Varicose veins are swollen, enlarged vessels, typically appearing blue or purple beneath the skin, most often in the legs. This condition arises due to faulty one-way valves inside the veins, which allow blood to pool and cause the vein to bulge and twist, leading to venous insufficiency. While often viewed as cosmetic, varicose veins can cause discomfort, aching, and heaviness, and untreated, they can lead to serious complications like skin ulcers. Effective treatment requires a specialist in vascular health to diagnose the underlying cause and select the appropriate intervention.
The Core Specialists
Three primary types of physicians possess the specialized training necessary to manage the full spectrum of varicose vein disease. Vascular surgeons have extensive experience in treating the entire circulatory system, including arteries, veins, and lymphatic vessels. Their training involves a rigorous general surgery residency followed by a vascular surgery fellowship, preparing them for both open surgical procedures and minimally invasive techniques.
Phlebologists are physicians dedicated solely to the diagnosis and treatment of vein disorders, such as varicose veins and chronic venous insufficiency. They often come from various medical backgrounds but have undergone specific training in phlebology and may hold dedicated certification.
Interventional radiologists represent a third group, specializing in performing minimally invasive, image-guided procedures using tools like X-rays, CT scans, and ultrasound. Their expertise lies in catheter-based treatments, allowing them to precisely target and treat vascular issues from within the blood vessels.
Initial Assessment and Diagnosis
The initial consultation includes a detailed patient history and a physical examination to assess the location and severity of visible veins and any associated symptoms. The specialist looks for signs of chronic venous insufficiency, such as skin changes, swelling, or ulcers. The most informative diagnostic tool is the Duplex Ultrasound, also referred to as vascular mapping. This non-invasive technique visualizes blood flow and the structure of the veins in real-time. The Duplex scan determines which valves are incompetent and maps the exact path of the veins requiring treatment, which is necessary for planning a precise intervention.
Spectrum of Treatment Options
The majority of modern varicose vein treatments are minimally invasive, having largely replaced traditional open surgery. Thermal ablation, including Endovenous Laser Treatment (EVLT) and Radiofrequency Ablation (RFA), is a common first-line approach for larger, underlying veins. Both procedures involve inserting a thin catheter into the faulty vein under ultrasound guidance to deliver heat energy, which causes the vein wall to collapse and seal shut. Vascular surgeons and interventional radiologists frequently perform these thermal techniques.
Sclerotherapy involves injecting a solution, called a sclerosant, directly into the vein to irritate the vessel lining and cause it to scar and close. For larger veins, the sclerosant is often mixed with air to create a foam, which displaces the blood more effectively and maximizes contact with the vein wall. Phlebologists commonly utilize both liquid and foam sclerotherapy for smaller veins and branch varicosities, often to complement a primary ablation procedure.
Newer non-thermal, non-tumescent (NTNT) methods, such as Mechanochemical Ablation (MOCA) and cyanoacrylate adhesive closure (vein glue), offer alternatives that do not require the extensive local anesthesia used in thermal procedures. MOCA combines a mechanical scraping of the vein lining with a liquid sclerosant, while the adhesive technique uses a medical-grade glue to seal the vessel, eliminating the risk of heat-related nerve damage.
Traditional surgical ligation and stripping, which involves physically tying off and removing the main faulty vein, is now reserved for very severe or complex cases. This older method is more invasive, requires a longer recovery time, and has a higher recurrence rate compared to contemporary endovenous treatments. Specialists with a surgical background, like vascular surgeons, perform the limited number of open procedures still necessary.
Choosing a Qualified Practitioner
Selecting a practitioner should focus on their specific qualifications and experience with the full range of modern venous procedures. Confirming board certification in a relevant specialty, such as Vascular Surgery or Interventional Radiology, indicates a high level of training in vascular disease management. Physicians specializing solely in veins may also hold certification from bodies focused on venous and lymphatic medicine, demonstrating dedicated expertise in phlebology. During the initial consultation, patients should inquire about the specialist’s experience with the specific procedure recommended for their condition. It is helpful to ask how many times they have performed a particular treatment, such as RFA or cyanoacrylate closure, and what their facility’s accreditation status is.