What’s the Difference Between Varicose Veins and Spider Veins?

It’s normal to see some veins under the surface of your skin, especially if you have a fairer complexion. But if you have veins that are more noticeable or bothersome, you may have signs of varicose veins or spider veins. These veins appear when blood leaks back into the lower part of the vein as a result of an abnormal valve in the vein. As blood flows backward, it can get stuck and cause the vein pressure to build, leading to swelling in the vein walls and a larger appearance.

Varicose and spider veins can appear anytime throughout life and are most commonly found on the legs. While both are often harmless, varicose veins can be a symptom of an underlying problem. Knowing the difference between the two can help you determine when to seek care.

What do varicose and spider veins look like?

Both spider and varicose veins are enlarged veins visible under the skin. Varicose veins are larger, with a rope-like appearance. They may bulge if you’ve been standing for a long time and appear blue or purple in color. Varicose veins often appear on the calf, the back of the leg, or near the ankles and feet.

Spider veins appear finer and branch out from a central point, almost like tree branches or a spider web. They’re more superficial, which means they’re closer to the skin’s surface. Spider veins can be red, blue, or purple. Like varicose veins, spider veins are common on the legs. They can also appear on the face. 

How are varicose vein symptoms different from spider veins?

Many people with varicose and spider veins are generally unbothered by them, except for their cosmetic appearance. For others, severe varicose veins may cause pain where the veins bulge, swelling in the legs, and an overall feeling of heaviness. In addition, varicose veins that are caused by chronic venous insufficiency can experience skin changes or damage, including venous leg ulcers, which can appear darker in color and hard to the touch.

The majority of patients with spider veins won’t have symptoms aside from their visibility. However, if you feel itching or cramping near where the veins are visible, it’s a good idea to see a doctor to rule out potential underlying medical conditions.

What causes varicose and spider veins?

Veins have an important job of circulating blood through the body. Small valves in our veins help pump that blood forward towards the heart. However, increased pressure in the lower extremity veins can cause those valves to weaken. When valves can no longer function properly, blood can pool, increasing the pressure in the veins and weakening the vein walls. This causes them to swell and become visible through the skin. 

Both varicose and spider veins are caused by the same type of damage, but spider veins appear smaller because the damage occurs in smaller blood vessels. 

Who is likely to develop them?

Both men and women can develop varicose and spider veins, although it’s more common in women because of hormonal changes that occur during pregnancy and menopause. Other risk factors for varicose and spider veins may include:

• Family history and genetics

• Obesity, which puts extra pressure on the legs

• Age, as the small valves in the veins are more likely to weaken over time

• Prolonged standing or sitting
  

When should I seek care for spider or varicose veins?

In many cases, mild varicose or spider veins that don’t cause uncomfortable symptoms or affect your quality of life don’t necessarily need treatment. Often, there are things you can do at home to improve blood circulation in the legs, such as wearing compression stockings or elevating your legs.

However, if you are bothered by the appearance of your varicose or spider veins, or you are experiencing pain, swelling, or leg wounds that won’t heal, you should talk to a vascular surgeon. Vascular surgeons are experts in venous treatment as well as identifying any other underlying causes that may be contributing to your varicose veins, such as chronic venous insufficiency, which requires medical treatment. Talking to a vascular expert is important for ruling out any potential complications and understanding all of your treatment options. 

What are my spider and varicose vein treatment options?

At your first appointment with a MedStar Health vascular surgeon, your doctor will ask you questions about your medical history, symptoms, and your lifestyle, including how much of your day involves standing or sitting. Our goal is to understand how your veins are affecting your daily life so we can recommend individualized treatment options that will address your specific needs and goals.

We’ll also conduct a physical exam to look at the surface of your skin and the veins. Perhaps most importantly, we’ll also evaluate any signs of an underlying problem, like arterial disease that could be linked to your symptoms. That’s one of the major benefits of seeing a vascular surgeon. Because we specialize in all diseases of the vascular system, we’re trained to recognize and treat any cause of vascular disease in the legs—or elsewhere in the body.

Most patients with varicose veins will undergo an ultrasound in the office so we can look for any backwards flow of blood in the veins. We’ll review your test results and treatment options so we can come up with a plan together. Ultimately, spider veins and varicose veins don’t go away on their own, and there are many things we can do to treat them, including:

• Lifestyle changes: Our vascular surgeons will often recommend conservative treatment options first to see how you can manage symptoms in the least invasive approach. For example, wearing the right size compression stockings can help to provide external pressure on the veins. This helps to minimize symptoms, although they won’t make them disappear. In addition, incorporating more movement into your day can help if you are otherwise sedentary or stationary. Getting up every 30 minutes can help to improve blood flow in the legs. In addition, achieving and maintaining a healthy weight can help to alleviate some of the pressure that was contributing to the venous swelling.

• In-office procedures: There are a variety of procedures we can perform in an office visit to improve or eliminate the appearance of varicose and spider veins. These may include laser therapy (endovenous thermal ablation) or chemical ablation (sclerotherapy), commonly called injection therapy.

• Surgical options: Vein surgery options include tying off veins, stripping the vein, removing the vein, or pulling out the vein in pieces. These procedures are performed in an operating room or outpatient surgery center.

After treatment, some patients experience relief right away. Others may have some soreness, bruising, or mild swelling. We encourage our patients to wear compression stockings after any procedure and to move around. Most patients fully recover in less than one week.

What can I do to avoid varicose and spider veins?

Compression stockings, staying active, and maintaining a healthy weight can help to prevent venous insufficiency and lower your risk of varicose or spider veins. However, some people are just prone to them. 

Varicose and spider veins share many similarities, and it’s possible to have both at the same time. The good news is that most of the time, they aren’t dangerous. But if yours are bothersome, painful, or causing signs of complications, our vascular surgeons are here for you. Seeing a surgeon doesn't necessarily mean you have to have surgery. The depth and breadth of our expertise ensures you can feel confident that we can identify any underlying conditions and recommend the right treatment options, tailored to your specific needs and preferences.
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