What a phlebologist checks before treating spider veins

What is a phlebologist, and is it a doctor?

Yes. A phlebologist is a doctor who specialises in the veins; vascular surgeons see vein problems too. At CREAMÉ the consultation is with Dr. Marat Takoev, a phlebologist practising since 2010, trained in cardiovascular surgery, angiology and endovascular diagnosis and treatment.

Why the veins beneath come first

Spider veins are fine veins in the skin, up to about 1 mm across, and on their own they are mainly a cosmetic concern. But visible veins can also be the sign of leaking valves in larger veins beneath, which cause aching, heaviness and swelling. That is why guidelines advise checking the veins beneath before spider or reticular veins are treated: treating the surface alone while the cause beneath goes unchecked can leave the problem in place.

What happens at the first visit

• Your story: symptoms, any past clots, your medicines and allergies.
• An examination of your legs while you stand, looking at the veins, any swelling and the skin around the ankles.
• Other causes: the arteries, joints or nerves can cause leg symptoms too, and the doctor considers them.
• A decision about a scan: if you need a duplex ultrasound, the doctor explains why and what it involves.
• A plan, which for many people begins with everyday measures, not a procedure.

Do I need a duplex ultrasound scan?

Not always for a first look, but usually before any treatment. A doctor learns a lot from examining the legs; duplex ultrasound confirms varicose veins and shows which veins are leaking, and guidelines advise it before spider or reticular veins are treated. The phlebologist tells you whether you need one, and why.

Signs that call for a specialist's assessment

• Varicose veins that ache, feel heavy, itch or swell.
• Skin near the ankle that darkens or turns eczema-like.
• A vein that becomes hard and painful.
• A wound below the knee that has not healed within two weeks.
• A fan of small blue and red veins around the ankle and the side of the foot (corona phlebectatica), linked with more advanced vein disease.

Signs that need a doctor now

A calf or leg that becomes painful, swollen and warm, especially with red or discoloured skin, can be a clot in a deep vein: go to an emergency department the same day. Sudden shortness of breath, chest pain or coughing blood needs an ambulance (998 in the UAE). A vein that bleeds also needs urgent care.

What helps in the meantime

Everyday measures often ease aching veins: regular walks, keeping to a healthy weight, resting with your legs raised and staying out of the heat, which in Dubai means walking in the cooler hours or indoors. The evidence for exercise is for easing symptoms rather than for removing veins. If your veins appeared in pregnancy, they often shrink back at least partly in the first months after the birth, so decisions usually wait three to six months after delivery.