What are the symptoms of spider veins?
Spider veins usually do not cause symptoms.

What are the symptoms and signs of varicose veins?
Most patients with varicose veins have very few or no symptoms. The symptoms are usually worse at the end of the day because of the increased pressure, and feel much better when the legs are elevated or if elastic compression stockings are worn. Patients can experience:

• non-specific aching, throbbing, tired, itchy, restless legs, especially after standing for a while and at the end of the day.
• swelling of the ankles and feet.
• spontaneous bleeding from the varicose veins.
• superficial thrombophlebitis (inflammation and clotting of the varicose veins).
• worsening of eczema (inflamed, itchy, red rash).
• darkening of the skin especially around the ankle (haemosiderin staining) and inflammation and hardening of the skin (lipodermatosclerosis).
• small cuts that ooze and are slow to heal and which can develop into problem-open ‘venous ulcers’. These ulcers can take months or even years to close.

Factors that increase your risk of developing spider veins and varicose veins include:

• Age – Ageing causes wear and tear on the valves in the veins that help control blood flow.
• Sex – Women are more likely to develop the condition.
• Pregnancy.
• Family history – Your family members have spider veins or varicose veins.
• Weight – Being overweight or obese.
• Standing.
• Sedentary lifestyle.
• Hormonal changes – The hormonal fluctuations experienced during pregnancy and around the time of menopause.

Endovenous
The preferred methods today use endovenous or minimally invasive, catheter-based procedures. The main vein with non-functioning valves is punctured with a needle using ultrasound guidance. A fine catheter is passed up the vein to within 2 cm of where it joins the deep system. This vein is then sealed so that there is no flow or pressure being transmitted to the large branches (varicose veins). There are different types of catheters, which either use heat (radiofrequency or laser), superglue, or a combination of trauma to the inside of the vein and a chemical (pharmaco-mechanical).

This procedure takes care of the underlying problem. It is usually combined with phlebectomies or sclerotherapy to take care of the large, unsightly varicose veins.

The advantage of endovenous techniques over traditional open surgery is less pain and bruising and quicker recovery and return to normal activities.

Open surgery
Traditional open surgery involves disconnecting the non-functioning superficial vein from the deep system and stripping the vein from the leg (e.g. Trendelenberg and Strip procedure). It is still used in patients who are not suitable for the endovenous technique.

Sclerotherapy
Another treatment is injection sclerotherapy. During treatment, a chemical sclerosing solution is injected into the affected veins. The injection irritates the inside of the vein, and over time, the vein will collapse and fade from view. A programme of repeat injections is often needed to get to the desired outcome.

Spider veins can be treated with micro-sclerotherapy, or laser sclerotherapy, or a combination of both, depending on the size of the vessels.