When very small vessels at the surface of the skin become enlarged, they can form webs of blue, purple, and red spider veins.  The medical term for these malformations is telangiectasia.  The more common term is spider veins.  They can occur in males and females; however, they are more common in women and may be related to the presence of female hormones.  They are usually of cosmetic concern; however, on occasion they may signal a more serious venous disorder especially if they are prominent below the ankle, a condition known as corona phlebectasia.  Generally spider veins do not pose a risk, however in rare cases the can bleed and be more than a nuisance.

Spider veins are most effectively treated with sclerotherapy.  Laser therapy can also be used; however, it is associated with a higher recurrence rate and has been shown to be not quite as effective.

These veins are the bulging types seen usually in the lower thigh and calf area.  The underlying problem is the lack of competent valves in the vein.  Under normal conditions, valves located about every six inches in the veins prevent the blood from flowing backwards, down the leg. When the valves do not work, blood goes down the vein, increasing the pressure and causing pain and distension or enlargement of the veins in the lower leg.  This is a medical condition and left untreated can result in significant problems, such as pain, discoloration, ulceration of the skin, edema or swelling of the legs and an increased risk of blood clots.

  This condition is readily diagnosed with Colorflow doppler ultrasound.  This noninvasive painless ultrasound exam is done in our office and is used to evaluate patients with symptoms suspicious for venous insufficiency.

Venous ulcers can form in the ankle area and lower calf when longstanding venous insufficiency leads to very high venous pressures in the lower leg.  The superficial tissues in the lower leg cannot properly perfuse with arterial blood, and thus the skin and subcutaneous tissue suffer.  This leads to death of the tissue and open non-healing sores known as venous ulcers.  The treatment for this disabling and pathological condition starts with an accurate evaluation of the veins involved.  Oftentimes incompetent perforating veins in the calf area are identified as the cause. 

Once the pathological veins have been defined, delineated and properly mapped, treatment can then begin.  Effective treatments include endovenous radiofrequency catheter ablation, ligation and division of incompetent perforating veins, and foam sclerotherapy.  The modality of treatment will be determined by the venous abnormalities that are causing the ulcer.  Often the ulcer will heal within weeks of treatment.