Health Topics

Treatment of Varicose Veins and Spider Veins

What is the difference between varicose veins and spider veins?

Varicose veins commonly develop as we grow older, but can be treated with exercise, support hose, or surgery. Varicose veins are large, raised, swollen blood vessels. They usually develop in the legs.

Spider veins are smaller, red to purple and blue dilated vessels. Spider veins are easily visible and are found just under the skin. They are also most often seen on the legs and thighs.

What causes varicose veins and spider veins?

A number of factors predispose a person to varicose and spider veins. These include:

  • Heredity
  • Occupations that involve a lot of standing (These include nursing, hair styling, teaching, and working in a factory.)
  • Obesity
  • Hormonal influences during pregnancy
  • The use of birth control pills
  • Post-menopausal hormonal replacement
  • A history of blood clots
  • Conditions that cause increased intra-abdominal pressure including tumors, pregnancy, constipation, and externally worn garments like girdles

Four other reported causes include:

  1. Topical steroids
  2. Trauma or injury to the skin
  3. Previous venous surgery
  4. Exposure to ultraviolet rays

Who is affected by varicose veins and spider veins?

Varicose veins and spider veins develop more often in women than in men. They increase in frequency with age. An estimated 30 percent to 60 percent of adults have varicose veins or spider veins.

Symptoms of varicose veins and spider veins

Many patients with varicose veins complain of pain, described as an aching or cramping in the legs. Other common symptoms include:

  • tiredness
  • restlessness
  • burning
  • throbbing
  • tingling
  • heaviness in the legs

Pain caused by varicose veins is usually relieved by elevating the legs or by wearing support hose.

In women, symptoms might be worse during the menstrual cycle or during pregnancy. Patients also might develop swelling, ulcer formation, and an increase in the pigmentation or color of their skin, especially in the ankle region. Occasionally, varicose veins may develop superficial phlebitis (inflammation of a vein) which is characterized by pain and redness along a varicose vein.

What are the treatment options for varicose and spider veins?

There are three major treatments for varicose veins and spider veins.

Support Hose

The most conservative approach is simply to wear properly fitting medical grade support hose, especially when the veins cause painful or uncomfortable symptoms. These stockings can generally be purchased at any surgical supply store and at some pharmacies. They come in below-the-knee, above-the-knee, and pantyhose styles. They also come in different compressions, varying from 15 to 20 mmHg and up to 40 to 50 mmHg.

Weight loss (if needed), and exercise also can help improve and varicose veins and or prevent spider veins.


Sclerotherapy, which has been available since the 1930s, is another treatment option. This procedure uses a highly concentrated saline solution or a specially made detergent that is injected directly into the vein, causing the vein to disappear gradually over three to six weeks. The procedure is simple, relatively inexpensive, and can be performed in an outpatient setting. Complications are minimal but do include pigment staining, blisters, and — rarely — the formation of a skin ulcer. Patients are encouraged to maintain their active lifestyles immediately following the injections. They are able to drive themselves home after the procedure because no sedation is needed for this relatively painless procedure.


Another treatment option is a treatment with specialized vascular lasers or intense pulsed light. These devices uses heat energy from laser light to selectively damage or destroy abnormal veins. The advantage of this method is that no needles or sclerosing solutions are required, however there might be some minor discomfort. Side effects do occur, including discoloration or staining and blister formation.

Not all patients need treatment for their varicose veins or spider veins. Many people have no pain or other symptoms. For these individuals, no treatment is necessary, unless they want the veins removed for cosmetic reasons.

Are there any people who should not receive sclerotherapy?

Sclerotherapy generally is not advised for pregnant women and people who are not able to walk or move around.

Will my insurance cover the cost of support hose, sclerotherapy or surgery?

Some insurance companies do cover the cost of treating varicose veins, but generally not spider veins. The best approach is to check with your insurance company before considering treatment options.