Frequently Asked Questions

FAQ Sections

Q: Do activities such as crossing your legs while sitting, smoking, and hot showers cause spider veins?

A: The tendency to develop abnormal veins is largely hereditary. While crossing your legs does put pressure on the skin and surface veins, it has never been proven to cause varicose veins or spider veins. Smoking injures your heart and arteries, but there is no evidence that it directly harms your veins. Hot showers and baths cause the superficial veins to transiently dilate. This effect is temporary, and does not lead to the formation of spider veins or of varicose veins.

Spider veins develop in two ways: tiny pre-existing veins can enlarge and become dilated over time, or new veins can actually form. Although these processes are largely under genetic control, other conditions such as pregnancy, hormone-containing medications, hormonal fluctuations (such as menarche as a teenager and monthly menstrual cycles), can stimulate their appearance. This is why spider veins are usually worse in women.

Because the tendency to develop spider veins is largely genetic, there is not much you can do to prevent them. Compression stockings, exercise, leg elevation, avoidance of prolonged standing, etc. are helpful to control symptoms, but do not prevent progression of the defective veins. Spider veins are commonly an indication that bigger vein problems lurk below. These larger diseased veins not infrequently cause spider veins, and can be easily revealed with an ultrasound evaluation. If the larger veins are diseased, they need to be treated first. Otherwise, any type of spider vein treatment will give disappointing results.

If you experience these symptoms, your phlebologist can quickly and easily perform a duplex ultrasound examination. A duplex examination will look for thrombosis or reflux in the deep, superficial, and perforator veins. This will allow your phlebologist to determine the presence and pattern of venous disease, as well as formulate the best treatment plan.

Q: Are spider veins truly a cosmetic problem, or can they cause symptoms?

A: Although spider veins are widely known to cause aching and pain, they are generally considered to be a cosmetic problem by Medicare and insurance companies. Spider veins will tend to enlarge and bulge slightly over time. They, however, cannot stretch to the extent of becoming varicose veins. As such, sclerotherapy to treat spider veins is not a covered procedure.

Q: How effective is sclerotherapy?

A: You can generally anticipate a 50-90% improvement in the appearance of your veins. It is important to remember that things get worse before they get better, and fading is gradual. We do expect noticeable improvement after three treatments (if you need that many). The overall process takes months, but complete disappearance of spider veins is often achieved.

Q: Do you use saline for injection?

A: No. Although effective for small spider veins, hypertonic saline (salt) solutions are quite painful. We at the Vein Center use FDA approved STS (sodium tetradecyl sulfate) in various concentrations as our sclerosant of choice. This solution is effective on different sized veins and cause very little discomfort.

Q: How painful are the injections?

A: The pain from sclerotherapy with STS is mostly from the needle. We use a tiny 30-gauge needle. Most patients report only a slight stinging or burning sensation. Some, however, find the process quite painful. Your experience will depend largely on your natural “pain threshold”. If you have a low pain tolerance, cosmetic sclerotherapy may not be for you. Most patients who have previously undergone cutaneous laser treatment of their spider veins (not to be confused with EVLA) say that the injections are less painful than the laser treatments.

Q: When will I see changes in the appearance?

A: You will begin to see a change in color in approximately 3-4 weeks. The veins will turn from dark blue or purple to pink, and gradually fade away. The exact length of time varies with the type of veins treated and from patient to patient.

Q: How many treatments will I need?

A: For most varicose veins and refluxing saphenous veins, one treatment is all that is needed. Spider and reticular veins do require several treatments. The number of sessions varies with the number, size, and location of the veins to be treated. In addition, a patient’s desired level of cosmetic results will have an impact on the number and extent of treatments. We can usually achieve the desired results in 3-5 sessions spaced 6-8 weeks apart.

Q: Is sclerotherapy safe for anyone?

A: The contraindications for sclerotherapy include: pregnancy, breast-feeding, non-ambulatory status, allergy to the sclerosant agent, pre-existing blood clotting tendencies, and the inability to follow the pre-op or post-op instructions.

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