Varicose veins are swollen, twisted vessels that appear beneath the skin, most often in the legs. They develop when one-way valves inside the vessels weaken or become damaged, allowing blood to pool instead of flowing efficiently toward the heart. This condition, which can cause pain, aching, and cosmetic concern, is known medically as chronic venous insufficiency.
Vascular Surgeons and Phlebologists
The two specialists traditionally associated with the most comprehensive management of vein disease are vascular surgeons and phlebologists. Vascular surgeons complete extensive training focusing on the entire circulatory system, including both arteries and veins. This broad expertise qualifies them to handle the full range of vascular conditions, from simple varicose veins to complex cases requiring surgical intervention. They are trained in both traditional open surgery and modern, minimally invasive techniques.
Phlebologists focus exclusively on the diagnosis and treatment of vein disorders, such as chronic venous insufficiency, varicose veins, and spider veins. Phlebology, also known as venous and lymphatic medicine, is a dedicated subspecialty. Although not recognized as a primary specialty by the American Board of Medical Specialties (ABMS), physicians can achieve certification through the American Board of Venous and Lymphatic Medicine (ABVLM).
Specialists Focused on Minimally Invasive Procedures
Other specialists play a role in modern varicose vein treatment, especially those specializing in image-guided procedures. Interventional Radiologists (IRs) are experts in using medical imaging, like ultrasound, to guide catheters and instruments inside the body. This expertise makes them highly skilled in procedures such as Endovenous Laser Ablation (EVLA) and Radiofrequency Ablation (RFA). These outpatient methods involve inserting a catheter into the faulty vein and using heat energy to seal it shut, allowing blood to reroute through healthy veins.
Thermal ablation techniques are often performed under local anesthesia and result in minimal downtime, which is an advantage over traditional surgery. The IR’s proficiency in real-time imaging ensures precise placement of the treatment device. Some dermatologists also treat vein issues, but their focus is on smaller, more superficial cosmetic veins, such as spider veins. They commonly use non-thermal methods like sclerotherapy, which involves injecting a solution that causes the vein to scar and fade away.
Selecting the Right Vein Specialist
When choosing a specialist, patients should focus on specific training, certifications, and experience in venous disease rather than the doctor’s initial medical title. Board certification is a strong indicator of specialized knowledge, either in a recognized field like Vascular Surgery or Interventional Radiology, or by the ABVLM. Certification as a Registered Physician in Vascular Interpretation (RPVI) is also desirable, as this demonstrates expertise in performing and interpreting the duplex ultrasound necessary for accurate diagnosis.
It is beneficial to choose a doctor who makes vein treatment a primary focus of their practice, ensuring they have more experience with the necessary procedures. Patients should ask how many endovenous procedures the specialist performs per week to gauge their expertise. Furthermore, a qualified clinic should utilize up-to-date technology and ensure the doctor is directly involved in the diagnostic ultrasound exam, as this is the foundational step for a successful treatment plan.