Varicose veins and spider veins can be diagnosed and treated by different types of doctors, so it’s important to understand the training backgrounds and capabilities of vein care specialists.
Specialists that diagnose and treat varicose veins and spider veins include:
- Vascular surgeons
- Interventional radiologists
- Phlebologists
- Dermatologists and Dermatologic Surgeons
Experience level and treatment options can vary by specialist. It is recommended to ask about the specialist’s credentials before your visit to see if their practice is right for your condition.
Vascular Surgeon — Specialist in Treating Vascular Conditions
Vascular surgeons provide comprehensive care for disorders of the vascular system, which includes arteries, veins and capillaries. They also treat conditions of the lymphatic system, which is the network of organs and tissues that help the body eliminate toxins.
According to the Society for Vascular Surgery, a doctor may become a vascular surgeon through additional specialty training after completing a general surgical certification process. They may alternatively seek a direct vascular surgery certification through a training process that combines both core surgical training as well as specialized vascular surgical training in one program.
According to the Society for Vascular Surgery, as well as the American Board of Surgery, vascular surgeons have advanced knowledge and expertise in diagnosing vascular conditions using non-invasive methods, including imaging techniques like duplex ultrasound, MRI, CT scanning and angiography. They are well equipped to understand the complexities of vascular conditions and provide comprehensive and in-depth treatment for chronic venous disease.
Vascular surgeons offer both minimally-invasive endovascular treatments, as well as more invasive surgical treatments, so symptoms that may indicate more complex vascular disorders requiring significant care can be evaluated and addressed with the most appropriate techniques.
Vascular surgeons can diagnose and treat varicose veins, as well as more serious conditions of the vascular system. According to the UCSF Division of Vascular & Endovascular surgery, varicose veins and spider veins are not always a cosmetic concern, and may sometimes be indicative of more serious conditions or lead to complications like blood clots or skin ulcers. This means that a vascular surgeon’s expertise can offer valuable insight into these conditions to address them in a comprehensive manner. In addition to short-term treatments, vascular surgeons may also build long-term relationships with patients that require dedicated management of their vascular conditions.
Interventional Radiologist – Imaging Specialist for Minimally Invasive Treatments
Interventional radiologists, sometimes known as ‘pinhole surgeons,’ are doctors who specialize in using X-rays, MRI, ultrasound and other types of imaging techniques to provide minimally invasive treatments for many types of diseases in nearly all organ and tissue systems. Historically, interventional radiologists have been pioneers of minimally invasive treatments that deliver localized care to diseased areas of the body without disrupting or damaging surrounding tissue.
Interventional radiology, also known as surgical radiology, is a subspecialty of the radiology discipline. According to guidelines described by the Society of Interventional Radiology, a diagnostic radiologist may further specialize in interventional radiology by completing 1-2 years of additional training. A doctor may alternatively complete a certification process that combines both diagnostic and interventional radiology training in one program.
Interventional radiology uses imaging technology to visualize parts of the body as a treatment is delivered. This use of imaging allows them to insert small tubes, known as catheters, wires, sheaths and needles into arteries, veins, or similar ducts to deliver localized treatment to a diseased area. Such treatments may include stenting, where a small tube is used to keep a passageway like an artery open, or chemoembolization, where cancer fighting drugs are delivered directly to a tumor. According the Society of Interventional Radiology, many other treatments for a wide variety of conditions can be delivered using these techniques, and these minimally invasive treatments often only require small incisions in the skin and offer short recovery time.
Because Interventional radiologists can visualize conditions in the body with imaging techniques while simultaneously delivering treatments, they are well equipped to diagnose and treat varicose veins and spider veins, as well as other venous complications.
Dermatologist and Dermatologic Surgeon - Skin Specialist
Dermatologists specialize in diagnosing and treating nail, hair and skin conditions, which can include varicose veins and spider veins. Dermatologists focus on procedures and techniques to improve both the health and appearance of the skin.
Dermatologic surgeons are specialists within dermatology and receive at least three years of additional training compared to dermatologists. They are able to offer more complex surgical treatments for a wide variety of skin conditions. According to the American Society for Dermatologic Surgery, dermatologic surgeons are leaders in the development and practice of treatments for conditions like skin cancer, aging and sun-damaged skin, scars, hair loss, unwanted body fat and varicose veins.
A dermatologist is capable of treating the appearance of varicose veins and spider veins, even if they are diagnosed as medically insignificant and just a cosmetic issue. Superficial light based treatments such as Intense Pulse Light Therapy, also known as IPL or photorejuvenation, may be used to treat small varicose veins or spider veins by heating and destroying the problem vein.
