Spider veins may be very isolated problems due to progressive enlargement of tiny veins in the skin. Frequently, however, they develop because of abnormal underlying veins which are under high pressure and feed blood into the spider veins. The “feeder veins” need to be treated to get rid of the overlying spider veins. Hence sclerotherapy without ultrasound to help see and close the feeder veins is often futile. If the larger abnormal veins are not treated before treating the spider veins, treatment of the spider veins alone will not be successful for long, since the underlying problems will still be forcing venous blood into the skin, causing more spider veins to form soon. This is a common problem for patients who receive surface LASER treatments or sclerotherapy for spider veins without first assessing the larger veins in the legs with color duplex ultrasound.
Treatment of spider veins through sclerotherapy with the assistance of ultrasound (so called ultrasound guided sclerotherapy) to treat the otherwise invisible feeder veins can be very effective.