Objective: To perform a comprehensive evaluation of sclerotherapy outcomes in patients with reticular varicose veins (C1 according to CEAP) using both objective digital analysis and subjective patient assessment, comparing the efficacy and tolerability of ozone sclerobliteration and the traditional polidocanol method.

Materials and Methods: This prospective comparative study included 70 patients (two equal groups of 35 each) with chronic venous disease classified as C1 (telangiectasias and reticular veins). Group 1 underwent ozone sclerobliteration using an ozone-oxygen mixture (ozone concentration 70 µg/mL), while Group 2 received conventional microsclerotherapy with 0.5% polidocanol. The objective dynamics of the vascular network were assessed using the author-developed digital photo-analysis software VesselAnalyzerPRO, which provides automatic vein segmentation and calculation of the affected area before treatment and 30 days after sclerotherapy. At the 30-day follow-up, patients were also surveyed using a dedicated questionnaire that included five parameters for tolerability and one rating for the cosmetic outcome.

Results: Both techniques demonstrated comparable efficacy: the mean reduction in visible vein area was 78.4 ± 6.2% in the ozone group and 76.9 ± 6.8% in the polidocanol group (p > 0.05). Differences in subjective tolerability were minimal: the mean total tolerability score was 4.34 ± 0.96 in the ozone group and 4.49 ± 1.00 in the polidocanol group (p > 0.05), indicating equally high patient comfort. The cosmetic outcome, according to patient self-assessment, was significantly higher in the ozone group (2.57 ± 0.50 vs. 2.20 ± 0.62 points, p < 0.001). This difference was attributed to side effects observed only after polidocanol sclerotherapy: 7 patients (20%) developed transient hyperpigmentation and/or matting, while no such complications occurred after ozone sclerobliteration. The use of VesselAnalyzerPRO provided reproducible quantitative indicators and enabled an objective comparison of cosmetic outcomes.