Varicose Veins and Spider Veins: Symptoms and Treatment

Medically Reviewed by Jabeen Begum, MD on May 10, 2023
7 min read

Varicose veins are large, raised, swollen blood vessels that twist and turn. They usually develop in the legs and can be seen through the skin. They result from a weakening in the blood vessel wall or from faulty valves. They can show up anywhere on the body but most often appear on the legs or pelvic area.

Spider veins are smaller, red, purple, and blue vessels that also twist and turn. Spider veins are easily visible through the skin, as well. They affect the capillaries, the body’s smallest blood vessels. Spider veins, which are red or blue, look like a spider’s web or tree branch. They are typically visible on the legs and face.

A number of things can put you at risk for varicose veins and spider veins. These include:

  • Heredity
  • Occupations that involve a lot of standing, such as nurses, hair stylists, teachers, and factory workers
  • Obesity
  • Hormonal influences of pregnancy, puberty, and menopause
  • The use of birth control pills
  • Postmenopausal hormone replacement
  • A history of blood clots
  • Conditions that cause increased pressure in the abdomen, such as tumors, constipation, and externally worn garments like girdles

Other reported causes include trauma or injury to the skin, previous vein surgery, and exposure to ultraviolet rays.

Varicose veins and spider veins develop more often in women than in men. They increase in frequency with age. An estimated 30% to 60% of adults have varicose veins or spider veins.

Many people with varicose veins complain of pain, described as an aching or cramping in the legs. Other common symptoms include tiredness, restlessness, burning, throbbing, tingling, or heaviness in the legs. Pain from these veins is usually relieved by elevating the legs or by wearing support hose, also called compression stockings.

In women, symptoms may be worse during certain parts of the menstrual cycle or during pregnancy. Less common is swelling, ulcers, and a darkening of the skin, especially in the ankle region. Occasionally, varicose veins can form a painful blood clot with inflammation of the vein, a condition called thrombophlebitis.


There are seven major treatments for varicose veins and spider veins:

1. Support (compression) stockings. The most conservative approach is simply to wear properly fitting support hose, especially when the veins cause pain or discomfort. They create gentle pressure in the leg. That keeps blood from pooling in veins and also helps with leg swelling. These stockings can generally be purchased at any surgical supply store and at some pharmacies. They come in below-the-knee, above-the-knee, and pantyhose styles.

2. Lifestyle changes. Good skin hygiene, weight loss (if needed), and walking can help treat varicose veins and spider veins. You can also try:

  • Not standing or sitting for long periods without taking a break
  • Not wearing high heels for long periods. Shoes with lower heels can help tone calf muscles and improve blood flow through the veins.
  • Elevating your legs while sitting, resting, or sleeping -- ideally, to a level above your heart
  • Not crossing your legs at your knees or ankles
  • Physical activities that move your legs, which will improve muscle tone

3. Sclerotherapy. This procedure can eliminate the pain and discomfort of varicose veins and prevent complications, such as ulcers or vein bleeding. It may also be used simply to improve appearance. Sclerotherapy uses a highly concentrated saline (salt) solution or a specially made detergent that is injected directly into the vein. The chemical irritates and scars the inside of the vein, making it collapse and causing the vein to disappear gradually over 3 to 6 weeks. It could take 6 months for larger veins to disappear.

During sclerotherapy treatments, you may feel small needle pricks as your doctor injects the veins. You can also experience temporary muscle cramping. Afterward, you’ll need to wear medical-grade compression stockings for a few weeks.

The procedure is simple, relatively inexpensive, and can be performed in an outpatient setting.

4. Endovenous laser ablation is a procedure in which a small laser fiber is inserted into the vein. Your doctor will make a tiny cut near the vein and put in a small catheter. A device at the tip of the catheter heats up the inside of the vessel. Pulses of laser light are delivered inside the vein, which causes the vein to collapse.

Endovenous ablation therapy is minimally invasive and generally safe and complication-free. There are, though, risks, including infection, damage to the blood vessel, inflammation of the vein, and, rarely, heat damage to nerves, although this typically goes away in a short time. In extremely rare cases, blood clots that form in the veins can travel to the lungs.

The procedure is done as an outpatient under local anesthesia.

5. Radiofrequency occlusion. A small catheter is inserted into the vein. The catheter delivers radiofrequency energy to the vein wall, causing it to heat, collapse, and seal shut. The procedure is generally done in an outpatient or office setting, sometimes under local anesthesia.

6. Surgery. Surgical techniques to treat varicose veins include ligation (tying off of a vein) and stripping (removal of a long segment of vein).  Traditional vein stripping and ligation involves tying veins shut and removing them through small cuts in your skin. The surgery takes 2-3 hours and is usually done in an outpatient setting. Full recovery takes 1-2 weeks.

Although vein stripping and ligation is generally safe, risks include infection at the incision site, bruising, or irritation of a nerve that runs by the veins that are stripped.

In endoscopic vein surgery, your doctor will make a small cut in your skin near the vein and use a tiny camera at the end of a thin tube to move through the vein. Then they will use a surgical device at the camera’s end to close the vein.

Another procedure, ambulatory phlebectomy, allows for the removal of large surface veins through very small incisions that do not need stitches. Surgery may be performed using local, spinal, or general anesthesia. Most patients return home the same day as the procedure. First, the doctor will outline or mark the vein to be removed, then inject local anesthesia into the skin. They will make a tiny cut and use a surgical instrument or a large needle to hook the vein through the opening. Next, they will remove the vein segment by segment. Afterward, you’ll need to wear compression stockings for at least 1 week.

An enhanced version called transilluminated power phlebectomy involves fewer cuts and less pain, bleeding, and scarring. Your doctor will insert a fiber optic light under your skin while at the same time injecting a saline and local anesthetic mixture. This makes a silhouette of the veins to guide placement of an instrument that cuts the vein into small pieces and suctions them out.

Surgery is generally used to treat large varicose veins, ones that become severe enough to cause skin ulcers or sores.

7. Lasers and intense pulsed light. Surface laser or intense pulsed light treatments, such as Vasculight and PhotoDerm, are other options. These devices use heat energy to selectively damage or destroy abnormal veins. An advantage of these treatments is that no needles or sclerosing solutions are required; however, there may be some minor discomfort. Side effects do occur, including discoloration or staining and blister formation.

For varicose veins to be treated successfully, several sessions may be required, usually at 6-week intervals. Laser therapy is most effective for small varicose veins and spider veins, but lasers are also used in endovenous ablation therapy to treat larger varicose veins. Doctors may also use laser therapy as an additional treatment after sclerotherapy, endovenous therapy, or surgery for larger varicose veins.

Intense pulsed light therapy (IPL) uses high-intensity pulsed light to shrink certain sizes of varicose veins and small spider veins. IPL differs from laser therapy, which uses a single emitted wavelength, by emitting a spectrum of light.  IPL may help when sclerotherapy or laser therapy don’t work.

Not everybody with varicose or spider veins has pain or other symptoms. They might want the veins removed, however, for cosmetic reasons.

Many insurance companies cover the cost of treating varicose veins, but generally not spider veins. The best approach is to check with your insurance company before considering treatment options.