Reticular veins are those deeper, darker veins that form bluish networks that crisscross over the thighs and lower legs. Like the saphenous veins, reticular veins are a normal part of venous anatomy. They are supposed to take venous blood from the skin and transport it to the deep veins in the leg, where it is pumped back to the heart by the calf muscle pump. Reticular veins carry blood to “perforator veins”, which are called that because they perforate the muscle fascia (or surface) to connect to the veins in the deep part of the leg. Reticular veins don’t have valves, but perforator veins do. When the valves in the perforator veins malfunction, it allows blood to flow in the wrong direction—from the deep portion to the surface of the leg.
Reticular veins can cause problems in two ways. First, they can themselves become enlarged, varicose, and unsightly. Second, they are usually the source of spiders veins. If you have spider veins, you will also have reticular veins feeding the spider veins—even if they are not visible. Attempts to treat spider veins without treating reticular veins frequently results in early recurrence of spider veins.
Far and away the best way to treat reticular veins is with sclerotherapy. It is possible to treat them by surgical means, but that will invariably result in unnecessary scaring. Surface laser should not be attempted to treat reticular veins, as doing so may result in permanent cosmetic disfigurement. Usually both ultrasound guided and surface sclerotherapy are required to obtain the best results.