Varicose veins are a common vascular condition affecting millions, often causing physical discomfort and cosmetic concerns. These enlarged, twisted blood vessels typically appear just beneath the skin, most frequently in the legs and feet. They require specialized medical attention to diagnose the underlying cause and determine the most effective treatment. Understanding which medical professional to consult is the first step toward relief.
What Varicose Veins Are
Varicose veins develop when the one-way valves inside the veins become weak or damaged, a condition known as venous insufficiency. Healthy veins rely on these valves to ensure blood flows upward, against gravity, toward the heart. When the valves fail, blood flows backward and pools within the vein, causing it to stretch, enlarge, and twist into a bulging appearance.
This pooling of blood places increased pressure on the vein walls, which can lead to symptoms beyond the visible blue or purple veins. Patients often report an aching, heavy, or tired feeling in their legs, especially after long periods of standing or sitting. Common complaints also include throbbing, muscle cramping, and swelling in the lower legs and ankles. Symptomatic varicose veins are a medical condition that can progress if left untreated.
Medical Specialists Who Treat Varicose Veins
Varicose veins are treated by several types of specialists who focus on the vascular system. The appropriate specialist for a patient often depends on the severity of the vein disease and the type of treatment required. These physicians diagnose and treat disorders of the arteries, veins, and lymphatic vessels.
Vascular surgeons are highly trained specialists who offer comprehensive care for vein disease, including both surgical and non-surgical options. Their extensive training covers the entire circulatory system, meaning they are equipped to manage complex cases, including deep vein issues or arterial disease. They perform traditional open surgery as well as modern, minimally invasive procedures.
Phlebologists, often called vein specialists, are physicians dedicated exclusively to the diagnosis and treatment of venous disorders. These doctors may come from various medical backgrounds but have advanced training focused solely on conditions like chronic venous insufficiency, varicose veins, and spider veins. Their expertise lies in modern, office-based, minimally invasive treatments.
Interventional radiologists play a significant role in modern vein care. These doctors specialize in performing targeted, image-guided procedures, which is precisely how many contemporary vein treatments are delivered. They use imaging technology, such as ultrasound and X-rays, to navigate catheters and instruments inside the body to treat the diseased vein without large incisions.
How Doctors Diagnose Vein Disease
Diagnosis of vein disease begins with a physical examination, where the specialist inspects the legs while the patient is standing to observe visible varicose veins and check for swelling. The doctor also discusses the patient’s symptoms, medical history, and any family history of vein problems. While visible appearance suggests a diagnosis, confirming the underlying cause requires advanced imaging.
The primary diagnostic tool used to assess vein health is the Duplex Ultrasound, sometimes called a Doppler Ultrasound. This non-invasive test combines traditional ultrasound imaging, which provides a two-dimensional picture of the vein structure, with Doppler technology, which measures the direction and speed of blood flow. The Duplex Ultrasound allows the doctor to visualize the internal structure of the vein and identify malfunctioning valves.
The test reveals the precise location and extent of venous reflux, which is the backward flow of blood that causes the vein to swell. This detailed mapping of the venous system guides the specialist in creating a targeted treatment plan. By identifying the origin of the faulty valve, the doctor ensures treatment addresses the root cause of the varicose veins, not just the visible symptoms.
Modern Treatment Options
Modern treatments for varicose veins have largely moved away from invasive surgery toward effective, minimally invasive procedures requiring little downtime. These therapies focus on sealing off the diseased vein, causing blood to naturally reroute to healthy veins nearby and improving circulation. Most procedures are performed in an outpatient setting, allowing patients to return home the same day.
Sclerotherapy is a common, non-surgical treatment best suited for smaller varicose veins and spider veins. The procedure involves injecting a liquid or foam solution, known as a sclerosant, directly into the affected vein. This solution irritates the blood vessel lining, causing it to collapse, seal shut, and eventually fade away as the body reabsorbs the tissue.
For larger varicose veins, thermal ablation techniques like Endovenous Laser Ablation (EVLA) and Radiofrequency Ablation (RFA) are the preferred methods. In both EVLA and RFA, a thin catheter is inserted into the diseased vein, guided by ultrasound imaging. EVLA uses laser energy while RFA uses radiofrequency energy to heat the vein wall from the inside, causing it to collapse and permanently seal. These procedures have high success rates and allow patients to resume normal activities within a day or two.
Traditional surgical methods, such as vein ligation and stripping, are rarely performed today but are still reserved for the most severe or complex cases of vein disease. Ligation involves tying off the affected vein, and stripping is the physical removal of the entire vein through small incisions. Because of the effectiveness and minimal recovery time of ablation and sclerotherapy, these surgical options are now primarily historical procedures in the treatment of most varicose veins.