Anatomy of a Vein Center: What to Assess When Seeking Care for Your Veins

Updated on: February 2, 2017

More than 80 million people have varicose veins or spider veins. These conditions are often hereditary, but hormonal factors including puberty, pregnancy, menopause and the use of birth control pills can also play a role. Additional external factors may include age, leg injury, obesity, lack of exercise and prolonged sitting or standing.

Spider veins are small clusters of red, blue or purple veins that are commonly found on the calves, thighs and ankles. These annoying, unattractive veins are actually enlarged capillaries, which present as purplish or reddish lines or web-like discolorations.

Varicose veins are thick, blue, ropy veins that have lost their ability to circulate blood back to the heart causing it to pool in the legs. Healthy veins function using one-way valves that keep the blood moving in the right direction. Sometimes a vein may become incompetent, allowing blood to leak back down, away from the heart and lungs, and pool in the legs. This congestion can result in fatigue, swelling, throbbing, heaviness, aching and restlessness in the legs. In advanced cases, skin rash, pigmentation changes, inflammation, ulceration and bleeding may occur.

Treatment options vary. Most patients shy away from treatment as they are most familiar with outdated stripping procedures that were typically painful and came with a prolonged convalescence. Recent advances in vein treatment now offer patients easier, less painful alternatives. Procedures are now being performed in an office setting, with no general anesthesia and little or no downtime.

With all of these changes, patients have various options about where they can obtain treatment. Lately, there are a lot of physicians offering vein care as a supplement to their overall practice. Additionally, a multitude of “laser clinics” are cropping up offering basic vein treatments.

So how do you know you are getting the best advice and the most up-to-date vein treatments available? Here are some points to consider.

The Facility

Is the vein clinic focused exclusively on vein treatment?

In many practices, diverse mixes of patients are frequently lumped together in the same office. Even a vascular surgeon may see a variety of patients, and it’s inevitable that the more serious, arterial-related cases will take precedence over patients seeking treatment for varicose veins. This is why choosing a vein-dedicated practice is important. Vein patients generally present with more isolated problems. This allows specialized vein practices to run more efficiently with improved patient flow, shorter wait times and superior patient satisfaction.

Do the facilities look clean and professional?

Vein specialists generally do all their diagnostic testing and perform all of their procedures right in their vein clinics, so the appearance of the office can tell you a lot about the practice.

Are there RVT ultrasound technicians on-site?

RVT technicians are the most credentialed to perform ultrasound-guided diagnostics as part of the evaluation process.

Questions you will want to ask include: “How are my vein problems diagnosed?” and “Are you proceeding with treatment without a thorough Ultrasound?” Ultrasound evaluation of vein anatomy and physiology is mandatory, and any clinic that does not offer it is not providing a thorough evaluation.

Is the facility an ambulatory surgical center fully certified by the AAAASF and the AAAHC?

These organizations provide accreditation to out-patient surgical facilities with the goal of improving patient safety and quality of care.

The Physician

Are you satisfied with the vein doctor’s credentials?

Vein specialists are board certified in general surgery, but also more specifically in vascular surgeryand phlebology (a specialty in venous diseases). To find out more about your doctor’s certifications visit the American Board of Surgery at To find out more about your doctor’s specialty, visit the American College of Phlebology at

Does your doctor hold either an RPVI or RVT designation?

This designation shows that they are qualified to interpret ultrasound exams, which represent the single most important tool in diagnosing your vein problems. While many doctors may claim to be experts, only a qualified vein specialist has the deep and broad knowledge of your venous system that will yield the most accurate diagnosis and underlying causes of your varicose veins.

Most importantly, are you comfortable talking to the vein doctor?

Your doctor should be knowledgeable and able to answer any questions that you may have. You don’t want to be in the position of having this important work done to your body without feeling like you can ask as many questions as you like – and be completely satisfied with the answers you receive.

Is the doctor performing all of your treatments?

Some doctors delegate various follow-up treatments to nurses or technicians. Whether or not they are qualified, they may not be aware of your entire case and what exactly has been done up to that point. This can lead to poor follow-up and disjointed care.

Advanced Procedures

Does the clinic offer state-of-the-art laser procedures?

A qualified vein specialist has all the necessary equipment to treat your veins with exactly the right procedures tailored to your specific problem. Many part-time phlebologists offer only one or two modalities of therapy centered on sclerotherapy. You’ll want to be sure that any vein specialist you see offers a full range of the latest and most up-to-date treatments available for vein conditions, and that he or she has successfully treated many patients before you.

What procedures should a comprehensive vein clinic offer?

Varicose veins: EVLT or EVLA and VNUS Closure. Spider veins: Vein Gogh (as seen on The Doctors TV Show) and/or Veinwave technology coupled with a combination of ultrasound-guided sclerotherapy and VeinLite sclerotherapy containing FDA approved medications including both AscleraTM and SotradecolTM. Saline injections are relatively dated, not currently approved by the FDA for sclerotherapy, can be painful, and may lead to increased complications.


What affiliations should my doctor have?

All vein specialists should be affiliated with The American College of Phlebology, The American Venous Forum and be a Fellow of The American College of Surgeons. These memberships show a dedication to the field of Surgery and Phlebology that all patients should expect of their provider.

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