Mark Whiteley, MS, FRCS, MBBS

A bulging vein around the ankle should always be investigated with a venous duplex ultrasound scan to find out exactly what is going on. However, as a general principle if the vein is horizontal and going across the ankle bone on the outer side of the leg, then it is often associated with varicose veins.

On the other hand if it is vertical and in front of the bone on the inside of the leg, then it might be the bottom of the great saphenous vein. However, most people would not term this as "across the ankle".

As with all veins in the legs, you should never have any treatment without a venous duplex ultrasound scan performed by a specialist vascular technologist who works within a specialist venous practice. This will show you whether the vein that you are concerned about is merely the only problem, which is uncommon if it is bulging, or if it is part of a varicose vein or "hidden varicose vein" pattern of problems.

With best wishes

I agree with many of the contributors that sclerotherapy should not be used in these areas. There are several papers now showing that this can be dangerous when injected in veins close to the eyes. If the veins are small and green/blue then endovenous laser can be used.

However over the last few years we have developed some techniques of performing phlebectomy under local anaesthetic and have recently removed a large vein from the side of the eye and going over the upper eyelid.

This is not a simple phlebectomy technique but one we have developed at the Whiteley Clinics and we are currently writing the technique up for the scientific journals.

Before thinking about how to treat the blue veins you see on the legs, you should be thinking about why are they there.
No doctor or nurse, no matter how clever, can tell that by simply looking at your legs or looking at a picture.

You need to have a venous duplex ultrasound scan performed by a specialist vascular technologist who does nothing but venous duplex ultrasound scans. This will tell you whether you have underlying venous reflux causing the veins.

In the majority of patients with visible veins on the surface, there will be underlying venous reflux causing increased pressure making the surface veins more visible.

Treatment then starts by treating the underlying veins first and seeing if the surface veins are still causing a problem. Sometimes they go as part of that treatment.

If you have the underlying veins treated successfully, and the surface veins are still present, that is when you can decide how to treat them. Treatment such as foam sclerotherapy, micro-sclerotherapy and even phlebectomy can be successful depending on how big the veins are, how deep they are, where they are and how thick the wall is on ultrasound.

At Whiteley clinics, we often treat the underlying veins first and then use a combination approach to give the optimal result-a process directed by the Whiteley protocol, and based on science.

There are a couple of answers to your question.
Firstly, research has shown that leg spider veins (telangiectasia) are different from spider veins above the heart on the face.
Because these leg veins are below the heart, they are affected by gravity. 

Published research has shown that 89% of patients with leg spider veins actually have underlying varicose veins. Therefore to make sure you have the best treatment for the spider veins, any vein specialist who is up-to-date with the research would recommend a high resolution venous duplex ultrasound scan first, and fixing any underlying venous reflux (hidden varicose veins) before trying to treat any spider veins on the surface.

The second point is that experience around the world from phlebologist's who deal only with veins shows that the optimal treatment for leg spider veins is Microsclerotherapy rather than laser. Laser on the surface of the leg has a high chance of burning the skin if turned up to the powers required to get rid of the leg spider veins.

There are a few new techniques such as CLACS that suggest a combination of sclerotherapy and laser. However, when you get away from aesthetic practitioners who treat face thread veins similar to leg thread veins and look at the top vein units around the world, the approach is always look for the underlying problem first with venous duplex ultrasound scan, treat that first and then use Microsclerotherapy for thread veins on the surface.