapy. One of them is coughing after injecting the sclerosing agent into the vein (usually large). Part of the agent reaches the deep vessels, and with blood flow, it leaks into the pulmonary trunk and small airways, causing clotting.

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