Spider Veins and Reticular Veins (feeding veins)

Spider Veins commonly affect millions of women and cause negative self image and may be associated with symptoms such as alterations in skin texture, discoloration and itching. Unlike varicose veins they rarely bulge above the level of the skin and do not pose a medical risk. However in very rare cases, if they are irritated, they can rupture and cause bleeding. In the great majority of cases they are asymptomatic and are considered a cosmetic blemish and are universally not covered by commercial health insurance plans. The medical term for Spider Veins is Telangiectasias: small, 0.2 to 1.0 mm, red or blue or purple veins located within the dermis layer and lie just below the skin. They are actually a confluence of dilated incompetent intra-dermal venules that, on the outside of the thighs and calves, are part of an extensive network of the Lateral Subdermic Venous System; a system that is separate from the Saphenous system. The Reticular Veins, commonly called “Feeder Veins,” they are 1 to 3 mm wide blue veins that can be seen running in a curvilinear fashion under the skin surrounding the spider complexes. These reticular veins also have incompetent valves allowing venous blood to run out toward the skin instead of draining the venous blood in the normal direction. Spider veins are often associated with a family history of varicose veins and may form as result of local skin injury or sun damage, and are more commonly seen with obesity, advancing age, and thinning of the skin. They are especially sensitive to female hormonal influence and commonly develop in females during their reproductive years. They are usually found on the thighs, calves, ankles, and the nose and tend to be progressive. Spider veins may also result from abnormal micro connections between small subcutaneous arteries and veins (arteriovenous anastomosis) which bypass the normal microscopic capillary network and enlarge to the point that they appear like a spider. These dermal and subcutaneous veins (unlike muscular veins) are innervated by the sympathetic nervous system and they will dilate and contract in response to local and central nervous stimuli such as warming and cooling, stress, and circulating vasoconstrictor peptides such as Endothelin.


Spider vein complexes are commonly seen in two typical distribution patterns: horizontal and vertical arrays. The horizontal pattern runs parallel to the skin and cause a wide fan shaped linear array of telangiectasias. This pattern is very common on the outer thigh and is often seen in close association with reticular feeding veins which are connected to the superficial veins of the skin which are in turn connected to the deeper veins.

In the vertical pattern, the feeding vessel may be a small arteriole or venule which runs perpendicular to the skin and is typically seen as the central core in a spreading blush or arborization pattern. These small arteriovenous or arteriolar spider complexes are connected to the arterial system. Caution must be used when introducing medications into these vessels to prevent skin ulcers and systemic complications. This vertical pattern can be easily appreciated by placing a pencil eraser in the center of the spider, compressing the area to make it disappear and then quickly releasing pressure and watching the spider spread out in a circular pattern.

Spider veins and varicose veins can co-exist and it is important to obtain a proper diagnosis to determine the best means of treatment effectively clear the spider veins and prevent complications from varicose veins. Fortunately spider veins and their reticular feeding veins can be easily treated with a combination of direct injections (sclerotherapy) and topical laser utilizing the Dornier 940 nm wavelength system.