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How are varicose veins different than spider veins?

I have some type of vein issue going on with my legs and I had one friend tell me they are varicose veins and another friend tell me they are spider veins. What are the difference between varicose veins and spider veins? How do treatment options differ for varicose and spider veins?


Doctors Answers (7)

The difference between the types of veins in your body is primarily due to their size. The larger veins (over 3mm in diameter) can become twisted and dysfunctional, allowing reverse blood flow (reflux). Varicose veins can usually be seen as large blue rope-like bulging bumps and longer twisted lengths of vein just below the skin surface. Spider veins are red to purple in color due to the small size of the vein that is so close to the surface of the skin that the blood can partially re-oxygenate and appear red. There is also a middle sized vein between the very small spider veins and large varicose veins that are called reticular veins and can typically be seen on the back of your hand. Treatment for spider veins and reticular veins includes sclerotherapy injections primarily used on the legs, and lasers often used on the face, neck and chest. Treatment of varicose veins includes endovenous ablation using either a laser or RF catheter placed inside the varicose vein and thermally ablating the inside of the vein. This is a quick and comfortable office procedure that has replaced obsolete stripping procedures of the past. Larger veins can also be treated with injection of foam sclerotherapy and by micro-phlebectomy which is the physical removal of surface veins through a 1mm opening. Both procedures are comfortable office procedures done in a vein clinic.

The principal difference is size. They are physiologically the same in that they are dilated or enlarged veins. A spider vein is by definition a vein that is less than 2mm. A vein larger than 2mm is either a normal reticular vein or varicose vein by definition. The most versatile and usually the best treatment for these veins is sclerotherapy. The different sizes required different strengths and sometimes different types of sclerotherapy medication.

Spider veins are smaller (0.1-1.5 mm diameter), vary in color (purple, blue or pink), usually appear in multiples or clusters on any part of the leg, and respond to sclerotherapy or radiofrequency (VeinGogh). Varicose veins are much larger (4-10+ mm in diameter), light green in color, and require elimination of the deeper saphenous vein for a durable result. This usually means endovenous thermal ablation, ultrasound-guided sclerotherapy, or the new Varithena foam treatment combined with conventional sclerotherapy vs. phlebectomy.

Spider veins are tiny red little veins on the skin. Varicose veins are larger veins that bulge and are blue or you can feel them.

Spider veins are fine red or blue veins which appear on the surface of the skin. They can be as fine as a hair or the size of spaghetti (excuse the analogy). They are flat or slightly raised. Typically, they are asymptomatic or have occasional burning or aching. These can have feeder reticular veins below the surface. Varicose veins are larger and more prominent bluish vein often called bulbous. They can be asymptomatic, but as they come on gradually, most people think that the aching, tiredness, or burning is normal. Often varicose veins are caused by underlying saphenous reflux. Spider veins are considered a cosmetic problem while varicose veins with symptoms and saphenous reflux are a medical problem and covered by most insurance plans.

Varicose veins originate from under the skin, while spider veins are within the skin itself. Varicosities are usually removed with surgery, spiders with injection.

Chronic venous insufficiency is the official diagnosis for varicose vein disease. It is chronic; however, with appropriate treatment and a long term treatment plan for the rest of your life, you can significantly slow the formation of new varicose veins.

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