Prevention or Reversal of Deep Venous Insufficiency and Treatment: Why Are Spider Veins of the Legs a Serious and A Dangerous Medical Condition?

Spider veins (also known as spider hemangiomas) unlike varicose veins (dilated pre-existing veins) are acquired lesions caused by venous hypertension leading to proliferation of blood vessels in the skin and subcutaneous tissues due to the release of endothelial growth factors causing vascular neogenesis. More than 60% of the patients with spider veins of the legs have significant symptoms including pain, itching, burning, swelling, phlebitis, cellulites, bleeding, and ulceration. Untreated spider veins may lead to serious medical complications including superficial and deep venous thrombosis, aggravation of the already established venous insufficiency, hemorrhage, postphlebitic syndrome, chronic leg ulceration, and pulmonary embolism. Untreated spider vein clusters are also responsible for persistent low-grade inflammation; many recent peerreviewed medical studies have shown a definite association of chronic inflammation with obesity, cardiovascular disease, arthritis, Alzheimer’s disease, and cancer. Clusters of spider veins have one or more incompetent perforator veins connected to the deeper veins causing reflux overflow of blood that is responsible for their dilatation and eventual incompetence. The spider veins are, therefore, a manifestation of venous insufficiency. The medical literature shows that superficial venous insufficiency can cause deep venous insufficiency; and the treatment of superficial venous insufficiency leads to recovery of deep venous insufficiency. We have recently published our results showing that complete and aggressive treatment of superficial venous lesions accomplishes better results as compared to patients in whom spider veins were left untreated. (Ahmad et al. Prevention or reversal of deep venous insufficiency by aggressive treatment of superficial venous disease. American Journal of Surgery 2006; 191:33-38.) An effective method of treating the symptomatic spider veins is the use of electromagnetic energy in the form of intense pulse light, laser, and more recently a combination of laser and radiofrequency. Since the majority of patients with symptomatic spider veins have associated venous insufficiency, it is recommended that in addition to the treatment of spider veins, saphenous venous insufficiency be treated utilizing endovenous laser ablation or inversion PIN (perforation-invagination) stripping along with high ligation. In conclusion, the entity, spider veins of the legs, is not a cosmetic condition because this disease is frequently associated with venous insufficiency and disabling symptoms. Thus, comprehensive management is mandatory. Chronic inflammation associated with spider veins may lead to many degenerative diseases such as cardiovascular disease, diabetes, arthritis, Alzheimer’s disease, and cancer in later life. Early and aggressive treatment of spider veins is justified because it improves or reverses the deep venous insufficiency thus preventing the possible serious complications in the future. INTRODUCTION Venous disease of the lower extremities is a prevalent condition in United States and Europe. 2 The exact incidence of spider veins of the legs is not known. At least one study has reported the incidence in women to be more than 50%. Spider veins (also known as spider hemangiomas) of the legs are acquired lesions caused by venous hypertension, which leads to proliferation of blood vessels in the skin and subcutaneous tissues of the legs. Venous hypertension is the direct result of venous insufficiency. High pressure in the tissues causes the release of endothelial growth factors from fibroblasts and adult endothelial stem cells, present in the skin and subcutaneous tissue, causing neogenesis of blood vessels. 21 Varicose veins, on the other hand, are due to dilatation of the preexisting veins in the legs, and should not be confused with spider veins. The underlying cause of varicose veins is also venous hypertension. It is well known that the spider veins are associated with incompetent perforator veins connected to the superficial or the deep veins of the legs. Clusters of spider veins have one or more incompetent perforator veins connected to the deeper veins. If there are multiple clusters of spider veins in the legs, they can cause a large amount of reflux blood flow in the wrong direction causing extra burden to the deep veins from overflow of this blood, thus leading to the progressive dilatation of the deep veins. Once dilated, the deep veins remain incompetent. Spider veins are, therefore, a manifestation of venous insufficiency. The medical literature shows that