Vein Specialists & Information on Phlebology

Phlebology deals with diseases of the veins. It encompasses the diagnosis and treatment of pathological changes in the venous system, particularly in the legs, such as varicose veins, spider veins, and thrombosis.

Vein specialists, or phlebologists, are typically specialists in

• dermatology (skin doctors),
• general practice,
• internal medicine, or
• surgery,

who have completed 1.5 years of specialized training. This qualifies them to use the additional designation “phlebology.”

Since symptoms of venous disorders often manifest on the skin, for many patients, a dermatologist or their general practitioner is the first point of contact. Phlebology clinics are often also dermatology clinics.

The spectrum of venous diseases is broad. Among other conditions, vein specialists treat the following venous disorders:

• Spider veins are small, net-like or fan-shaped veins located directly in the epidermis; while they generally do not indicate a medical condition, they are nonetheless a cosmetic concern for many people.
• In varicose veins, the venous valves in the leg veins no longer function properly, so blood is not adequately transported back to the heart. The accumulation of blood in the legs leads to the characteristic dilation of the veins.
• A thrombosis is the blockage of a vein by a blood clot.
• Ulcer cruris is colloquially referred to as an “open leg.” This is typically an open, weeping wound on the lower leg that does not heal over an extended period of time.
• In phlebitis (vein inflammation), the inflammation of the superficial veins is recognizable by painful, red, and warm strands. Since there is a risk of thrombosis, the patient should consult a phlebology specialist immediately.
• Chronic venous insufficiency is characterized by inadequate return of blood to the heart. This leads to changes in the veins and skin, and in advanced stages, to leg ulcers.

Spider veins appear as net-like lines on the skin @ Rung Kh /AdobeStock

Before treating venous disorders, phlebologists will conduct a thorough physical examination. Some venous conditions, such as spider veins, can be detected with the naked eye alone.

However, phlebologists may also need to use diagnostic imaging techniques. Typical procedures used by vein specialists to diagnose venous disorders include phlebography and Doppler/duplex ultrasound.

Phlebography is an X-ray examination of the veins. With the help of a contrast agent—which makes the blood in the vessels stand out more clearly from the surrounding tissue on the X-ray image—the vascular system can be visualized very clearly, allowing for the detection of absent or insufficient blood flow, thromboses, or dilations. Magnetic resonance imaging (MRI) can also be used instead of an X-ray examination.

In contrast, Doppler/duplex sonography is a specialized form of ultrasound examination that can be used to determine blood flow velocity and detect abnormal flow patterns. This, in turn, allows for the identification of insufficient blood flow or obstructions—such as thrombosis—that impede blood flow.

Depending on the condition, vein specialists have various options available for treating venous diseases, such as:

• In vein sclerotherapy, a medication is injected into the diseased vein (for example, in the case of varicose veins), causing the vessel to collapse.
• Vein stripping is considered the treatment of choice for varicose veins in the trunk veins. In this procedure, a probe is inserted into the veins, the abnormally dilated sections are severed, and the varicose veins are then pulled out (stripping).
• In radiofrequency ablation for varicose veins, a catheter probe is inserted into the affected vein. A high-frequency current then generates heat, which seals off the vein.
• In laser treatment, the varicose vein is closed off by an artificial thrombosis created with a laser.
• Compression therapy is often used as one of the first measures in the treatment of venous diseases, but also in conjunction with other procedures. In this method, external pressure is applied to the veins using bandages and stockings (so-called compression stockings). This causes the vessels to constrict and increases the blood flow velocity. Furthermore, wounds heal faster, edema is reduced, and thrombosis is prevented.

Compression stockings apply pressure to the veins, thereby relieving them @ tibanna79 /AdobeStock

It is not possible to designate a single clinic as the “best clinic” or “top clinic” for phlebology. However, there are certainly doctors and clinics that specialize in the treatment of venous diseases and have extensive experience. You can find these phlebology experts in the Leading Medicine Guide.

The Leading Medicine Guide features only select, highly qualified medical experts and specialists. All listed doctors possess a high level of professional expertise, have extensive experience in the field of phlebology, and meet the Leading Medicine Guide’s strict admission criteria.