Spider Vein Disease

Many of our patients come into our Los Angeles vein clinic hoping to eliminate a very small set of veins in their legs and thighs.  These spider veins are usually responsive to minor vein procedures, but a small subset of patients may have a more difficult time getting rid of ‘stubborn spider veins.’  In the rest of the world, spider veins are called a number of terms things, including hyphen veins, thread veins, sunburst veins, stellate veins, and venous flares.  We categorize these small intradermal veins in the legs and thighs based on the CEAP classification of vein disease.  Telangiectasia and spider vein clusters are usually defined as a confluence of dilated intradermal venules measuring less than 1 mm in size. If you have stubborn spider veins in your legs and thighs and have tried laser, injection sclerotherapy, and foam sclerotherapy options, you may be pleased to learn about how your spider veins may be tied into your varicose vein problems. 
Studies have shown that many individuals who thought they only have spider veins, have in fact, associated varicose vein and reticular vein disease.  In other words, your small spider veins may be an early warning sign for a deeper underlying medical vein problem.  Somjers et al studied lateral and medial thigh telangiectasia and found that some clusters of spider veins may be associated with larger reticular veins.  In fact, problems with larger reticular veins in your legs may be contributing to your spider vein problem.
Engelhorn et al also demonstrated that these spider vein clusters were often associated with great saphenous vein reflux.  So, what does this mean for a healthy male or female who presents with spider veins that are just stubborn and won’t go away? Well, it means that sometimes what you may think of as a cosmetic spider vein problem may actually best be treated with medical vein solutions.  Dr. Raffy Karamanoukian is a board certified vein surgeon who has expertise in the management of cosmetic and medical vein problems.  If you are suffering from stubborn spider veins, you may consider scheduling a comprehensive consultation with Dr. Karamanoukian to determine whether you in fact, have a medical vein problem that may be related to family history, genetics, previous pregnancies, trauma, previous surgeries, or occupation. 
It is thought that nearly one third of the adult population in America has some degree of vein disease.  We all tend to think of the problem as purely related to varicose veins, but in actuality, these vein problems can be associated with spider vein, reticular veins, or bulging varicose veins.  In fact, some patients may have vein disease and not have one visible varicose vein on their legs.  How can that be? Venous disease is comprised of the veins that we see superficially and those that are hidden deep within the tissue.  If underlying vein valves are not working properly, patients may develop a condition known as venous reflux, causing symptoms of pain and discomfort.  If you have ‘stubborn spider vein,’ you may have an early warning sign that you have venous reflux without even knowing it. 
Some of the more common symptoms associated with venous disease include pain, discomfort, itching, burning, cramps, throbbing in the legs, restless legs, and heaviness.  Some patients may exhibit early muscle fatigue and leg pain that worsens at the end of the day.
During your consultation for vein treatment, Dr. Karamanoukian will begin with an examination and ask you about relevant medical history that can contribute to vein problems.  Next, a vein mapping procedure can be performed, followed by an ultrasound of vein lite examination.  This allows both you and Dr. Karamanoukian to see what the veins look like underneath the skin.  Finally, an ultrasound can be scheduled to determine how the veins function, including the degree of turbulence, flow rates, and the amount of venous reflux.
If on ultrasound examination, you are deemed to have venous reflux, you may benefit from several medically related vein treatments that are now at the forefront of vein therapy.  These treatments include microphlebectomy, endovenous therapy, and laser therapy.  Endovenous therapy includes EVLT, VNUS, Venefit, and Clarivein procedures.  In Endovenous therapy, a small fiber is used to non-surgically close off and eliminate defective veins that are unhealthy and poorly functioning.  These unhealthy veins contribute to venous reflux and damage the normal flow of venous blood back to the heart.  By controlling these veins, the venous flow is improved, leading to a gradual return to normal or near-normal vein flow.
If you have spider veins and venous reflux, it is natural and logical to treat the medical problems first before the cosmetic.  If the cosmetic spider veins are treated first in the presence of venous reflux, you may have a high chance of spider vein recurrence. 
This approach to vein treatment is encouraged by board certified Los Angeles vein surgeon Dr. Raffy Karamanoukian.  A recent study by CV Ruckley et al in Phlebology validated the necessity of this approach to vein care.  In the study, the authors concluded the following: “ …in patients presenting with telangiectasia, there is a need for studies employing high definition duplex to track reflux in saphenous systems, reticulars, and perforators.”
Vein problems are very pervasive among the healthy adult male and female population.  Schedule a consultation today to determine whether your vein problems are purely cosmetic, or a result of a medical vein problem that can be passed from one generation to the next.  Occupation, physical activity, family history, history of surgery or trauma, and pregnancies can all contribute to the development of spider and varicose veins.  By realizing that spider veins may be an early warning sign for varicose vein disease, you can treat your veins early and avoid costly ramifications to your health. 


Our office specializes in spider vein injections using the most advanced techniques available in the United States. In our Santa Monica vein center, sclerotherapy can be used to treat tiny thread veins as well as larger reticular veins that are blue or purple. By treating both small and medium sized veins, a more comprehensive elimination of unsightly veins is achieved. Dr. Karamanoukian has demonstrated his unique Hidef spider vein injection technique on television and uses the safest methods possible to achieve improvements in spider veins. 

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