The Women's Journal

Spider Vein Therapy Doesn’t Always Work

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By Anthony Alfieri, DO, FACC  

As a certified vein center, we see many cases each year of people who are disappointed in the treatment they received for their spider veins at other facilities. The problem is that most people do not understand what spider veins are or why they get them. They believe their spider veins are just a cosmetic issue and do not realize that the spider veins may be caused by another issue.   

Here is an example we have seen working with patients with spider veins: Mary Smith is a 43-year-old female who notices she has several spider veins on her legs. She finds them uncomfortable and cosmetically unattractive, so she goes to a center which specializes in treating cosmetic spider veins. She is told that for $300 dollars, the spider veins can be injected and they will resolve. This treatment method is called sclerotherapy. Mary may need to have multiple sclerotherapy treatments depending on how bad her spider veins are. Mary decides to have this painful and expensive procedure done, only to notice months later that her spider veins have returned. Unfortunately, this is a more common scenario than one might realize. 

At the Delaware Advanced Vein Center, we see several patients a week who present us with this scenario. The optimal evaluation of a patient with spider veins is a thorough history and a physical examination, for venous insufficiency. To diagnose whether Mary has venous insufficiency, she would schedule a vascular ultrasound study done on her legs to measure the vein size and to determine if her veins are adequately circulating blood from her lower extremities to her heart. The legs provide the heart 70% of the blood that it receives so the direction of the blood always flows towards the heart. 

In venous insufficiency, which can be a hereditary disease, valves in the veins are malfunctioning so the blood, which is supposed to flow to the heart, falls back into the legs and “pools” in the veins. This disease is relatively common and may affect up to 40% of the population. This can cause spider veins in the early stages; however, as the disease progresses, patient will notice darkening of the skin, heaviness of the legs, cramping, ulcers, and new varicose veins showing up. Thus, spider veins may be one of the earliest signs of venous insufficiency. Having spider veins does not mean you definitely have venous insufficiency. It just means this may be a symptom for a much bigger problem, not just a cosmetic nuisance.

It is important that patients who have spider veins get diagnosed properly and treated. Otherwise, just treating the spider is only treating a symptom, not the disease itself. If varicose veins are a family disease, then anyone with spider veins would be advised to undergo a vascular ultrasound evaluation at a vein center, so that if venous insufficiency is present, it can be treated appropriately, avoiding costly sclerotherapy which is doomed for failure. You can set up an appointment at our vein center for a free vein screening to determine if any testing is needed for further evaluation.


Anthony Alfieri, DO, FACC is a board certified interventional cardiologist who has been practicing in the New Castle County area for over twenty-five years. In that time he has seen and treated many forms of cardiovascular disease, one of which being the progressive and often painful and debilitating venous insufficiency, commonly described as varicose veins. Over the years, Dr. Alfieri came to realize that this problem was frequently underappreciated, misdiagnosed, and undertreated. It was this extensive experience and intense compassion for his patients that drove his desire to provide an effective and permanent treatment and led him to found Delaware Advanced Vein Center. With over twenty-five years of experience as an interventionalist, Dr. Alfieri is uniquely qualified to perform a multitude of vascular procedures with minimal discomfort and maximum, lasting results.


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