Phlebologist — Vein Disorder Specialist
A phlebologist is a doctor that specializes in the diagnosis and treatment of venous disorders. Phlebologists usually have a medical background in vascular disorders, dermatology or hematology.
Physicians of varying medical backgrounds with sufficient experience in treating venous disorders can become certified phlebologists by passing a written examination administered by the American Board of Venous & Lymphatic Medicine. The exam helps to ensure the physician’s competency in diagnosing venous diseases and syndromes, use of imaging tools such as duplex ultrasound, and treatments of venous conditions. Because phlebology certification is acquired after a doctor’s standard medical training, experience level and skill can vary significantly depending on the doctor’s medical background and commitment to continuing medical education.
Phlebologists are capable of treating varicose veins and spider veins with various techniques. Because a phlebologist’s experience level can vary greatly based on their medical background, it is recommended to consult your phlebologist directly to know what diagnostic methods they use, the treatments they are skilled in administering, and if their practice is appropriate for the condition you are seeking treatment for.
Treatment Options for Varicose Veins and Spider Veins
There are many treatment options available for varicose veins and spider veins, so it’s important to understand what each procedure involves, and what type of physician is capable of administering these treatments.
Sclerotherapy is a minimally invasive outpatient procedure used to treat superficial varicose veins and spider veins. A detergent-like solution called a sclerosant is injected into the problem vein, causing it to collapse, scar and eventually be absorbed by the body. This causes blood to reroute to healthy nearby veins.
Foam sclerotherapy is a newer version of this treatment, where a foaming sclerosant is used instead of a traditional liquid one. The foaming sclerosant more easily coats the inside of the vein, making the treatment more effective. According to the Mayo Clinic, the treated vein will fade in roughly two weeks to one month, and sometimes multiple treatment sessions are necessary.
Ultrasound guided sclerotherapy allows the treating physician to image veins that are not readily visibile throught the surface of the skin and apply the sclerotherapy to these deeper veins.
Sclerotherapy is a common treatment for varicose veins and spider veins, and may be appropriate for cosmetic as well as more medically necessary reasons. Sclerotherapy is offered by all vein specialists.
Endovenous thermal ablation is a minimally invasive treatment for backwards blood flow in the vein, called venous reflux. This helps treat varicose veins in the leg. The procedure works by inserting a long and narrow tube called a catheter into the great saphenous vein, which is the longest vein of the body and runs inside the legs. The end of the catheter has an element that heats the vein from the inside, causing it to shrink and collapse.
This treatment can be done with either endovenous laser ablation (ELA) which uses a laser to heat the vein, or endovenous radiofrequency ablation which uses radiofrequency emissions to heat the vein.
Endovenous thermal ablation of the great saphenous vein is not always necessary if the varicose veins or spider veins in question are not symptomatic of more serious venous reflux or other venous disease. It is recommended to consult with your vein specialist to decide if this treatment is correct for you. Endovenous thermal ablation is a minimally invasive technique, and is commonly offered by all vein specialists.
Ligation and stripping is an invasive method to treat varicose veins by removing them surgically. The procedure is now considered outdated and inferior to endovenous thermal ablation due to risks of vein reoccurrence, scarring and an extended, painful recovery time. This treatment is unlikely to be prescribed unless the vein being treated is too large or tortuous (twisted) for other treatments.
Ambulatory phlebectomy, also known as microphlebectomy, is a technique used to remove superficial varicose veins and reticular veins. A series of small incisions is made in the skin and the problem vein is clamped and pulled out with a small hook-like tool.
Transilluminated power phlebectomy is a newer advancement in phlebectomy where a thin, lighted probe is inserted underneath the vein being removed, allowing the physician to better see and treat deeper veins.
A vascular surgeon or dermatologic surgeon will commonly perform a phlebectomy in combination with ablation techniques or sclerotherapy to more completely treat an area of problem veins that are at varying levels of depth. Other vein specialists may offer this treatment as well depending on their medical experience performing the procedure.
Intense Pulse Light Therapy, also known as IPL or photorejuvenation can be used to treat spider veins. A wand like device is used to shine light on the effected area, which targets heat on the problem vein, causing it to shrink and be absorbed by the body. There are many different manufacturers of IPL devices that operate at different power levels, light wavelengths and are advertised as ‘beauty-grade’ or ‘medical-grade,’ although regulation in this terminology is lax. Efficacy of this treatment can vary, and side effects can include unwanted pigmentation issues in the skin.
Dermatologists and dermatologic surgeons are likely to prescribe this treatment, as it is most effective in treating cosmetic issues of the skin.
