Frequently Asked Questions About Vein Disease and Treatment at Medical Vein Clinic San Antonio
This page answers the most common patient questions about vein disease, varicose veins, venous insufficiency, treatment options, insurance coverage, recovery, and how Medical Vein Clinic in San Antonio approaches vein care. Questions are organized by topic. If your question is not answered here, call us at 210-622-8000 or book a consultation at medicalveinclinic.com/book-an-appointment. Both of our San Antonio locations — Stone Oak and Northwest San Antonio — offer free vein evaluations.
About Varicose Veins and Vein Disease
What are varicose veins?
Varicose veins are large, swollen, rope-like veins that are visible on the surface of the skin. These veins are most commonly on the legs and can be very sensitive, painful, and swollen, but they can occur with no symptoms at all. If varicose veins appear on your legs, the one-way valves inside of your veins have failed and blood is traveling the wrong direction and “pooling” in the leg veins.
What are symptoms of varicose veins?
Aching in the lower legs without relief. Muscle cramps or pain in lower legs. Feeling of heaviness in the lower legs after standing or sitting for long periods of time. Mild to severe swelling of the ankles, or legs in general. These symptoms are not present in each case, but having one symptom can potentially lead to the rest.
What causes varicose veins?
When blood is not returned properly from the legs to the heart, varicose veins can appear. Normal leg veins have valves that open allowing blood to flow upward toward the heart and close to prevent back flow or venous reflux. If valves are not closing correctly, blood falls in the wrong direction and pools inside the vein making it difficult for muscles to push the blood up to the heart. The blood going the wrong direction (reflux) overfills and expands the superficial veins close to the skin, making them appear as varicose veins and spider veins.
How common are varicose veins?
Varicose veins are one of the most common venous disease symptoms affecting the world today. This issue is very prevalent, affecting one out of two people over 50, and 20% of all adults.
What are symptoms of venous insufficiency?
If you are experiencing one or any of the following you may be suffering from venous insufficiency. Redness of the legs and ankles. Skin discoloration around lower legs and ankles. Swelling of the legs and ankles. Ulcers on the legs and ankles. Restless leg syndrome. Pain in the legs after standing or sitting for an extended time. Heaviness in the legs, especially later in the day. Aching in the legs, especially later in the day. Venous insufficiency causes these symptoms, as well as others, because of the abnormal circulation it creates in the legs, so get treated today!
Are there different types of vein insufficiency?
Yes, you can have insufficiency in deep and superficial veins. Varicose veins are the large, rope like veins that bulge out near the surface of the skin. Varicose veins grow over time and can result in significant pain and complication if left untreated. Deep vein insufficiency occurs in the deep veins and can be more difficult to diagnose. Our trained staff can perform diagnostic tests that can help determine which type of insufficiency you are at risk for. Depending on the type and stage of venous condition, there are many different treatment options. Your physician can explain all options in detail.
What is the difference between varicose veins and spider veins?
Varicose veins are large, raised, rope-like veins that bulge above the skin, usually on the legs. They are caused by faulty vein valves and often bring aching, heaviness, swelling, and itching. Spider veins are small red, blue, or purple veins that sit flat against the skin surface and are usually a cosmetic concern, though they can signal underlying vein disease. Both are treatable at Medical Vein Clinic. We treat varicose veins with radiofrequency ablation, Varithena, and VenaSeal, and we treat spider veins with sclerotherapy, a quick in-clinic injection.
What is venous reflux?
Venous reflux happens when the one-way valves inside your leg veins stop working. Healthy valves push blood up toward the heart. When they fail, blood leaks backward and pools in the lower legs. This pooling causes the pressure that leads to varicose veins, swelling, skin changes, and the aching or heaviness many patients feel at the end of the day. Venous reflux is the root cause of most chronic venous insufficiency, and we confirm it with diagnostic ultrasound before recommending any treatment.
What is the Rust Tattoo™ that Medical Vein Clinic refers to?
Rust Tattoo™ is a term coined by Medical Vein Clinic to describe the brown or rust-colored skin discoloration that appears on the lower legs as vein disease advances. It happens when blood pools in the leg veins and iron leaks into the surrounding skin, staining it permanently if left untreated. The discoloration is a warning sign that vein disease has progressed and needs evaluation. Early treatment can prevent it from becoming permanent.
What Happens If Vein Disease Goes Untreated
What happens if varicose veins and vein disease go untreated?
Varicose veins worsen over time without treatment. People with varicose veins have five times the risk of developing deep vein thrombosis (DVT) or dangerous blood clots, according to research published in the Journal of the American Medical Association (JAMA), February 27, 2018. A recent study also shows that 25% of patients progress in venous disease within six months without treatment. Progressive complications include permanent skin discoloration on the lower legs (Rust Tattoo™), more varicose veins, skin scarring, open wound ulcerations, serious infections, and in severe cases, tissue loss. Symptoms including itching, burning, pain, swelling, heaviness, restless legs, and cramping all worsen over time. Varicose veins can also limit mobility and eventually prevent sleep. Early treatment prevents all of these outcomes.
