If the venous insufficiency is not treated, sclerotherapy results may be marginal at best or if they are successful, reticular and spider veins are at high risk of recurrence. It is not only important to check for truncal venous insufficiency but also look for and treat perforator venous insufficiency. The spider veins are the 'tip of the iceberg' as there is much much more disease below the skin - so treating the spider vein is only part of the treatment. The feeder veins, the perforator veins have to be treated for a successful outcome. This is an expensive endeavor in terms of time, resources, catheters, experience and money spent.