Circle of Care

What to expect when you seek treatment for varicose and spider veins

Over 80 million Americans have varicose veins or spider veins. Fortunately, patients can now turn to newer, minimally invasive procedures that allow these troublesome veins to be eradicated, without turning to out-dated vein stripping procedures. These treatments can all be performed in the privacy of a doctor’s office and with minimal downtime. With more and more centers offering care for these troublesome leg veins, how do you know you are receiving the most effective, comprehensive treatment available? Today’s state of the art, vein-dedicated facilities should offer a strict “5-Step Circle of Care” plan to all of their patients.

Step 1: Initial Consultation — Every patient’s condition is unique and requires a thorough evaluation prior to initiating a treatment plan. For this reason, we offer an initial complimentary* vein screening to evaluate each patient’s condition prior to beginning treatment. This allows the physician to recommend a customized treatment protocol for varicose veins, spider veins or both. For patients, this takes the guesswork out of how their situation needs to be treated without incurring costs to obtain that information. Patients can receive a full explanation of which procedures are considered cosmetic and which procedures are fully covered by their insurance carrier.

Step 2: Ultrasound Evaluation/Interpretation — Ultrasound is the single most important tool used to diagnose your vein problems and recommend the appropriate therapy. It is a mandatory initial step for every patient. No advice regarding leg vein treatment should be dispensed without this simple, painless and non-invasive test. In addition, the person performing and interpreting the test should have the appropriate credentials. Your sonographer should hold the RVT (Registered Vascular Technician) certification, which is the gold standard for persons performing your exam. The physician who evaluates the ultrasound exam should be a qualified vein specialist, who holds an RVT, RPVI or RPhS certification. This ensures that they have the deep and broad knowledge of your venous system that will yield the most accurate assessment of the underlying cause of your vein disease.

Step 3: Discussion of Comprehensive Treatment Plan — Vein-dedicated facilities treat the root of the problem rather than just the surface abnormalities. No two patients are alike and all require a customized approach, which should be comprehensive and clearly explained. Your doctor should be knowledgeable and able to answer any questions that you may have. Vein specialists are usually board certified in general surgery, but also, more importantly, in Vascular Surgery and Phlebology. They should also hold the title of being a Diplomat of the American Board of Phlebology (ABPh) and be a Fellow of the American College of Surgeons (FACS). To find out more about your doctor’s credentials, visit the American Board of Surgery at or the American College of Phlebology at

You don’t want to be in a position of having this important work done to your body without the ability to ask questions freely – and be completely satisfied with the answers you receive. Also, make sure your doctor is the one performing your procedure. Some doctors delegate various follow-up treatments to ancillary personnel. 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.

Step 4: Treatment Options — You’ll want to be sure that you are offered all the latest and most up-to-date treatments available for vein conditions, and that your surgeon has successfully treated many patients before you. Treatment options vary. Most patients shy away from treatment as they are most familiar with outdated stripping procedures that were painful and came with a prolonged convalescence. Recent advances in vein treatment now offer patients an easier alternative:

  • Varicose veins: Most patients will have underlying venous insufficiency detected on ultrasound examination. Endovenous Laser Therapy (EVLT) or Endovenous Laser Ablation (EVLA) and /or VNUS Closure should be available to correct this.
  • Spider veins: VeinGogh and/or Veinwave technology coupled with a combination of ultrasound-guided foam 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.

Step Five: Post-Treatment Evaluation — During your post-treatment evaluation, your treated veins will be evaluated and the physician will determine if additional procedures are needed. Once your varicose veins have been successfully treated, you can begin treatment for your spider veins, if necessary. If present, it is important to treat the underlying varicose veins first, to ensure the most optimal results.

*Additional diagnostic ultrasound testing may be required, which will be billed to your insurance carrier.

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