Varicose Veins vs. Spider Veins: Which One is Worse and How Are They Treated?

Are your legs marked by visible vein damage? You’re not alone: About one in four adults (23%) in the United States have varicose veins, and at least four in five adults (80-85%) have smaller swollen reticular veins or tiny, sprawling spider veins.

No matter which of these vascular distortions appears on your lower extremities, our expert team at Advanced Vascular Surgery has a minimally invasive treatment solution to clear them from your skin and improve your circulation.   

Let’s take a closer look at the “spectrum” of lower extremity vein damage and disease, from underlying causes and risk factors to treatment options and prevention. 

Vein function: A short tutorial

Veins are low-pressure, low-velocity vessels that expand easily. They act as your body’s primary “blood reservoir,” holding about 70% of your blood supply; they also function to transport deoxygenated blood from your body and extremities back to your heart. 

Veins contain one-way valves that help the vast volume of blood circulate efficiently. Your lower extremity blood flow also gets a major assist from your leg muscles — when you’re physically active, your leg veins work better. 

When vein valves are damaged

Veins can’t keep blood flowing efficiently if their valves are weakened or damaged. As a result, blood repeatedly pools behind the impaired valves, straining the surrounding vessel wall and causing it to swell, twist, dilate, and distort — or become “varicose.”

Vein damage risk factors

Several risk factors make damaged, dilated leg veins more likely, including:

• Older age (over 50); close family history
• Too much sitting; excess body weight
• Frequent standing (working on your feet) 
• Female gender; multiple pregnancies

Vein damage is a form of venous disease that can happen with or without more extensive underlying venous disease. This means that vein distortions can result from chronic venous insufficiency (CVI), or their presence can eventually cause it. 

Venous disease is a spectrum

Essentially, venous disease occurs on a “severity spectrum,” with smaller spider veins (telangiectasias) and reticular veins on the mild end of the scale, and larger varicose veins (varicosities) on the moderate to severe end. 

Varicose veins

Varicose veins are distortions of larger surface veins that measure over 3 mm in diameter. They have a visibly swollen, raised appearance on the skin — much like a thick, knotty, twisted rope. They may throb, ache, or feel itchy (or have no symptoms at all).

Varicose veins can be mild, but they can also gradually progress to a more severe problem that causes worsening circulation and leg pain, swelling, heaviness, or fatigue.  

Spider veins 

Spider veins are flat, sprawling “telangiectasia webs” of small vessel clusters (capillaries, venules, and arterioles) that have become dilated. While a spider vein “lattice” can spread across a large area, each damaged vessel is smaller than 1 mm.    

By themselves, spider veins are just a cosmetic concern. They can, however, indicate the emergence of underlying venous disease, especially if they occur alongside reticular or dilated veins measuring 1-3 mm in diameter. These mid-sized “feeder” veins connect large subsurface veins to small surface capillaries. 

Expert vein clearance options

Mild varicose veins and virtually all spider veins are treated as solely a cosmetic concern, provided they aren’t causing symptoms (and most don’t). Bothersome varicose veins pose a greater potential threat to your circulatory health and are regarded as a medical issue. 

Conservative vein care

No matter where you land on the spectrum of vein damage, wearing fitted compression garments can help ease bothersome symptoms, slow (or stop) vein damage progression, and improve your circulation. You may also benefit from:

• Engaging in regular exercise 
• Losing excess body weight
• Quitting smoking or vaping 

It’s also important to avoid prolonged sitting or standing; frequent positional changes promote better blood flow and reduce venous pressure. 

Vein clearance treatments

Conservative care can stop vein damage progression and even help prevent the formation of new vein dilations, but it can’t make varicose veins or spider veins go away — or even improve their appearance.

Luckily, minimally invasive vein clearance treatments can. Our treatment approach is guided by vein diameter and severity:

Sclerotherapy

Spider veins, reticular veins, and small varicose veins are cleared with sclerotherapy. This treatment involves injecting the damaged vessels with a chemical agent that irritates their lining, causing it to collapse inward, seal shut, and gradually fade away. 

Endovenous laser therapy (EVLT)

EVLT treats mid-sized or larger varicose veins with targeted thermal energy. We make a tiny incision and thread a catheter through the damaged vessel using ultrasound guidance. The tip of the catheter emits controlled heat, which causes the vein to collapse as we withdraw it. 

Microphlebectomy

For very large varicose veins that cause persistent symptoms, we may recommend a minimally invasive surgical procedure called microphlebectomy, which uses a series of tiny “micro-incisions” to access and remove diseased veins in sections.

Ready to clear away vein damage?

Do you have visible vein damage you’d like to clear from your skin? We’re here to help. Schedule a vein evaluation at Advanced Vascular Surgery in Kalamazoo, Allegan, Battle Creek, Coldwater, Sturgis, or Three Rivers, Michigan, today.