Vascular spider veins The Phlebology Clinic / Venous insufficiency of the lower limbs / Vascular spider veins Introduction Description of the condition Risk factors Recognition and diagnosis Treatment methods Frequently asked questions Introduction Vascular spider veins, more technically known as telangiectasias, are small, dilated blood vessels visible beneath the surface of the skin. Definition "telangiectasia" comes from the Greek language. The word 'telos' (τέλος) - means 'end', 'angeion' (ἀγγεῖον) is simply 'vessel', and the word 'ektasis' (ἔκτασις), is the 'extension' or 'stretching' of something. When these three words are put together, we semantically obtain the phrase: "vascular end dilatation", and thus the term telangiectasia. Vascular spider veins should not be called and equated with so-called 'bursting vessels'. The term "bursting vessels" suggests mechanical damage to the vessels, whereas telangiectasias are caused by blood circulation disorders, increased venous pressure or hormonal changes, leading to dilatation rather than rupture. For many years, spider veins were equated with an aesthetic defect. We now know that this is a gross oversimplification and is usually not the case. The occurrence of vascular spider veins is a harbinger or expression of a larger venous problem. It is therefore useful to understand the causes of their formation, ways to prevent them and to become familiar with the available treatments. Description of the condition Vascular spider veins of venous origin are most often located on the legs, very shallowly under the skin (at a depth of 180 micrometres to 1 mm below it). For this reason, they can be seen by patients. Telangiectasias can take on a variety of shapes and arrangements. They can be seen as red, purple or blue lines on the skin, resembling 'spider veins'. Spider veins can be of venous, arteriovenous and arteriovenous origin. The former are most commonly encountered. Typical telangiectasias are between 0.1 and 1 mm in diameter. Slightly larger than these are the so-called venulectasias (usually less than 2 mm in diameter; they are located deeper than telangiectasias and are often darker in colour, usually bluish or purple). The vessels superior to telangiectasia and venulectasia are the so-called 'vasculature'. reticular veins (reticular). Dilated to 2-4 mm, reticular veins can become prominent under the skin and arrange themselves into winding greenish vascular structures. They are smaller than typical varicose veins. Dilated reticular veins are often directly connected to and may be the source of spider veins. All these vessels usually form a single vascular tree, and its arrangement ultimately determines the extent and shape of the spider vein. The shape of the spider vein and where it occurs is indicative of the mechanism of its formation. Spider veins most commonly appear on the legs, and are far more common in women, particularly those giving birth. Typical sites of their occurrence are the thighs (lateral, medial-posterior and inferior-medial surfaces), also the lateral surfaces of the lower legs and the ankle area. Occasionally, vascular spider veins occur as single findings under the skin (so-called isolated telangiectasias). More often, however, they form multi-level tree systems, and only the shallowest - most distal part - of the vascular tree is seen under the skin. They then represent the first stage of a disease process known as chronic venous insufficiency. W CEAP classification (English. Clinical-Etiology-Anatomy-Pathophysiology) telangiectasias and dilated reticular veins were placed in class C1. It was classified as a benign stage venous diseasewhich is a harbinger of venous insufficiency leading to varicose veins coming out. straight and linear branched (tree-shaped) spider veins (radial arrangement) papular (round spots) Telangiectasias occurring in the lower limbs can occur at any age and in any person. The development of vascular spider veins on the legs is a gradual process, and their formation can be influenced by a number of factors that influence each other and intensify their effects. Unlike similar lesions occurring on the face, telangiectasias on the legs are associated with abnormalities in venous circulation and may coexist with other symptoms of venous insufficiency. This complex mechanism of onset makes the identification of risk factors the first and necessary step towards effective prevention and treatment. However, there are some factors that significantly increase the risk of their formation. Below you will find a list of the most important ones risk factors contributing significantly to the occurrence of vascular spider veins on the legs. Risk factors genetic predisposition - Heredity plays a major role in the occurrence of spider veins; female gender - women are more prone to telangiectasia due to hormonal changes, e.g. during pregnancy or menopause; number of pregnancies and births in women - hormonal