top of page

Frequently Asked Questions:



Q: Is it important to have a board-certified physician to treat my veins?


A: Yes. Board certification is an indication that a doctor has devoted a tremendous amount of time and effort to demonstrate his or her skills in a specific area of medicine and passed a rigorous examination. Any doctor with a medical license can legally perform the vein treatments described on this website, regardless of how much training they have had in vein disease. However, only certain specialties of medicine are devoted to the treatment of vein disease. You can be sure that your doctor is a certified specialist in the diagnosis and treatment of vein disease if he or she is a board-certified Vascular Surgeon or a diplomate of the American Board of Venous and Lymphatic Medicine. Dr. Manley is certified by the later organization. You can find board-certified vein doctors in your area by visiting



Q. I had an ultrasound of my veins but I was not standing up for part of it, is that a good study?


A. No. The deep venous system is evaluated with the patient lying flat, but it is not possible to perform a proper examination of the superficial venous system unless the patient is vertical (standing) or almost vertical on a tilt table. If your venous ultrasound was done entirely with you lying down, it could not properly evaluate the superficial venous system that is where virtually all varicose veins originate.



Q. What causes varicose veins?


A. Patients frequently ask why they have varicose veins. This is a difficult question to answer because most of the time we just don’t know. There is clearly a hereditary factor that makes it more likely to develop varicose veins if one or more of your parents had the problem. For women, pregnancy is one of the main risk factors with varicose veins becoming more likely with each pregnancy. Other factors that may play a role in promoting varicose veins are obesity and long periods of standing or sitting. Sometimes a traumatic injury to a leg can cause varicose veins in that leg. It is not unusual for a patient to have severe vein disease in one leg and for the other leg to be normal.



Q. What does the term “varicose veins” mean?


A. The term “varicose veins” is both a medical term and a layman’s term. Medically speaking, the term “varicose veins” refers to abnormally dilated tributary veins that measure 3 mm or more in diameter. In lay usage, the term “varicose veins” is often used to refer to any visible veins on the legs, no matter what size the veins are. The medical terminology for all types of superficial venous disease is “venous insufficiency.”



Q. What does the term “spider veins” mean?


A. “Spider veins” is a lay term for relatively small visible or mildly bulging veins on the legs. The term is not a medical word. The medical terminology for visible surface veins that are less than 1 mm in diameter is telangiectasia and veins between 1 and 3 mm are called reticular veins.



Q. What is venous insufficiency?


A. Venous insufficiency is the medical diagnosis for patients with varicose veins. Venous insufficiency is the result of high blood pressure in the leg veins due to a failure of one or more of the one-way valves within the veins. There is no relationship between arterial hypertension (common hypertension) and venous hypertension (venous insufficiency).



Q. Can I have vein disease if my legs look normal?


A. Yes, it is possible to have completely clear skin with no outward signs of vein disease and still suffer from venous insufficiency. We sometimes see patients with symptoms of vein disease such as leg aching, heaviness, tiredness, itching, numbness, restless legs, etc. with significant saphenous vein reflux and clear skin. These patients need treatment and will get resolution of most of their symptoms. A venous ultrasound is needed to evaluate the deep and superficial venous systems to find out if these symptoms are due to vein disease.



Q. What are the symptoms of vein disease?


A. Common symptoms of vein disease (venous insufficiency or varicose veins) include leg pain/aching, burning, itching, tiredness, heaviness, or numbness. Other symptoms include restless leg syndrome, leg cramps, or ankle/leg swelling. Visible changes include bulging veins, brown or red pigmentation changes to the lower legs, rash on the legs, blue or black veins or discoloration of the ankles or feet, and thickening of the skin of the lower legs. The ultimate sign of vein disease is a venous ulcer (opening of the skin) in the lower leg.



Q. One of my legs is bigger than the other. Could this be vein disease?


A. Yes. A patient with venous insufficiency (even if there are no visible varicose veins) can develop enlargement of the entire leg. Treatment of underlying disease can make the leg return to normal or near normal size.



Q. Don’t I need to keep my varicose veins for good circulation?


A. Absolutely not. Varicose veins have failed and the blood is flowing down the vein instead of up. These veins are impairing the circulation and removing them improves the efficiency of blood return to the heart. A patient with bulging veins still has millions of good veins.



Q. Should I get my veins fixed before my next pregnancy?


A. Yes. Pregnancy is the biggest factor that makes varicose veins worse in women and pregnant patients with varicose veins can have miserable pregnancies. In the past, when the only treatment for vein disease was “vein stripping” resulting in long periods of down time and disability, patients were told to “have all your babies and then get your veins fixed.” Today, with modern office-based, no downtime procedures, the advice is the opposite: “Get your veins fixed before your next pregnancy so you can enjoy the experience without leg pain.”



Q. Can I have my “spider veins” treated with a laser instead of sclerotherapy?


A. There are a number of lasers on the market for the treatment of “spider veins.” We have lasers of this type at our facility that we use in select situations, such as treating facial veins. However, sclerotherapy is clearly the treatment of choice for “spider veins” (telangiectatic and reticular veins) on the legs. External lasers are only effective in treating the tiniest veins. The problem with external lasers is that it is impossible with today's technology to get enough heat through the skin and into the vein to destroy the vein without damaging the skin. Someday, there may be a breakthrough that makes external lasers more effective on "spider veins" of the legs, but for now the treatment of choice is sclerotherapy. 



Q. Do you offer free varicose vein consultations?


A. We’re sorry but we cannot offer patients free consultations for vein disease. Visible varicose veins are often a sign of significant underlying venous disease that needs medical attention. It is illegal for medical facilities to offer any inducement (such as gifts, discounts, or free visits) to encourage a patient to use their medical insurance benefits.

bottom of page