Insurance and Coverage
Will my insurance cover my varicose vein treatments?
YES. Most insurance covers treatment of the veins that are considered medically necessary. Patient co-pays and deductibles vary, but most insurance covers our treatments when we validate that veins are medically incompetent/bad.
What does "medically necessary" mean for insurance coverage of vein treatment?
Insurance covers vein treatment when it is medically necessary, meaning your symptoms are documented and tied to a diagnosed vein problem rather than treated for appearance alone. To establish this, we perform a diagnostic ultrasound to confirm venous reflux and typically document a trial of conservative care, including compression stockings worn daily for about three months. If your symptoms persist, you qualify for a covered procedure. Medical Vein Clinic verifies your coverage before your appointment, so call 210-622-8000 to confirm your benefits.
Does Medicare cover varicose vein treatment?
Yes. Medicare covers varicose vein treatment when it is medically necessary and your symptoms are documented. This includes diagnostic ultrasound and the treatments we use to treat venous insufficiency and varicose veins. Medicare also covers treatments like VenaSeal and, in many cases, other procedures we offer such as GAE for knee pain. We verify your Medicare benefits before your visit. Call 210-622-8000 to confirm your coverage.
What to Expect at Your First Visit
What can I expect when I visit the clinic?
Each patient will be scheduled for an initial evaluation. If it’s determined you have signs or symptoms of underlying vein problems or varicose veins, a follow-up appointment will be scheduled to conduct a thorough ultrasound of your legs, at which time we will map your veins and identify those that need treating. This ultrasound session will take about an hour. Patients need to refrain from drinking caffeine before the ultrasound procedures as caffeine makes the veins constrict.Most insurance companies require that patients complete a 12-week conservative therapy period, wearing compression stockings to see if that temporarily improves the varicose vein symptoms. After 12 weeks, patients will return to the clinic for a follow-up exam. At that time, we will submit to your insurance company for approval to treat or close the bad veins. Once the insurance company approves the procedures, we will schedule your treatments.
Can you treat all my bad veins in one day?
Usually it takes multiple, short visits to the clinic during a one-week period to treat your veins. We use a numbing medicine called lidocaine during procedures. For your safety, we can only administer a limited amount of lidocaine each day. Most treatments take just a few minutes on one to four days, depending on the number of bad veins in each leg.
How long am I at the clinic for treatments?
Each treatment session lasts about 10 to 15 minutes. You will be in the clinic a total of about one hour from start to finish of your visit.
During and After Your Procedure
Will I miss work after the procedure?
Watch: What happens during a varicose vein procedure at Medical Vein Clinic
No, there is no need to miss work following each treatment. You can go back to work that day, but you need to walk 10 or 15 minutes every hour while you are awake. Patients can resume normal activity; however, no excessive exercise or lifting over 25 pounds.
If I’m on blood thinners, do I have to stop them?
No, you can continue on your blood thinners during your treatment period.
Do I go to sleep during the procedure?
Patients are wide-awake during their procedures. We simply use a little numbing medicine around the veins while treating them.
Can I drive myself home after the procedure?
Yes, you can, as long as you take breaks after driving 20 minutes or so, and get out and walk.
Is the procedure painful?
Patients generally say they don’t consider it painful. You will feel the initial injection of the numbing medicine, followed by the coolness of the fluid injected around the vein.
Will I be able to walk after my procedure?
Watch: Walking after varicose vein treatment — what patients experience
Yes. Walking is encouraged immediately after your procedure. We ask patients to walk 10 to 15 minutes every hour while awake for the first few days after treatment. Walking promotes healthy blood flow, reduces clot risk, and supports the closure of treated veins. You can resume most normal activities the same day. Avoid strenuous exercise, heavy lifting over 25 pounds, and prolonged sitting or standing for three weeks.
Is there any post-procedure care?
The bandages will need to stay on for 48 to 72 hours. Afterwards, patients will wear compression stockings for three weeks following their procedures to ensure successful closure of the bad veins.
Will my legs feel strange after the procedure?
They will probably feel a little heavier because of the numbing fluid and bandages used on the legs following the procedure. While you may feel a little numbness to touch for an hour or two, the muscles will work just fine.
What are complications of vein treatments?
Fortunately, the procedures our physicians perform have rarely been associated with any serious complications when performed properly. Minor complications often seen include bruising, mild itching, tenderness, and tightness in the treated leg for up to two weeks following the procedure.
If the vein is closed by the procedure, where does the blood go?
Our legs have many veins in them, so the blood that would have flowed through the closed vein simply flows through other healthy veins post-procedure. Losing the affected vein is not a problem, getting rid of the bad vein helps the circulatory system.
Compression Therapy
What is compression and does it work?
