A physician will perform a complete physical examination and compile a thorough medical history. The patient will be asked about their symptoms and a list of current medications will be taken. The physician will also ask the patient about general health because people with certain conditions (e.g., circulatory problems, heart conditions, diabetes) may be advised against treatment.

During the physical exam, the physician will closely examine the legs or other areas where the veins are present. Occasionally, x-ray (low doses of electromagnetic radiation to create images on film paper or fluorescent screens) or ultrasound (high-frequency sound waves to create images of internal organs or tissue) may be used to assess vein disorders and the severity of the problem.

There are several options available for treating spider veins, and they are usually effective. The American Academy of Dermatology notes that treatment procedures have an 80 to 90 percent chance of improving the appearance of spider veins.

Support hosiery is often the first level of treatment recommended for patients with spider veins. This gently compresses the leg muscles, which helps veins move blood and keeps them from stretching. However, many patients with spider veins choose sclerotherapy, the chief method for treating both spider and varicose veins.

Sclerotherapy is a procedure that is relatively inexpensive, rarely results in scarring and has few adverse consequences. It is also relatively painless for most patients and requires no anesthesia. During the procedure, the physician uses a very fine needle to inject a dose of concentrated salt solution (saline) or a specially developed chemical solution into the spider vein. This irritates the lining of the vessel, causing it to swell and stick together. After the vein closes up or collapses, it turns into scar tissue that is absorbed by the body over a period of months. Blood that previously had traveled through the spider veins will shift to other nearby blood vessels. 

A dermatologist or a vascular surgeon can perform the procedure, usually on an outpatient basis. The type of physician used depends on the diameter of the blood vessel because treatment of larger vessels is associated with more complications (e.g., blood clots).  

In most cases, between one and three treatments are necessary to successfully treat a spider vein. Each session typically lasts between 15 and 45 minutes. Treatments are often scheduled between four and six weeks apart to allow for proper healing. Sometimes a number of larger veins can be injected during a single treatment session. In addition, any larger varicose veins that may be attached to spider veins will likely be treated at the same time.

Most patients experience few side effects from sclerotherapy. When they do occur, they are usually short-lived. Possible side effects include swelling, bruising, itching, redness, soreness and muscle cramps. Patients may also experience a stinging sensation at the injection sites.

Patients can resume normal activities immediately after a sclerotherapy session. However, they may be advised to avoid strenuous activities for the first 24 hours.

Other treatments that may be used to treat vein conditions such as spider veins include:

• Electrodesiccation. Electrical current is used to seal off veins.
  
  
• Laser surgery. Uses the heat of high-intensity light to selectively destroy abnormal veins.
  
  
• Surgical ligation and stripping. An incision is made in the skin and the damaged vein is either removed or tied off.
  
  
• Ambulatory phlebectomy. Veins are removed through a series of small incisions along the path of an enlarged vein.

In some cases, a physician may use a combination of these techniques to treat spider veins.

Spider veins that appear during pregnancy often disappear on their own without treatment within three months after the baby is delivered. For this reason, pregnant women are often encouraged to postpone treatment for spider veins. Women who are breastfeeding may also be instructed to postpone treatment until they cease nursing. This is due to the fact that physicians are unsure of the effect the solutions used during sclerotherapy will have on a nursing infant.

While treatment for spider veins is usually successful, there are certain side effects and risks associated with the procedure. These include:

• Allergic reaction. Allergic reactions (an exaggerated response of the immune system caused by a substance) to the solution used in sclerotherapy sometimes occur.
  
  
• Blood clots. Treatments sometimes can cause blood clots that may require further treatment.
  
  
• Pigmentation changes. Brownish splotches may appear that can take several months to fade. This is the result of blood moving outside the blood vessel and depositing in the surrounding connective tissue when the vein is injected. Pigmentation changes do not occur with every injection but are more likely when numerous blood vessels are being treated.
  
  
• Scarring. Permanent scarring occasionally will occur as a result of these procedures.
  
  
• Telangiectatic matting. Fine reddish blood vessels (telangiectasia) may appear near the treated area. This can be treated with further injections.