Spider veins (telangiectasia) - these are tiny vessels commonly found on the surface of the skin. The condition may be isolated to that level but more often the spider veins are fed by larger veins located just under the skin called reticular veins. Some spider veins may not be as benign as they appear. A cluster along the course of the saphenous vein or more commonly in the ankle area consisting of fine spider webs (corona phlebectatica paraplantaris) may be a sign of increased venous back pressure (stasis) in either the long or short saphenous vein. The condition should be treated aggressively since, if allowed to progress, may eventually lead to skin changes and ulceration.
Reticular (feeder) veins - are situated deeper in the skin and form a network throughout the body. They may be part of the "lateral subdermic venous plexus or network" commonly found in women on the outer thigh and which is often the source of spider veins in the area. Occasionally, they may become very enlarged and tortuous due to high pressure backflow through a communicating (perforator) vein from the deep system.
Facial, hand and breast veins - primarily due to genetic factors, unsightly veins can appear in other parts of the body with aging. These veins respond very well to sclerotherapy and usually no more than one or two sessions are required. Very large, dilated veins on the hands can also be eliminated with sclerotherapy or ambulatory phlebectomy using a very fine hook for extraction.
Pelvic and vulvar veins - these varicosities may arise during pregnancy with the associated dilatation of the veins in the pelvis and resultant backflow. Usually these vessels are of small to medium caliber and respond well to sclerotherapy. They must be injected as high as possible since their source lies deep in the pelvis. It is also for this reason that they are prone to recurrence. Very large pelvic veins (pelvic congestion syndrome) need to be investigated thoroughly with venography( vein x-rays) prior to embolization via catheter or surgical resection.