changes and the increasing prevalence of pelvic venous insufficiency seem to have the greatest impact on the occurrence of extensive venous telangiectasias; age - With age, the incidence and severity of venous disease increases, which translates into the occurrence of telangiectasia; lifestyle - prolonged standing or sitting promotes the formation of vascular spider veins on the legs; hormone replacement therapy and oral contraception - may increase the risk of vascular problems, including the incidence of vascular spider veins; obesity - excessive body weight resulting in changes in the thickness and stiffness of the subcutaneous tissue lead to expansion and failure of the subcutaneous circulation. Pregnancy is one of the most significant factors significantly increasing the risk of the appearance of vascular spider veins (telangiectasias) on the legs. Mechanism of formation In most cases, telangiectasias are acquired, secondary in nature and arise during life. A special category is made up of young women (before the age of 20), in whom the occurrence of vascular spider veins in the lateral descents (on the thighs) or in the hind legs ('below the knees') indicates with a high degree of probability a developing pelvic venous insufficiency and existing hormonal disorders. The second special category is the so-called secondary (iatrogenic) telangiectasias, which are the result of past surgical, laser or non-haemodynamically performed sclerotherapy treatment. This is why the correct diagnosis of venous disease and its treatment in the correct sequence is so important. Currently, the occurrence of venous telangiectasias is associated with venous insufficiency, endocrine disruption, inappropriate subcutaneous tissue expansion and excessive muscle mass growth. A complementary theory suggests that telangiectasias are the result of local tissue hypoxia, a phenomenon that leads to endothelial inflammation and vascular neoplasia. In phlebological assessment, it is crucial to determine the relationship of dilated vessels to the superficial and deep venous system and to look for links to pelvic venous insufficiency. With a reliably performed venous Doppler ultrasound examination, we are able to assess which telangiectasias are associated with congestion or insufficiency of the deep venous system, which are directly associated with superficial venous insufficiency, and which connect directly to reticular and subcutaneous venous insufficiency. The presence of abundant and tortuous telangiectasias must always take into account the presence of arteriovenous connections under the skin (so-called arteriovenous anastomoses). Recognition and diagnosis The modern diagnosis of vascular spider veins and dilated reticular veins is based on taking a medical history (including pregnancy in women), physical examination and a thorough clinical assessment by a phlebologist. Ultrasound evaluation and a good mapping of the venous dilatations, determining their distribution and mechanisms of formation are always the most important. Before planning treatment, the phlebologist (in addition to the ultrasound assessment of the venous capacity of the abdominal, pelvic and lower limb veins) should always assess the overall distribution of spider veins on the legs. Treatment methods The doctors of the Phlebology Clinic, based on their experience, believe that the most effective treatment of vascular spider veins on the legs requires a holistic approach to venous disease. Holistic therapy not only effectively eliminates spider veins, but also significantly reduces the risk of their recurrence in the future. For this reason, it is not uncommon for us to treat pelvic venous insufficiency first, followed by lower limb venous congestion and secondary venous insufficiency (descending approach). Only after these factors have been eliminated and modifiable risk factors have been reduced do we proceed to treat telangiectasias on the legs. The most effective method in the treatment of vascular spider veins is still microsclerotherapy and its variations in combination with the use of compression therapy (compression stockings). Compression therapy is used by patients in the post-operative period and as part of broader prevention. Only this approach increases the chances of success. Micro-sclerotherapy procedures for vascular spider veins, venlectasia and dilated reticular veins involve injecting a sclerosant (a chemical substance that damages the vein from within) into the lumen of the affected vessels in liquid or foamy form. The sclerosant (obliterating agent) injected into the vessel initiates the process of fibrosis, overgrowth and atrophy of the obliterated vessels. This type of treatment is usually performed in series at 3-6 week intervals. After 4-15 weeks, the telangiectasias fade and disappear. Compression sclerotherapy - what does it involve? Transdermal methods using thermal energy are sometimes used in the treatment of spider