If my patient only has visible signs of spider veins (according to your CEAP chart) what's the likelihood they may have underlying venous disease?

The Edinburgh Vein Study published in 1999 in the British Medical Journal estimated that over 80% of the total population had reticular varicosities or telangiectasia (spider veins). However, the prevalence of varicose veins, as reported in studies, has not matched that of reticular varicosities or telangiectasia. Reported rates of varicose veins in the literature range from 2%-56% in men and from 1%-60% in women. The prevalence estimates in the literature vary because of differences in the methods of evaluation, criteria for definition, and the geographic regions analyzed.

What we do know is that chronic venous disease is extremely common. It is estimated that approximately 40-50% of individuals with spider veins have underlying venous disease contributing to the dilated capillary formation. In the other 50-60% of individuals with spider veins, their disease is limited to the surface telangiectasia and does not represent underlying venous hypertension. Treatment of these superficial dilated blood vessels can be futile if the underlying disease process is not addressed. These physical findings should cue doctors in on the possibility that venous disease exists warranting further questioning to see if the individual experiences symptoms in addition to early signs of venous disease. Any person with spider veins that experience symptoms of burning, itching, aching, heaviness in their legs should be further evaluated by duplex ultrasound. While vein disease signs and symptoms start out as mild, they can progress in severity if left untreated.