Varicose veins are a common condition where superficial veins, most often in the legs, become swollen, enlarged, and twisted. This occurs when tiny one-way valves inside the veins weaken or are damaged, causing blood to flow backward and pool, which increases pressure and stretches the vein wall. While often viewed as cosmetic, varicose veins can cause symptoms like aching, heaviness, and swelling, requiring professional medical evaluation. Determining the right specialist can be confusing due to the variety of medical professionals involved in vein care.
Starting the Treatment Journey
The process of seeking treatment typically begins with your Primary Care Physician (PCP). Your PCP performs the initial physical examination, assesses symptoms, and reviews your medical history to rule out other causes for leg pain or swelling. They often manage initial, conservative treatments such as recommending regular exercise, leg elevation, and the use of compression stockings.
If symptoms persist, your PCP will usually issue a referral to a specialist. The definitive diagnostic tool is the Duplex Ultrasound. This non-invasive test uses sound waves to create a real-time image of the veins, allowing the specialist to visualize blood flow and accurately assess the function of the vein valves. The ultrasound results determine the extent of the venous disease and guide the selection of the appropriate specialist for treatment.
Key Specialists Who Treat Varicose Veins
The most qualified practitioners for treating varicose veins fall into three distinct specialties. A Vascular Surgeon is a physician trained in the diagnosis and surgical management of all diseases affecting the arteries and veins throughout the body. Their expertise includes both open surgical procedures and minimally invasive endovascular techniques, equipping them to handle complex cases, including those requiring traditional vein removal.
Interventional Radiologists (IRs) are specialists who use advanced imaging guidance, such as ultrasound and X-rays, to perform minimally invasive procedures. They focus on catheter-based treatments, using tiny instruments inserted through small incisions to treat diseased veins from the inside. This makes them skilled in performing image-guided thermal ablation procedures, which are standard care for many varicose vein issues.
A Phlebologist is a physician dedicated specifically to the diagnosis and treatment of vein disorders. While they are experts in venous disease, they may have a primary board certification in another field, such as Internal Medicine or Dermatology. When seeking a Phlebologist, look for certification from recognized bodies, such as the American Board of Venous and Lymphatic Medicine, which demonstrates focused expertise in vein care.
Understanding Common Treatment Options
Current treatments for varicose veins are primarily minimally invasive, designed to close off the faulty vein so blood is redirected to healthier pathways. Endovenous Ablation, using either radiofrequency (RFA) or laser energy (EVLA), is a common first-line treatment for larger veins. A thin catheter is inserted into the abnormal vein under ultrasound guidance. The energy heats the vein wall, causing it to collapse, seal shut, and eventually scar down.
For smaller varicose veins and spider veins, Sclerotherapy is the typical treatment method. This involves injecting a liquid or foamed chemical solution, known as a sclerosant, directly into the vein. The sclerosant irritates the inner lining of the blood vessel, causing inflammation that makes the vein walls stick together and close.
Surgical Ligation and Stripping is generally reserved for cases where veins are extremely large, twisted, or when minimally invasive techniques have not been successful. This surgery involves tying off the affected vein at its junction with a deep vein, followed by the physical removal, or “stripping,” of the diseased segment through small incisions. While more invasive, it may be necessary for severe venous disease.
Making the Final Selection
When choosing a specialist, the most important factor is the physician’s specific training and experience with the required procedure, not the title. For complex venous disease, a physician with a recognized board certification in an ABMS (American Board of Medical Specialties) field, such as a Vascular Surgeon or an Interventional Radiologist, offers the broadest spectrum of diagnostic and treatment capabilities. These specialists are trained to manage potential complications and address underlying vascular issues.
You should inquire about the specialist’s experience with the specific procedure recommended, such as the number of endovenous ablations performed annually. The severity and location of your varicose veins will dictate the best treatment. Select a provider who is experienced, board-certified, offers all relevant options, and with whom you feel comfortable.