I work for a surgical practice that specializes in treating varicose veins as well as spider veins and other disorders related to vein problems. I’m not an MD, but I’ve written all of our practice’s patient education material. With regards to spiders you typically see 2 groups of people. One group has very faint and superficial spider veins that aren’t caused by an underlying condition. If you have the more severe kind, there’s a good chance you’ve got Venous Reflux.
Leg veins are filled with 1-way valves that allow the blood to return to the heart, but not fall back down to the leg (kind of like on a roller coaster’s first hill that allows the coaster to go up but not fall down). What happens is that people with standing professions, family history of venous disease, or other contributing factors (such as having babies), will be at high risk for having these valves break. The result is that the blood starts flowing the wrong way through the leg veins and creates even more pressure on the valves below it, which results in a chain-reaction of failures in these valves. The increase pressure can manifest in 1 of two ways or both ways. Either the pressure blasts out into the smaller vessels, resulting in spider veins, or it causes the major leg veins to balloon out. Many people experience both.
Varicose and spider veins can be quite painful, but luckily the science has really advanced on the subject over the past decade or so. If you have venous reflux and don’t treat the underlying condition and just receive sclerotherapy, your results are going to be terrible. Because you haven’t fixed the source of the pressure, they’re going to keep coming back again and again. If you don’t have reflux then sclero alone should be fine. Cosmetic practices and most plastic surgery practices aren’t checking for reflux.
The way reflux is tested for is an ultrasound doppler study of the bloodflow in your leg (it’s a lot like getting an ultrasound of a fetus), fairly quick an painless, and the results will show whether the blood in your leg is flowing the wrong way (given your family history, it sounds likely). Once reflux is established pretty much all health insurances will pay for treatment, especially if you are symptomatic (pain, swelling, restless legs, trouble sleeping etc). We use the VNUS Closure procedure to shut down the damaged vein and prevent the blood from flowing backwards. This is done in the office with local anesthesia (i.e. you’re awake) and you literally walk out of the office after about an hour.
After the source of the pressure is shut down, we will administer sclerotherapy, and unlike the groups that aren’t closing down the refluxing veins, the longterm results are much better. We have a great website with lots of information about Venous Reflux, Varicose Veins, and Sclerotherapy including some animations that explain things better than I can with words here.
As far as the number of sessions, it really depends on the extent of the varicosities, and their diameter. Only a certain volume of sclerotherapy chemicals (sclerosant) may be safely injected in any given day, which is why it can take so many sessions. I would look for a vein specialist in your area who is board certified with the American College of Phlebology and stay away from internet specials. Insurance should cover this (assuming you don’t just have very minor cosmetic spiders), so it’s worth seeking out someone who knows what they’re doing.
I would also suggest compression stockings and elevation at night as a form of alleviating any symptoms you may have. If you have further questions, I’d be happy to help answer them or feel free to PM me if you’d like to ask more questions in private. Best of luck.
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