Telangiectasias (aka spider veins, varicose veins, thread veins) are blood vessels typically less than 2mm in diameter and can be either blue (de-oxy) or red (oxy) in color. Since these veins are superficial and have no elastic membranes they are able to distend and double their volume when traumatized, thus we are able to destroy and achieve closure to the smallest of veins by using sclerotherapy injections. The following is a brief summary to these injections:

Even for smaller telangiectasias, a 30 gauge needle needs to be bent at a 20 degree angle with the bevel point up.
Begin treating telangiectasias after reticular veins have been successfully treated. Both telangiectasias and reticular veins can be treated in the same session.
Develop a two-handed technique, typically one hand is stretching the skin and supplying balance to the other hand during the injection.
Always lay the needle flat on the skin prior to the injection, this will make the injection less painful to the patient.
Advance needle while applying small amount of pressure to plunger, positive pressure on the syringe is necessary for the sclerosant to be absorbed by the vein while it distends.
Be sure to inject the entire vein segment, you need to be able to see the initial endothelial injury at the time of the injection and subsequently later by physical observation (vein is darker, irritated).
NO aspiration is necessary for telangiectasias.
Start from thigh and work down (proximal to distal) per quadrant of the leg. Assume that the veins are flowing in the direction of the heart, however they may also be flowing in the direction of gravity.
If you get a visible wheal, STOP injection! If you get wheals immediately on entering, you are injecting too forcefully.
Only arterioles can be injected around or below the ankles.
Treat telangiectasias and reticular veins in the same session will reduce the possibility of matting and/or staining associated with the injections.
Allow 4 weeks for complete resolution.

Remember, these injections are very superficial (<2mm in depth) and thin walled thus they are capable of distending to double their volume. These veins are above the fascial plane and are surrounded by loose connective tissue and it will be necessary to be trained on proper technique and post treatment care.

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