Frequently Asked Questions

Dr. Joan L. Warren, M.D. answers your most commonly asked questions about vein disease and treatment. Click on a question to learn more.

Phlebologist: Vein Treatment Specialist

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.

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

Types of Vein Disease

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.


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. They may be red, purple, or blue and most often appear on the legs and face. Spider Veins are generally not painful and can be treated cosmetically.

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

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.

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.

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

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.

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.

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.


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

Ultrasound Guided Sclerotherapy
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?

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.

Yes, for a time. 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

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.