Both varicose veins and spider veins are dilated superficial veins. Even though they sound similar there are many differences that will be discussed here in detail, highlighting both of their clinical features, symptoms, causes, investigation and diagnosis, prognosis, and the course of treatment they require.
Varicose Veins
Varicose veins occur on lower limbs most commonly. However, they can occur elsewhere, as well. Ex: Vulval varicosities; these appear during pregnancy. Veins are thin walled capacitance vessels. Their walls cannot withstand excessive pressures. The amount of smooth muscle inside the wall of a vein is significantly less than that in an arterial wall. Veins carry blood towards the heart, with the help of the pressure generated by surrounding muscles. These skeletal muscles help veins carry blood up to the heart against gravity. There are small valves positioned along the veins dividing the veins into small compartments. As muscles around a lower compartment contract, the increased pressure pushes the blood up through a valve and into the compartment above. That valve closes when the muscles relax; therefore blood doesn’t flow back down. There are two venous systems in the leg; a deep and a superficial system. There are communications between these two systems. These communications are called “perforators”. Varicose veins occur due to incompetence of venous valves in the deep, superficial or perforator systems. When venous valves do not function, a continuous column of blood forms along the vein. The vein wall cannot withstand this increased hydrostatic pressure, and it coils on itself. Thus, coiled and dilated superficial veins become visible. Valve incompetence is a common sequel of superficial venous clotting. The body mechanisms that dissolve a clot do not differentiate that well between venous valves and clots. It damages and destroys both. Varicose veins and ulcers, which follow superficial clot formation, are medically known as “post-phlebitic limb”. Varicose veins cause a significant leakage of blood under the skin giving rise to venous ulcers. Venous ulcers occur on the medial aspect of the leg, are painful, bleed a lot and are difficult to treat. Sclerotherapy, spaheno-femoral ligation, stab evulsion, and stripping are common treatment modalities for varicose veins. Venous ulcers do not heal as long as the underlying cause lingers.
Spider Veins
Spider veins are also known as telangectatsia. Spider veins are dilated small veins. They usually measure around a few millimeters. Even though spider veins occur anywhere, most common site is the face. There are many reasons for telangiectasia. Congenital causes include port wine stain, Klipple Trenaunay syndrome, and hereditary hemorrhagic telangiectasia. Cushing’s disease, carcinoid syndrome, angiomas, scleroderma and radiation also cause spider veins. A good clinical history and a thorough physical examination are necessary to detect the underlying cause for telangiectasia. While sclerotherapy treats spider veins, they will recur unless the underlying cause is treated.
What is the difference between Varicose and Spider Veins?
• Varicose veins are dilated large veins while spider veins are small veins.
• Varicose veins occur commonly on legs while spider veins occur on the face.
• Spider veins are localized while varicosities can appear all along the legs.
• Venous incompetence is the cause for varicose veins while spider veins may be due to a hereditary defect of the vein wall.
• Varicose veins do not show a clear genetic link while some types of telangiectasia are hereditary.