Some people have the inherited potential to develop small branching superficial veins in the skin. These are often called "spider veins". They are common on the lower extremities, and may appear early in life, especially during the reproductive years. These spider veins many times become more prominent and abundant during pregnancy. Unlike varicose veins (the larger, deeper dilated veins), these smaller vessels in the skin are not influenced by the presence or absence of damaged or incompetent valves. Many treatments have been used to treat spider veins (chemical peels; electric wire diathermy; cautery; lasers; injection sclerotherapy). The "gold standard", and still the most cost effective treatment, is injection sclerotherapy. The technique of injection sclerotherapy is to inject a small amount of sclerosing solution (a solution approved by the F.D.A. for vein injections) into the veins using a small gauge needle. This requires loope magnification and fibro-optic illumination and is a very tedious process. The initial reaction is swelling and bruising for several weeks. Over the next several months, the walls of the veins collapse, adhere together, scar down and the vessel is obliterated. This process has no advese affect on the overall circulatory system. Some vessels do not respond to this treatment. It is often necessary to re-inject about 15% of the spider veins because of incomplete obliteration of the vein channel. The most common problem seen with this treatment (especially if the spider veins are very prominent) is hemosiderin deposits. Occasionally blood will become trapped in a spider vein as it is shrinking. A "trapped blood" collection is known as a hemosiderin deposit. This results in a brown or black pigmentation in the skin. This problem usually disappears, but it may take months or years to resolve. This is one reason I like to perform a "test dose" on a prominent plexus of spider veins before proceeding with mutiple vein injections during a typical 30 min. office session. We are still trying to find a laser that will eliminate spider veins in a cost effective and efficient manner. The 940 nm wavelength gives an effective penetration with optimal absorption by hemoglobin. There is less chance of skin pigmentary problems. Re-treatment and cost is still a draw-back to this laser system.
