If my patient only has visible signs of spider veins
The medical term for spider veins is telangiectasias and in addition to the cosmetic issues they are associated with, they can also cause symptoms such as itching, burning, dry skin, warm skin, bleeding, or pain. These veins measure <1mm, while reticular veins measure from 1-3 mm, and varicose veins measure >3mm. Spider veins can either be purely a cosmetic issue, or they can be the tip of the iceberg where more significant underlying venous insufficiency may be present. Prior to treatment of spider veins, all patients should have a venous ultrasound performed for more significant venous disease. If one simply treats the spider veins prior to treating the underlying veins, the spider veins can come back in either the same location or a different location. The proper therapy is to first perform venous ablations prior to sclerotherapy of spider veins.