If complications develop or symptoms become more severe despite home treatment, it may be necessary to medically treat or surgically remove the damaged veins. The course of treatment depends on the size and type of vein and the severity of the disease.

The following are procedures for small varicose veins and spider veins...

Sclerotherapy
Sclerotherapy is a nonsurgical treatment for varicose veins that involves injecting a saline or detergent-like solution into the vein, causing the lining of the vein wall to swell, stick together and ultimately seal shut. Once the vein is sealed, the flow of blood is stopped and scar tissue develops in the vein. With the diseased vein sealed, blood is forced into healthier veins. The treated vein is absorbed and eventually becomes nearly invisible. Sclerotherapy may need to be performed multiple times over the course of weeks or months to achieve the desired results.

Sclerotherapy is commonly used to treat small veins or to improve the appearance of larger veins after more invasive corrective surgery. The American Academy of Dermatology states that most patients will experience a 50%-90% improvement in the appearance of varicose veins if the procedure is performed correctly. The procedure is minimally invasive, does not require anesthesia and can be performed in a doctor's office.

Side effects of sclerotherapy may include mild stinging, bruising, and rashes around the injection site. These symptoms usually disappear. Additionally, the vein could become infected, inflamed or lumps of coagulated blood may develop. These symptoms are not dangerous and can usually be decreased by applying heat, taking aspirin or antibiotics to relieve inflammation or by draining the coagulated blood.

If sclerotherapy is performed strictly for cosmetic purposes, the procedure will likely not be covered by insurance. However, treatment may be covered if medically necessary.

Laser Surgery
Laser surgery can be used to destroy spider veins and small varicose veins by sending a very strong beam of light through the skin onto the vein, making the vein slowly disappear. There are no needles or incisions. Patient discomfort is limited to a small pinch when the laser hits the skin. This can usually be soothed by cooling the skin prior to and after the 15-20 minute procedure. Side effects are minimal and include some redness and swelling of the skin that disappears within a few days. Patients may also notice some skin discoloration for a week or two after treatment. Most veins require two to five treatments to achieve the desired results.

Phlebectomy
Medium-sized and larger varicose veins can be removed by a procedure called stab avulsion or phlebectomy. This procedure can be performed using local or general anesthesia. Small stab incisions are made in the skin to allow a tool to be placed through the skin to hook the vein and pull it out through the skin incision. The vein is then pulled until it breaks, causing the varicose vein to be removed in pieces. This process is repeated until all targeted varicose veins have been eliminated. Common side effects may include pain, bruising, hematoma, and bleeding.