Patients sometimes ask about the various visits and tests they will need to go through to treat varicose veins. If you are a new patient looking for a doctor to evaluate your legs, here is the process. Most vein doctors will roughly follow the same procedure.


The initial visit can reveal important factors that may affect your treatment. The doctor will physically exam your legs and ask you a series of questions. How long have you had these veins? How are the symptoms affecting your life?  Do you have restless legs at night or heaviness at the end of the day? Do you experience itching over the veins? Do you experience pain and pressure after exercise or during your menstrual cycle? Is there a family history of varicose veins?  Do compression stockings make your symptoms better?

Some people have very serious symptoms from their veins such as ulcers, discoloration on the legs, or swelling. Other patients may have small spider veins which don’t cause many symptoms. If the symptoms and the exam warrant further evaluation, then typically a venous ultrasound is ordered.


The primary cause of varicose veins is venous insufficiency. This condition refers to veins that do not transport blood effectively back to the heart. The increase in pressure can cause aching fatigue, swelling, and varicose veins. Interestingly, sometimes people have venous insufficiency even without these symptoms.

Venous insufficiency is diagnosed using ultrasound. An ultrasound is a simple painless procedure where an ultrasonographer uses a machine to view the veins inside your leg, map them out, and take measurements. It will show how the blood is flowing in your veins, and whether or not they have venous insufficiency. The ultrasonographer looks for backflow (also called “reflux”). The ultrasonographer can measure the severity of the backflow, and the vein vein itself. This allows us to determine which therapies, if any, are required for each patient.


After an ultrasound, your doctor will discuss options. No two patients are alike. Often, the treatment plan can be slightly different for each patient. The San Francisco Vein Center provides multiple options, from sclerotherapy to minimally invasive venous closure (laser, radiofrequency, or adhesive). We also are capable of a full range of surgery or endovascular options if needed. Depending on your individual vein anatomy, your doctor may offer you various treatment options:


If your ultrasound determines that you do not have venous insufficiency, but you have spider veins on your legs, you may just need sclerotherapy. This is a simple treatment for spider veins using tiny injections. It is done in the office. Usually patients experience some mild “stinging” pain which does not last long.  Sclerotherapy works well for small veins. In order to have the best results, patients need to wear compression stockings faithfully for 2-3 weeks after each treatment. Also, multiple sessions can be necessary to achieve the best results.

Compression Stockings

Most patients with venous insufficiency benefit from good compression stockings. These stockings help to decrease pressure in the superficial veins, and redirect more flow into the deep veins in the leg. This usually helps the venous system function better. Stockings also help decrease swelling and can effectively heal ulcers. Venous insufficiency is a mechanical problem of poorly functioning veins and compression stockings are primarily a mechanical treatment. Compression stockings are also a requirement by most insurance companies in order to get authorization for a vein closure procedure.

Vein Closure

Patients who have venous insufficiency will typically need treatment. There are different types of treatments. Your doctor will choose the best treatment for you depending on your individual conditions and vein anatomy. However, most vein treatments do essentially the same thing. They close the vein with failing valves. This allows your body to use alternative healthy deep veins to return blood to the heart. This procedure is typically done in the office. In rare circumstances, it needs to be done in the operating room. Be sure to choose a vein doctor who is a surgeon so they have both options available to them.


Follow up is important after a vein closure procedure. The follow up should be scheduled in less than a week after your procedure. it allows your doctor to verify to verify that the veins treated have been adequately closed and that there are no blood clots in the deep veins. Deep vein thrombosis (or DVT) is a complication of this procedure that occurs in about 1% of patients, and can be treated with a blood thinner. It is rare, but it is imperative that every patient have a postoperative check to assure that there is no evidence of this clot.

Once this follow up is finished, our protocol is to see patients one or two months afterwards to see if any additional sclerotherapy is needed to treat smaller spider veins. Sometimes this spider vein treatment is paid for by insurance companies, if ablation procedures were required.


We work very hard to make sure we get proper insurance authorization for our surgeries and procedures! This a moving target and insurance companies are not always consistent. We are good at knowing what information each insurance company requires. This allows us to get the proper documentation to them in a timely fashion and avoid unnecessary. long waits. We advocate for our patients in order to get them the treatment they need.