Varicose veins are the sausage like veins that appear “above” the surface of the skin. This distinguishes them from the very fine spider veins that appear on the surface of the skin. Spider veins appear as fine purple, blue or red veins in a network sometimes looking like a “spiders web”. Varicose veins, if severe, can look like a bunch of grapes, particularly around the inside of the knee. Varicose veins are invariably associated with a deeper vein that is not working. This “incompetent” deeper vein has either faulty or absent one-way valves that results in back pressure down the vein and the subsequent appearance of varicose veins on the surface. Thus, varicose veins can be thought of as “escape routes” for the underlying back pressure.

Spider veins on the other hand rarely have any underlying incompetent veins but invariably are associated with larger surface veins with faulty valves. These “reticular” veins which are blue or green in appearance also have back pressure which then leads to the formation of spider veins (“telangiectasia”). Because of the association of varicose veins and spider veins with these “high pressure” feeder veins it is critical that these associated veins are treated for a satisfactory result to be obtained.