Symptomatic (or merely unsightly) venulectasias and telangiectasia on the lower extremities occur in 29% to 41% of woman and 6% to 15% of men in the United States. These smaller veins are most commonly indirectly or directly connected to larger reticular or varicose feeding veins. 53% of these patients experience associated symptoms. If not treated early this issue will inevitably lead to progressive worsening or superficial venous valvular insufficiency, eventually leading to deep venous valvular insufficiency
Varicose veins most likely lead to the development of telangiectasia either through associated venous hypertension with resulting angiogenesis or vascular dilation and/or through an associated increased distensibility of the telangiectatic vein wall. Although telangiectasia associated with varicose veins may appear at first as erythematic streaks, over time they turn blue. Often they are directly associated with underlying varicose veins so that the distinction between telangiectasia and varicose veins become blurred. Multiple studies using Doppler and duplex ultrasound examinations have demonstrated that telangiectasia is associated with underlying reticular veins.
Leg telangiectasia may be associated with underlying venous disease even when no obvious reticular or varicose veins are present. Duplex imaging or venous Doppler study revealed the 23% of patients without clinically apparent varicose veins demonstrated incompetence of the superficial venous system. The abnormal legs, however, show a very high incidence, (>74%) of incompetence of superficial venous system, mainly sapheno-femoral incompetence.
These statistics demonstrate the need for a clinical or non-invasive diagnostic work up in patient with telangiectatic leg veins and reinforces the view that “spider leg veins” arise from underlying varicose veins via venous hypertension, thus leading to the release or activation of vasoactive substance with resultant capillary or venular neogenesis (angiogenesis).