By Jeremy Crane MD FRCS, Consultant Transplant and Vascular Surgeon
Thread veins are tiny engorged veins, visible on the skin surface. They are often unsightly and can occur as little clusters or individual veins. They are also known as ‘flare veins’, broken veins’ or ‘spider veins’. Medically they are ‘telangiectasia’.
Thread veins are extremely common, up to 50% of women below 30y have thread veins, rising to 70% of women over the age of 70y. About 10% of men have them too. Thread veins can appear on the face or body but the legs are by far the commonest site. Some people simply live with them, but others, in particular women, find them deeply distressing.
Thread veins are caused by a weakness of the vein wall, often hormonally driven, worsening with age, with thread veins becoming more apparent post pregnancy and during the menopause. Some thread veins are associated with underlying varicose veins; as a vascular surgeon, whenever I examine a patient with thread veins, the presence of underlying varicose vein disease will be investigated. This is important as treatments are not as effective and recurrence rates after treatment are higher with the presence of underlying untreated venous disease.
Whilst thread veins are found in all skin varieties, from black skin types to very pale skin, there can be a genetic component with prominent thread veins more common in some families.
Unless there are underlying varicose veins, there are no preventable measures to stop thread veins appearing. Some people talk about not crossing their legs, or avoiding hot baths and saunas or wearing tight clothes but none of these bear any relation to the onset of thread veins!
There are a few treatment options for leg thread veins, including laser therapy, but the evidence demonstrates microsclerotherapy is the only treatment that gives repeatable good results and therefore microsclerotherapy is the gold standard treatment for lower limb thread veins.
Microsclerotherapy involves the injection of ‘sclerosant’ (a common type is ‘fibrovein’) into the veins using tiny needles. The sclerosant destroys the lining of the vein wall; the vein becomes inflamed and collapses and the body reabsorbs the damaged blood vessel over time. In one microsclerotherapy session, the amount of sclerosant micro-injections will depend on time allocated for the treatment, whether one or both legs are being treated and the extent of thread veins. The microinjections are with tiny needles and are not normally painful although they can be a little uncomfortable.
Outcomes with microsclerotherapy are pleasing overall. However, it is important to realise it is not a ‘quick fix’. The veins that initially disappear can come back, or take a few weeks to vanish altogether. Often bruising and red blotches appear and these usually settle within a couple of weeks; in other words, legs treated can look worse before looking better. As there are often many veins to treat and coupled with veins that are treated but do not disappear straight away, most patients need 2 to 4 treatments to obtain maximum benefit. Compression hosiery worn for a few days after sclerotherapy has been shown to improve outcomes although some practitioners do not advocate compression at all and still achieve excellent results!
Whilst the veins treated are destroyed, there are no methods to stop new ones forming. Development of new veins within months or years after successful treatment, does not constitute to treatment failure, it demonstrates the chronicity of venous disorders.
Microsclerotherapy is the gold-standard treatment for spider veins. The British Association of Sclerotherapists maintain high standards of practice in sclerotherapy, and have helped microsclerotherapy gain a reputation as a safe and effective treatment for telangiectasia in the legs.