Vericose Vein Varicose and Spider Veins

What are varicose and spider veins?
Knowing how veins work is important in understanding the development of venous disease and varicose veins.

Arteries and veins are the body's transportation system. They carry blood, with its vital cargo of oxygen and nutrients, to every part of the body. Arteries move blood from the heart to the tissues and veins bring it back to the heart.

The pumping of the heart helps push blood through the arteries. But on the return trip, this force is much weaker in the veins. In addition, blood flow in the veins of the lower body must move upwards, against gravity, pumped by the leg muscles.

To keep blood in the veins flowing in the right direction, veins have one-way valves–like flaps–that open to let blood flow upwards and then shut to keep blood from draining back downwards toward the feet.


What causes varicose veins and spider veins?
Varicose veins are almost always caused by weakening of the one-way valves in the leg. When the valves don't work properly, blood "leaks" or flows backwards. Over time, this venous reflux or backed-up blood puts pressure on the veins, causing them to stretch, thin and dilate. Varicose veins usually occur close to the skin's surface on the back of the calf, the inside of the thigh, or in the groin area. The danger of varicose veins and venous reflux is that stagnant blood can cause thrombophlebitis (clotting of the veins), pain, swelling, cramps, heaviness, skin changes and even ulceration.

Spider veins are smaller varicose veins that appear as small purple blue lines or "spiders" that are even closer to the skin's surface. Typically on the legs, they can also occur on the face.

What are the risk factors for varicose veins and spider veins?
A family history or genetics is the single most important risk factor for varicose veins and venous disease. More pressure on the legs can also bring on both conditions. For varicose veins and venous reflux, triggers can be excess weight, spending long hours standing or sitting, and pregnancy. Age, female gender, hormonal changes and sun exposure also increase the chances of developing varicose and spider veins.

What are the symptoms of varicose veins and spider veins?
Enlarged, ropey-looking varicose veins look dark purplish or blue and can appear twisted or bulging. They are often uncomfortable, causing swelling and painful aching or cramping in the legs and feet. Skin changes/dermatitis and ulceration may also occur.

Spider veins are noticeably red or blue, and often look like tree branches or spider webs. Though usually not dangerous, they can cause itching and burning.

How are varicose veins and spider veins diagnosed?
A physician can often diagnose varicose veins and spider veins by visual examination as well as an ultrasound.

What are the treatment options for varicose veins and spider veins?
Most varicose and spider veins can be managed with simple lifestyle changes, such as wearing compression stockings, standing less, weight loss and raising the legs when sitting.


  • Endovenous Laser Therapy: Used for treatment of varicose veins and venous reflux. A laser guided into the main leaking vein heats and seals it shut, while the remainder of the bulging branch veins are removed via small incisions (ambulatory phlebectomy). Nearby healthy veins will take over normal blood flow.
  • Sclerotherapy: A liquid chemical injected into the small veins seals them shut, stopping blood flow. Nearby healthy veins take over normal blood flow.


  • Ligation, stripping and phlebectomy: Damaged veins are tied shut and removed through small incisions in the skin. Ligation and stripping is rarely needed anymore as the endovenous laser procedure is usually adequate to treat the veins. Branch veins that remain can later be removed thru small incisions called micro/stab phlebectomy.
For An Appointment Call

Robert J. Grossi, MD
Vascular Surgery

Gary A. Gwertzman, MD
Vascular Surgery and Wound Care

Stephen P. Haveson, MD
Vascular Surgery and Wound Care

Daniel Han, MD
Vascular Surgery

Vascular Labs