The gold standard therapy for spider and small varicose veins is still sclerotherapy. Sclerotherapy irritates the inside of the vessel with a solution called a sclerosant, which is typically made of hypertonic saline, sodium tetradecyl sulphate (STS), or polidocanol.
The latest technology is when STS or polidocanol are mixed with air or carbon dioxide for Foam Sclerotherapy.
Foam Sclerotherapy can be done with ultrasound guidance to make sure the sclerosant solution is within the desired vessel. These treatments can be mildly to moderately uncomfortable, and it takes a few treatments, performed one month apart, for best results.
The sclerosant solution irritates the vessel, and then the body resorbs the damaged vessel and removes it. When the body breaks down the blood vessel, hemosiderin, an insoluble form of tissue storage iron, is often released, causing a reddish brown discoloration that can last for months.
It is best to treat these vessels in the winter in case of any hyperpigmentation to allow time for it to fade before shorts and bathing suit season. Other minor complications can include bruising, discomfort, infection, or inflammation, which is very rare.