Exams and Tests

The most important tools in diagnosing varicose veins are the physical examination and medical history. Varicose veins are typically diagnosed based on their appearance, and no other special tests are needed to confirm the diagnosis.

• The medical history will include questions about any vein problems, serious leg injuries, or leg ulcers you have had in the past, as well as any other risk factors you might have, including whether your family has a history of varicose veins. Talk to your doctor about any symptoms you are having (such as swelling, fatigue, or cramps in your legs) and what you have been doing to treat your symptoms, if anything.
• During the physical exam, the doctor will examine your legs and feet (or any other affected areas) for varicose veins. You will likely stand during this test. Varicose veins are usually easy to see. The doctor will also check your legs for tender areas, swelling, skin color changes, ulcers, and other signs of skin breakdown. To study the blood flow in your legs, the doctor may ask you to move your legs around in different positions.

If a problem with the deep veins or complications are suspected based on your symptoms and exam, other tests may be done.

Duplex Doppler ultrasound is the most commonly used noninvasive test that can help your doctor study blood flow in your leg veins.

An ultrasound might be done if you are considering having a procedure to treat varicose veins.

Treatment Overview

The goals of varicose vein treatment are to reduce symptoms and prevent complications. For some, the goal may be improved appearance. Home treatment—such as exercising and wearing compression stockings—is the first and often best approach.

If home treatment does not help, there are procedures or a surgery that can treat varicose veins. These include:

• Sclerotherapy. A chemical (sclerosant) is injected into a varicose vein to damage and scar the inside lining of the vein, causing the vein to close. This usually works best for small veins.
• Laser treatment. Laser energy is used to scar and destroy varicose veins. This is called ablation.
  • Simple laser therapy is done on small veins close to the skin, such as spider veins. The laser is used outside of your skin.
  • Endovenous laser therapy uses a laser fiber inserted into the vein. Laser ablation inside the vein makes the vein close up.
• Radiofrequency treatment. Radiofrequency energy (instead of laser energy) is used inside a vein to scar and close it off. It can be used to close off a large varicose vein in the leg.
• Phlebectomy. Several tiny cuts are made in the skin through which the varicosed vein is removed.
• Ligation and stripping. Incisions are made over the varicose veins, and the vein is tied off (ligated) and removed (stripped).

Treatment may be needed to remove the damaged veins, treat complications, or correct an underlying problem that is causing the varicose veins. The size of your varicose veins affects your treatment options. Generally, larger varicose veins are treated with ligation and stripping, laser treatment, or radiofrequency treatment. In some cases, a combination of treatments may work best. Smaller varicose veins and spider veins are usually treated with sclerotherapy or laser therapy on your skin.

Some people may want to improve how their legs look, even though their varicose veins are not causing other problems. In these cases, a procedure or surgery may be appropriate—as long as there are no other health problems that make these treatments risky. For more information, see:

Varicose Veins: Should I Have a Surgical Procedure?

What To Think About

If you are thinking about having a vein treatment, you may want to know which treatment is best for you. No single approach is best for treating all varicose veins. Talk to your doctor about your choices.

If you are considering a surgery or procedure, consider some questions about treatment. These questions might include: How much experience does the doctor have with the particular treatment? How much do the exam and treatment cost?

All treatment methods—including all types of surgery, sclerotherapy, laser, and radiofrequency ablation—can scar or discolor the skin.

Treatment can be more difficult for deep veins that are damaged or for perforating veins, which connect the deep and superficial veins. These veins may be treated with surgery, radiofrequency ablation, or sclerotherapy, or a combination of these treatments.