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VARICOSE VEINS, VENOUS FLARES, SPIDER VEINS, THREAD VEINS, TELANGIECTASIA.
These are all disorders where veins of differing size become dilated and more distended than usual. The term varicose vein is usually used for veins greater than 4mm in diameter that have become raised and lumpy in the leg when standing. Smaller vessels visible under the skin but not actually raised are referred to by many names; spider veins, thread veins, reticular veins, venous flares and telangiectasia.
VARICOSE VEINS
This occurs when the superficial veins become dilated and irregular (see picture). There are several reasons for this occurring.

1. Inherited vein wall weakness
2. Faulty valves
3. Prolonged standing (occupational)
4. Raised venous pressure and hormonal effects in pregnancy
5. More common as we get older
6. After damage to the deep veins of the leg (ie DVT)
Once "varicose" the valves in the superficial veins do not work and the flow follows gravity, down the leg when standing (see diagrams) This is why the pain and swelling due to varicose veins is often worse after standing or at the end of the day.
VENOUS FLARES, SPIDER VEINS, THREAD VEINS, TELANGIECTASIA
Small veins under the skin may become more visible than normal. There are two reasons for this, either the veins are more dilated and prominent than normal or the skin and underlying supporting tissue around the veins becomes thinner and weaker.

If the veins appear because they are more dilated than normal then there may be more pressure in the veins caused by abnormal larger veins. For example, the above spider/thread veins are often seen in patients with varicose veins. It is important therefore that the function of the larger veins in the leg is assessed before local treatment is given to the small skin veins.

The problem may however be due to thin skin and weak supporting tissue. The veins themselves may not be abnormal, but appear more prominent than usual. In this situation local treatment is more appropriate.