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Varicose veins are a common problem and affects nearly 25% of the US population.  Most affected individuals are essentially asymptomatic and do not need to pursue any specific treatments. Instead, simple wellness measures including exercise, compression stockings, leg elevation when appropriate and smoking cessation.  However, for those with symptoms including leg pain, leg heaviness, itchy or discolored skin, and restless legs that are affecting their quality of life despite conservative measures, a vein evaluation is recommended. The goal is to find not only what kind of doctor do you see for varicose veins, but a vascular specialist that does it really well.  The best vein doctors will help you manage your symptoms and offer treatment alternatives that match your symptoms and can be done without disruption to your normal routine.  So let’s begin with some advice on selecting which doctor is best for you from your internet search:

Be certain that your vein doctor is board-certified and “trained” in vascular treatments.  So this goes beyond a piece of paper indicating completion of some test , but also informs you that the vein specialist completed a formal residency or fellowship in endovascular treatments. 

Vein evaluation is a must!  If you have no symptoms but are concerned about cosmetics, you do not need endovascular treatments.  Vein ablation is best suited to manage symptoms of venous insufficiency.  Receiving unnecessary treatments is not to your advantage and instead focus should be on cosmetic treatments available including laser or cosmetic sclerotherapy.

If you are having treatment for venous insufficiency, the most advanced techniques are endovascular ablation, foam sclerotherapy, and venaseal.  In some cases, MOCA or mechanochemical ablation can also be considered. Stripping is an older technique and is no longer the preferred or best treatment for underlying vein disease.  It has a higher level of complications and is less effective

Phlebectomy is still very useful for large protruding veins that are not suitable for ablation or sclerotherapy.  In fact, treating large protuberant veins with sclerotherapy can lead to longer healing periods with sometimes long lasting cosmetic skin discoloration.  Phlebectomy is a fast and efficient tool to eliminate large varicose veins without any large incisions. 

The above factors focus on being certain on the qualifications of your vein doctor and the breadth of their skills to offer various treatment solutions tailored to your symptoms, anatomy, and vein presentation.  The other qualities are more abstract and are the individual feeling you get about your interaction with the staff and vein specialist.   Being given appropriate time and patience to your questions and concerns reflects on how much value the vein clinic places on the individuals care.   We often see high volume centers in multiple settings that emphasize getting as many tasks done in one day, rather than focusing on quality. If you feel less than satisfied with the interactions, it’s very reasonable to consider a different vein clinic even if you have to travel extra miles.   Just remember if you can’t get the time and answers to your questions, what is the likelihood you will see the time and commitment given to your vein treatment. Getting high level care is difficult because the experience of a vein doctor is so variable and due to financial constraints, many clinics today are trying to fit as many cases in a limited daily schedule.  Something has to give and that generally is quality. The final results will make the extra commute worthwhile and that level of expertise can only be delivered by the very best vein clinics committed to continuing education, investment into new technology, and you the patient for time.


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