What is the recommended treatment for spider veins?

Treatment for Spider Veins

Sclerotherapy is the first-line treatment for spider veins, with polidocanol (Asclera) being the FDA-approved agent of choice for uncomplicated spider veins ≤1 mm in diameter in the lower extremities. 1

Treatment Options Based on Vein Size

Spider Veins (≤1 mm)

• Sclerotherapy with 0.5% polidocanol is the recommended treatment 1
  • Inject 0.1 to 0.3 mL per injection site
  • Maximum 10 mL per session
  • Use a fine needle (26 or 30-gauge)
  • Insert needle tangentially and inject slowly
  • Apply compression immediately after injection

Reticular Veins (1-3 mm)

• Sclerotherapy with 1% polidocanol is recommended 1
  • Same injection technique as for spider veins
  • Longer compression period (5-7 days vs 2-3 days for spider veins)

Post-Treatment Protocol

1. Apply compression stockings immediately after treatment 1
2. Patient should walk for 15-20 minutes immediately after the procedure 1
3. Maintain compression for:
   • 2-3 days for spider veins
   • 5-7 days for reticular veins 1
4. For extensive varicosities, longer compression with higher compression class stockings is recommended 1
5. Advise patients to:
   • Avoid heavy exercise, sunbathing, long flights, hot baths for 2-3 days 1
   • Continue daily walking during recovery period 1

Treatment Efficacy

Clinical studies show high success rates with sclerotherapy:

• 95% treatment success rate at 12 weeks with polidocanol 1
• 87% of patients reported being satisfied or very satisfied with treatment 1

Alternative Treatments

For patients who cannot undergo sclerotherapy, endovenous thermal ablation (radiofrequency or laser) may be considered for larger veins with documented reflux exceeding 500ms 2.

Important Considerations and Precautions

Contraindications

• Known allergy to polidocanol
• Acute thromboembolic diseases 1

Potential Complications

• Anaphylaxis (rare but serious)
• Venous thrombosis and pulmonary embolism
• Arterial embolism
• Tissue ischemia and necrosis with extravasation 1

High-Risk Patients

Exercise caution in patients with:

• Reduced mobility
• History of deep vein thrombosis or pulmonary embolism
• Recent major surgery (within 3 months)
• Prolonged hospitalization
• Pregnancy 1

Follow-Up Care

• Early follow-up ultrasound within 1-2 weeks is recommended to confirm successful closure and rule out complications 2
• Repeat treatments may be necessary if the extent of varicose veins requires more than 10 mL of sclerosant
• Subsequent treatments should be separated by 1-2 weeks 1
• Small intravaricose thrombi that develop may be removed by microthrombectomy 1

Sclerotherapy remains the gold standard treatment for spider veins with decades of clinical experience supporting its efficacy and safety when performed correctly 3, 4.