Thread veins (spider veins or telangiectasias) are a common problem and are predominately of cosmetic concern. They are tiny dilated blood vessels in the skin that occur usually on the face and the legs and are typically an isolated finding with no other venous abnormalities. They can cause itching or minor aches.

Causes

Thread veins develop when tiny superficial veins become dilated and distended with stagnant blood. They are often related to pregnancy or hormonal variations and are most common in women. In some cases, thread veins can be secondary to an incompetent venous valve in the superficial venous system. A more extensive assessment by Duplex ultrasound may be necessary to evaluate the root cause of the problem. If a valve within a deeper vein is found to be abnormal, it must be dealt with to properly address the thread veins (cf. varicose veins).

Treatment

If treatment is required, valvular incompetence similar to that seen with true varicose veins must be excluded and if present will require treatment first. Otherwise treatment of the thread veins may not be successful and recurrence may be much higher. Therefore you will be assessed using a hand held doppler on your first visit.

Thread veins can be treated by micro-sclerotherapy, laser or microwave treatment.. The follwoing will relate to microsclerotherapy which is frequently treatment of choice for thread veins/ spider veins on the legs. This involves injecting a dilute sclerosant (sodium tetradecyl sulphate 0.5%) into the tiny vessels. The aim is to cause a mild inflammatory reaction within the thread vein that will destroy it and ultimately allow the vein to disappear. This treatment can be performed in the clinic (although not on the NHS) and does not require an anaesthetic. The needle is tiny (like a small insulin needle) and is very well tolerated.

Most patients require between 2-6 treatments around 2-4 weeks apart and should be aware that rarely does all the thread veins dissapear. Each treatment takes in the order of 15-20 minutes. You will have small sticky tape and "dental rolls/ cotton wool " applied to the injection sites and a bandage applied for compression (Please remember to wear loose trousers because you will have a bandage applied to your leg at the end of the procedure).

You can continue your normal activity immediately and keep active (although avoid vigorous activity for the first 2-3 days). You can take the bandage and sticky tape off after 2 days.

More often patients will comment that 70-80% of their veins have improved by 8 weeks post treatment and are satisfied. Expect the site to look inflammed and red for the first few days and occasionally brusing will persist for some time (weeks).

You shouldn't undergo this treatment if you are pregnant, immobile, had a previous DVT, allergic to the sclerosant or have a very sensitive skin condition. It is also not wise to offer this treatment to patients with diabetes and active skin infections in the treated legs.

The main risks of this treatment are:

Thread veins may recur/ persist

Hypersensitivity resulting in discomfort and very rarely blisters/ tiny ulcers

Very faint brown staining at the site of the injections that may take several weeks to fade