Superficial varicosities are the result of high-pressure flow into a normally low-pressure system. Varicosities carrying retrograde flow are hemodynamically harmful because they cause recirculation of oxygen-poor, lactate-laden venous blood back into an already congested extremity. The primary goal of treatment is the ablation of these reflux pathways with resulting improvement of venous circulation.
In the rare setting of deep system obstruction, varicosities are hemodynamically helpful because they provide a bypass pathway for venous return. Hemodynamically helpful varices must not be removed or sclerosed. This condition is encountered rarely, but when it is, ablation of these varicosities causes rapid onset of pain and swelling of the extremity, eventually followed by the development of new varicose bypass pathways.
Sclerotherapy, laser and intense-pulsed-light therapy, radiofrequency (RF) or laser ablation,  and ambulatory phlebectomy are the modern techniques used to ablate varicosities. Numerous reports describe success rates of greater than 90% for less invasive techniques, which are associated with fewer complications, with comparable efficacy.
Local treatment of the superficial manifestations of venous insufficiency is unsuccessful if the underlying high points of reflux have not been found and treated. Even when the patient appears to have only primary telangiectasias and the initial treatment seems to be successful, recurrences are observed very quickly if unrecognized reflux exists in larger subsurface vessels.
Missing the diagnosis of superficial truncal incompetence can cause significant complications (especially skin staining and telangiectatic matting) if spider veins and superficial tributaries are treated while high-pressure feeders remain open.
Food and Drug Administration (FDA) approval of drug labeling is an important concern for physicians and patients in the United States. Polidocanol is approved by the FDA
Approximately 23% of adults in the United States have varicose veins. This figure rises to 80% for men and 85% for women if reticular veins and spider telangiectasias are included