If you’re confused about the terminology of leg veins, you’re not alone. Many people use the terms spider veins and varicose veins interchangeably, but the truth is that they mean very different things.

If you think of the veins in your legs like a tree, you have very large vessels deep inside your leg that carry blood back up to your heart. Coming into those large veins are medium sized ones…like the branches coming of off the trunk.  These are closer to the skin’s surface of your leg. Next, coming off those are the very small branches and twigs which are the small veins in the skin itself.

varicose veinsspider veins
Varicose Vein (Pacific Vein Center) Spider Veins

The key to understanding why varicose and spider veins occur is understanding how the blood is supposed to flow in the legs. It flows inward and upward from the smaller veins to the larger ones. Now, remember that most of the time, this process must occur against the pull of gravity. To fight the constant “down and out” pull, each vein contains a series of one-way valves that keep the blood moving in the right direction.

Varicose veins occur when the valves fail in the medium and larger sized veins.  This causes them to fill with blood, swell and enlarge and bulge out on the surface of the skin. Varicose veins look swollen, blue and spongy. They are usually several millimeters to a centimeter (or more) in diameter.  They can also be painful. Most people with varicose veins will tell you that they can become inflamed, tender to the touch and ache. This usually happens after a long day of standing or prolonged activity.

In contrast, spider veins (also called telangectasias) are very small, only 1-2 millimeters in diameter.  They appear red, blue or purple and are often clustered in mats (spider web looking areas) within the skin. They are flat and generally don’t hurt. Lastly, spider veins do not have “feeder” veins like varicose veins do.

Most people who have varicose or spider veins generally don’t like them. Luckily, there are effective treatments for both these problems, but they are different.  Knowing which type of vein issue you have is important.

In general, varicose veins should be evaluated and treated by a vascular surgeon. Surgical vein stripping is an effective procedure, but may leave scarring. Lasers can be used for varicose veins, but the procedure is very different from laser treatment of spider veins. Internal, endoscopic lasers can be used to effectively heat and seal off these larger internal veins that are not functioning well.

Treating larger varicose veins is crucial for the successful treatment of smaller spider veins because they are the constant blood supply that keeps the surface open and visible.  Spider veins respond very nicely to both sclerotherapy (injections) and external laser treatment. Sometimes, a combination of both treatments is necessary to completely get rid of them. Deeper, larger, blue veins tend to do better with sclerotherapy and smaller, more superficial red veins respond well to laser.

Understanding the differences between the types of veins you have will help you choose a treatment plan. While varicose veins and spider veins are similar in nature, getting rid of them safely, effectively and completely takes finding the right provider with the right knowledge, skills and equipment to get the job done.


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