Frequently Asked Questions

Dr. Joan L. Warren, M.D. answers our patient’s most commonly asked questions about vein disease and treatment. Click on the questions to view.


Phlebologist: Vein Treatment Specialist

What is Phlebology?

Phlebology is the study of and the body of knowledge concerning the totality of venous disease.

What is a Phlebologist?

A Phlebologist is a physician who specializes in the diagnosis and treatment of vein disorders. Phlebologists must first become qualified medical doctors then undergo specialized post-graduate training in the field of vascular medicine to be certified.

What do Phlebologists do?

Phlebologists use vascular ultrasound, a non-invasive, painless test to accurately diagnose and manage all types of venous disease.


Types of Vein Disease

What are Varicose Veins?

Varicose Veins are veins that become abnormally swollen and twisted due to increased pressure. They are the result of a chronic condition symptomatic of underlying venous insufficiency. Left untreated, venous insufficiency, can produce tissue congestion, edema, and eventual impairment of tissue nutrition resulting in stasis and ulcers. Varicose Veins are sometimes bluish in color, protrude from the surface of the skin, and usually appear on legs and ankles.

What's the difference between Spider Veins and Varicose Veins?

Spider Veins and Varicose Veins are similar in causes but different in the way they appear.

Varicose Veins are the result of a diseased valve within the vein that does not fully close to stop blood in the vein from flowing in the wrong direction, resulting in large, distended veins in the legs. These veins are often purple or blue in color and can cause pain, numbness and fatigue in the legs. In advanced cases, Varicose Veins can cause leg ulcers (Venous Ulcers).

Spider Veins are clusters of tiny blood vessels that look like spider webs or tree branches that are very close to the surface of your skin. Spider Veins are generally not painful and can be treated cosmetically.

What are Spider Veins?

Spider Veins are small, twisted blood vessels that are visible through the skin. They may be red, purple, or blue and most often appear on the legs and face.

What causes Spider and Varicose Veins?

Healthy veins carry blood to the heart through a series of one-way valves. These valves allow blood to flow in the right direction from superficial veins to deeper veins and to the heart. In addition, these vessels are surrounded by muscles, which contract and help pump blood back to the heart. Normally, veins have a one-way valve to prevent back-flow.

If a vein has a defective valve, blood flows backwards and pools inside the vein causing pressure within the vein, weakening the walls. An inherited weakness of the vein wall (genetic) and circulation hormones that relax the smooth muscle of the vein wall are the most common causes. Females have high levels of such a hormone, called progesterone. Pregnancies, hormone replacement therapy, use of oral contraceptives as well as advancing age and occupations requiring a standing position are additional aggravators of varicose vein disease.

How are tiny Spider Veins treated?

There are now machines that use a hair-thin, insulated probe to thermocoagulate and instantly eliminate vessels on any skin type and on any part of the body. One of these machines is called the VeinGogh, requiring no anesthesia. Frequently this is used in combination with sclerotherapy and/or lasers to eliminate facial or chest spider veins.

What are the symptoms of Varicose Vein Disease?

Affected areas may have aching, cramping, throbbing, burning, tingling, itching, heaviness, and/or fatigue. Inflamed veins will be tender and sometimes warm to touch. More advanced disease can cause swelling, skin thickening, discoloration and ulcerations around the foot and ankle.

What is a Venous Skin Ulcer?

An ulcer caused by venous reflux is called a “venous stasis ulcer”. Early signs that a venous stasis ulcer may develop include a darkening of the skin in the area of the ankle. Gradually the skin may become leathery or waxy in appearance. Without treatment of the venous disease, the skin may breakdown and bleeding may occur.


Treatments for Vein Disease

What is a Duplex Ultrasound examination?

Duplex Ultrasound is a pain-free, non invasive test for a phlebologist to see the anatomy and check the flow characteristics of the veins beneath your skin. Useful information is then gathered and used to adequately diagnose your specific vein problem and to plan and guide treatment.

