Spider veins (synonyms: Spider varicosis; spider veins; ICD-10-GM I83.9: Varices of the lower extremities without ulceration or inflammation) are small, visible veins located directly in the epidermis. They are also called spider veins, which are small varices (varicose veins) in the skin. They often occur together with reticular varicose veins.
Sex ratio: They occur more often in women, especially on the thighs.
Peak incidence: middle-aged women.
Symptoms – Complaints
You can usually see the spider veins quite clearly. They are tiny, 1.0-3.0 mm dilated reticular or fan-shaped tortuous veins that are reddish-bluish in color. The reticular veins are blue to about 2 mm in size subdermal (“under the skin“) veins.
Localization: upper and lower leg
Causes
The cause of spider veins is multifactorial.
The occurrence is promoted by obesity (overweight) and pregnancy.
Chronic venous insufficiency (CVI), hormonal disorders, and constitutional vascular wall weakness are discussed.
Diagnostics
Clinical examination and orientation to the staging of chronic venous insufficiency (CVI) according to Widmer (see “Chronic Venous Insufficiency (CVI)/Classification” below).
In a further examination step, duplex sonography of the superficial and deep leg vein systems is performed to assess the venous outflow system of the lower extremities in its entirety and to exclude varicosis requiring treatment (perforator insufficiencies?), the latter may be the cause of spider veins.
Therapy
Surgical therapy of varicosis:
- Vein stripping (synonym: varicose vein stripping) – essential component of surgical therapy for varicosis (see “Vein stripping” below). Invaginating stripping methods, for example, by means of pin stripper, are used.
- Minichirurgische Phlebektomie (Synonym: Miniphlebektomie) – surgical procedure for the removal of side branch varices (see below “Minichirurgische Phlebektomie”).
- VNUS-Closure radiofrequency therapy (synonym: endovascular radiofrequency ablation) – procedure for the treatment of truncal varicosis (varicosis of the main trunk of the superficial venous system of the leg) and straight running side branch varicose veins (see below “VNUS-Closure radiofrequency therapy”).
Surgical therapy of spider vein varicosis and reticular varices:
- Sclerotherapy (sclerotherapy). In this procedure, 0.25% or 0.5% polidocanol injection solution (polidocanol/ macrogollaurylether; commercially known as aethoxysclerol) is injected directly into the spider veins with a fine cannula, which, in conjunction with a pressure bandage, leads to adhesion of the spider vein varicose veins. The injected solution leads after circumscribed distribution in the vascular system via an inflammation of the vein walls to a bonding and subsequently by resorption to a disappearance of the spider veins.
- Laser therapy: through treatment with a laser for vascular changes, the blood accumulated in the spider veins is painlessly brought to coagulation. The body dissolves the resulting small thrombos and at the same time closes the spider vein. Since there is no more blood in the closed vein, they are no longer visible as spider veins. The spider veins disappear completely without scarring.Laser treatment is comparable in effectiveness to sclerotherapy for vessel diameters up to 3.00 mm.The following lasers can be used: pulsed dye laser, argon laser, diode laser, neodymium YAG laser.
