Spider veins and varicose veins, what are the differences?

Varicose veins are veins which have reduced capability to transport blood back to the heart against gravity. This impairment leads to blood pooling in veins and – over time – the walls of the veins can stretch and appear as enlarged veins under the skin.

Varicose veins – what they are and where they come from

The visible varicose veins are usually only a part of the impaired segment and the full extent of venous insufficiency: Veins which are located deeper under the skin are often affected as well. They are also known as “hidden varicose veins”. The impaired functioning is caused by valves inside the vein which fully close in healthy veins to stop blood flowing downwards. If those valves stop closing properly blood can flow downwards. This phenomenon is called venous reflux1.

Varicose veins, mostly twisted, swollen and enlarged visible, are often a cosmetic concern by the affected person. Nevertheless, if they are not causing any discomfort or pain most of the time there is no immediate medical need for treatment. However, as the disease worsens discomfort and symptoms such as pain, irritated or sore skin and sleep disruption due to discomfort can develop. At this point , it is important to consult a physician to discuss treatment options.

1Professor Mark Whiteley; What exactly are varicose veins.

Spider veins – a sign of venous insufficiency?

Spider veins, also known as “thread veins”, or “surface veins”, commonly appear in the legs or on the face. These veins are tiny blood vessels in the dermis, which is the most superficial layer of the skin. If those blood vessels dilate, they become visible as small red or blue lines, often resembling a spider web (hence, the name “spider veins”). Spider veins are therefore not the same as varicose veins, nevertheless, they can be first signs of an underlying venous insufficiency.

Spider veins are more common than varicose veins

In a study, researchers were able to show a significant association between the level of spider veins (medical term: telangiectasia) and the severity of varicose veins2. Nevertheless, spider veins are much more common than varicose veins and therefore not all patients with spider veins will develop venous insufficiency which requires treatment3.

2C.V. Ruckley et al; Telangiectasia in the Edinburgh Vein Study: Epidemiology and Association with Trunk Varices and Symptoms, 2008.
3Professor Mark Whiteley; What are thread veins?

What is venous insufficiency?

Treatment of varicose veins and spider veins

Spider veins are usually not treated for any other than cosmetic reasons as they are of no are no reason for medical concern. Treatments are therefore typically not reimbursed by insurances. Varicose veins, on the other hand, can required medical treatment when causing pain or discomfort and are often covered by insurances policies. Typical treatment options for varicose veins include endothermal ablation methods such as treatment with laser or radiofrequency using a catheter, sclerotherapy or surgical stripping. Another thermal method, the echotherapy, has recently been introduced and allows treatment by using therapeutic ultrasound. In opposite to endovenous methods echotherapy no longer requires the insertion of a cable-like catheter into the vein or surgery and therefore works completely incision-free.

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