Q: I've had a consultation for spider vein reduction but was told that nothing could be done about my bigger, deeper veins because they could be the result of a medical issue. What issue could that be and what are my options?

A: Spider veins on the legs are common in women, often inherited from a parent, and may worsen with pregnancy. Small red vessels are seldom a problem and are easily treated, in the office, using a technique called "sclerotherapy". In sclerotherapy, solutions of salt, sugar or other chemicals are injected into the enlarged blood vessel, causing irritation to its walls and leading to the vessel closing up. This procedure must be repeated three or four times, at monthly intervals. The veins usually shrink by about 25% after each treatment, and results are permanent (but this doesn't stop new vessels from forming) . The cost per treatment is about $250 plus HST in our clinic.

In the case of bulging, blue vessels, the problem may be more complicated. There are two sets of veins in the legs. The deep veins run close to the bone and return blood directly to the core of the body. The superficial veins, the ones that you can see, collect blood from the surface skin and direct this blood into the deep veins through a series of "connector" veins. These connector veins have one-way valves that prevent the blood from "backing up" once it flows into the deep veins. If these valves become damaged, back flow can occur, with excess blood building up in the superficial veins, observed as bulging blue vessels under the skin. These are often termed "Varicose Veins".

Vascular surgeons use special tests, such as Doppler testing, to determine the cause of varicose veins and offer both surgical and non-surgical approaches to correct these. Rarely, pressure on larger deep vessels caused by an abnormal growth, such as a tumor, can lead to excess varicose vein formation. Finally, there are occasional hereditary causes of enlarged leg veins. In our clinic, patients with these large vessels are routinely referred to an excellent vascular surgeon with experience in the treatment of varicose veins. These specialists are the most qualified to deal with larger leg veins.

dr sheldon pollack

-Sheldon V. Pollack, M.D., FRCPC, Toronto Cosmetic Skin Surgery Centre, www.derma-surgery.ca