veins. Among the most popular are laser therapy and thermocoagulation. Many different types of transdermal lasers are available on the market. Thermocoagulation, on the other hand, involves closing small blood vessels with heat. This uses very fine needles, inserted into the lumen of the vessel. Each of these methods has both advantages and disadvantages. Practice shows, however, that in the case of limb telangiectasias, this type of treatment does not yield very satisfactory results and often exposes the patient to skin complications such as erythema, discolouration, discolouration, scarring or the formation of secondary telangiectasias. This type of spider vein treatment is used in patients with contraindications to microsclerotherapy procedures. Microphlebectomy, a once popular method of surgical removal of small vessels, has lost its importance in modern phlebology. Despite a certain effectiveness, this technique often led to unsatisfactory aesthetic results and even paradoxically stimulated the formation of new, difficult-to-remove vessels. As a result, we have moved away from this method in favour of more effective and less invasive solutions. We should remember that effective treatment of vascular spider veins and dilated reticular veins should always be preceded by a thorough analysis of the background of their formation. The treatment of small vessels itself should follow the principles of haemodynamics (blood hydraulics) and cannot consist only in randomly closing vessels with a sclerosant or a transcutaneous laser. Mostlyquestions asked Can vascular spider veins be prevented? The formation of spider veins cannot be completely prevented. Although factors such as: "favourable" genetics, a healthy lifestyle, regular physical activity or avoidance of prolonged standing or sitting, they can still appear even in people who are so well disposed. The greatest incidence of spider veins on the legs usually occurs in pregnant women. For this reason, especially during pregnancy and during long journeys, appropriate prophylaxis through the use of compression therapy (compression stockings and socks) is important. Can spider veins return after treatment? Unfortunately, despite effective treatment, there is a risk of new lesions developing in the future. This happens if risk factors are not eliminated and venous insufficiency of the pelvic and lower limb veins (the cause of microcirculatory insufficiency, which is often the generator of spider veins) is not treated well enough. Recurrence is statistically more frequent in women who have given birth several times, in ladies with obesity and in those who abuse hormone therapy. Can spider veins disappear on their own? Telangiectasias (the specialised name used to describe vascular spider veins) - once they appear - rarely disappear on their own. In most cases, it is the case that the resulting vascular tree slowly expands and the small vessels become wider and more pronounced under the skin. The exception to this is vascular changes that occur during pregnancy. The surge in hormone levels and increased blood flow during this period can lead to the dynamic formation of spider veins in the pregnant woman. However, after delivery, when these factors subside, many of the venous lesions may regress spontaneously, diminishing or even disappearing. Is sclerotherapy for spider veins painful? Sclerotherapy of spider veins commonly referred to as "micro-sclerotherapy" is a procedure performed to improve the microcirculatory function and aesthetics of the legs using fine needles. Their insertion through the skin is sometimes felt as a slight burning sensation. It is important that the phlebologist performing the microsclerotherapy procedure knows how to insert the needle through the skin and how to administer the sclerosant into the vessel so that the procedure is safe and minimally painful. This is one of the more difficult procedures that determines the aesthetic success of the treatment. It is important that the doctor performing it is able to assess the circulation on ultrasound and knows the basics of the haemodynamics of such procedures. How long does it take to recover from spider vein microsclerotherapy? After microsclerotherapy, most patients are able to return to normal activity after about 7-10 days. During this time, it is advisable to wear appropriately selected compression stockings, which accelerate healing, reduce swelling, possible leg pain and additionally protect against the occurrence of venous thrombosis. It is important not to expose oneself to strong sunlight for 4-6 weeks after the sclerotherapy treatment. Related issues 01 / Venous insufficiency of the lower limbs 02 / Pelvic venous insufficiency in women 03 / Microsclerotherapy Modern vein treatment We offer treatment both on an outpatient basis and in day ward admissions. The stay is of short duration. The patient spends between 1 and 5 hours in the Clinic. Make an appointment