What is laser sealing of veins?

Laser is light energy, which can be used to seal shut abnormal main superficial trunk veins, (GSV/SSV/AASV veins being most commonly diseased). Heat energy is used inside of these veins. When sealing the GSV (abnormal in 70% of people with varicose veins), usually treatment starts at a location in the vein around the knee. It is then treated from its junction to the deep system at the level of the groin down to the entry site near the knee. Ultrasound guided injections may be used to complete the closure of the GSV below the insertion site if also diseased.

What is Sclerotherapy?

Sclerotherapy is the treatment of varicose veins by injection of the veins with chemicals that cause their destruction. Spider veins generally disappear in three to six weeks, while larger varicose veins may take three to four months to respond. Many patients who have this treatment for cosmetic reasons also notice their legs feeling less tired and heavy especially at the end of the day.

Is sclerotherapy safe?

The majority of patients have no complications from sclerotherapy. Some patients can develop changes in skin pigment in veins injected. This is usually a temporary side effect with 90% of this “staining” disappearing after 1 year and 98% after 2 years. Less commonly, patients can develop new, superficial tiny blood vessels in previous areas injected. This “matting” usually dissipates over time if all sources of reflux have been eliminated surrounding the involved area. Serious complications such as skin ulcerations, anaphylaxis (allergy) to sclerosant, deep vein clots, and unintentional arterial injections are extremely rare.

This procedure requires a high degree of technical skill and special training to get the best results with fewest amount of complications.

What is Visual Sclerotherapy vs. Ultrasound Guided Sclerotherapy?

Visual sclerotherapy refers to injection of surface veins that are visible to the naked eye.

Ultrasound Guided Sclerotherapy is used to treat veins that are below the surface of the skin. These veins cannot be injected safely without assistance from an ultrasound image of the vein.


What Happens After Treatment

How will the blood in my veins get back to my heart after all the abnormal veins are removed or destroyed?

The backward flow of blood in varicose veins and main superficial trunk veins, (greater saphenous vein- GSV, small saphenous vein- SSV, anterior accessory saphenous vein-AASV), actually interferes with the normal venous return of blood. Removal of these areas of abnormal circulation actually improves circulation of blood in the treated leg. It is this improvement in limb circulation that causes improvement of symptoms of tiredness and heaviness in the limb.

Why can’t I just have the branches injected or removed if the main superficial trunk is abnormal?

For the treatment of visible veins to last awhile, the source that may not be visible to the naked eye must be controlled as well. Some insurance carriers will not pay for treatment of branch varicosities if an abnormal main trunk is not treated at the same time or before the branches are treated.

Why wear compression stockings?

Gradient compression stockings are used to prevent Deep Vein Thrombosis (DVT), during long plane flights and car/bus rides. This is especially important for people with varicose vein disease because they may have an increase risk for getting DVT. They can also temporarily reverse the effects of vein disease by lessening the discomfort, heaviness, swelling, and skin changes. They do this by improving blood flow back to the heart especially during leg muscle contractions.

Many insurance companies require a trial of compression stockings before approving other more definitive therapies. Compression stockings are also used to prevent and treat ulcerations caused from chronic venous insufficiency and in some patients with a DVT to hasten its resolution and prevent complications.


Prevention: What You Can Do

Is there anything I can do to prevent spider/varicose veins?

Getting plenty of exercise is the best way to ward off spider or varicose veins. Exercise helps keep your weight under control and your leg muscles toned, so your blood flows freely. Avoid sitting and standing still for long periods of time. If your job prevents frequent walking, stretch your leg muscles often to increase circulation.

Can I be cured of my varicose veins?

Varicose veins are a problem that can be successfully treated but the disorder cannot be permanently cured. The treatment of abnormal veins does not remove the original tendency of a patient to develop varicose veins. Therefore, many patients need “maintenance” treatments after their initial treatment is completed.