These are medical grade, knee-high and thigh-high socks or stockings that apply pressure to your legs. Compression is the most commonly prescribed treatment for venous disease issues and even leg ulcers. Compression treatment works, but only temporarily. The compression makes the vein valves close and function, even if they are stretched out. Compression certainly can help you achieve a level of comfort, as well as reduce pain and vein disease progression. However, as stated earlier, compression is not a cure for the cause of your problems. You will achieve a far more lasting and beneficial solution
to venous problems by having them treated by any of the ablation and surgical treatments described on our Vein
Procedures page.
Choosing a Vein Doctor
How do I choose a vein doctor and clinic?
Consider:
- Select a clinic that is dedicated exclusively to vein treatments (phlebology).
- Select an active member of the American College of Phlebology.
- Select a Board Certified physician.
- Select a physician and clinic that puts your health and interest first.
- Select a clinic with physicians there every day, not traveling in and out.
- Avoid a multipurpose clinic that happens to include vein treatments.
- Avoid multipurpose physicians doing part-time vein treatments. (Would you want a general practice physician to do your brain surgery?)
What credentials should a vein specialist have?
Look for a physician who is board certified in a relevant specialty such as vascular surgery, interventional radiology, or vascular and interventional medicine, and who holds registered certification in vascular interpretation (RPVI), meaning they are trained to read the ultrasound studies used to diagnose vein disease. Certification through the American Board of Venous and Lymphatic Medicine (ABVLM) shows added, focused expertise in vein and lymphatic care. You also want a doctor who personally performs or oversees your ultrasound diagnostics rather than treating appearance alone. For more on this, see our guide to choosing a vein doctor. Medical Vein Clinic’s physicians carry these credentials. Dr. John Hogg is a board-certified radiologist with ABVLM certification and over 30 years of experience, and Dr. Thomas Gianis is a board-certified vascular surgeon.
What is an ABVLM certification?
ABVLM stands for the American Board of Venous and Lymphatic Medicine. It is a national certifying board for physicians who specialize in diagnosing and treating vein and lymphatic conditions. A doctor who holds this certification has passed a rigorous exam proving advanced knowledge in venous and lymphatic medicine beyond their base specialty training. Dr. John Hogg, founder of Medical Vein Clinic, holds ABVLM certification (DABVLM), which reflects focused expertise in the conditions we treat every day.
Diabetes and Vein Treatment
I have Diabetes will that affect my treatment?
Watch: Dr. Thomas Gianis on vein treatment for diabetic patients
Diabetes does not disqualify you from vein treatment. In fact, diabetic patients are at significantly higher risk for vein disease complications including slow-healing wounds, skin ulcers, and limb-threatening infections — which makes early treatment especially important. Medical Vein Clinic evaluates all diabetic patients for both venous and arterial circulation problems. Our board-certified vascular specialists work with your primary care physician and endocrinologist to coordinate care. Most diabetic patients tolerate vein procedures well and see meaningful improvement in leg symptoms. Call us at 210-622-8000 to discuss your specific situation.
Conditions We Treat Beyond Varicose Veins
Does Medical Vein Clinic treat lymphedema?
Yes. We treat lymphedema and lipedema at both San Antonio locations, and Medical Vein Clinic is affiliated with the National Lymphedema Network. Care is led by Dr. Joshua Trock, a Doctor of Physical Therapy and Registered Vascular Technologist with LANA certification in lymphedema therapy. He combines diagnostic vascular ultrasound with advanced lymphatic therapy, an approach few clinics in San Antonio offer.
Does Medical Vein Clinic treat knee pain with GAE?
Yes. We offer Genicular Artery Embolization (GAE), a minimally invasive outpatient procedure for chronic knee pain caused by osteoarthritis. GAE reduces blood flow to the inflamed lining of the knee joint, easing pain and swelling without surgery. The procedure takes 30 to 60 minutes, requires no hospital stay, and most patients get relief lasting three to five years. GAE is performed by Dr. Thomas Gianis, a board-certified vascular surgeon, and is covered by most insurance plans including Medicare.
Does Medical Vein Clinic treat peripheral artery disease (PAD)?
Yes. We diagnose and treat peripheral artery disease at both San Antonio locations. PAD is a circulatory condition where arteries in the legs narrow or become blocked, causing leg pain, poor circulation, and wounds that do not heal. We diagnose it using ankle-brachial index testing and arterial ultrasound, and we treat it with lifestyle changes, medication, and minimally invasive procedures like angioplasty and stenting. PAD care is led by board-certified vascular surgeon Dr. Thomas Gianis.
Does Medical Vein Clinic treat pelvic venous disorder?
Yes. We treat Pelvic Venous Disorder (PVD), a leading cause of chronic pelvic pain in women. PVD occurs when pelvic veins become dilated and form painful varicose veins inside the pelvis, causing persistent pelvic pain, pain during or after intercourse, and bulging vulvar or thigh veins. We treat it with a minimally invasive catheter procedure that takes about an hour and requires no hospital stay. Up to 85% of women find relief within two weeks. PVD is treated by Dr. Thomas Gianis, and most insurance plans cover treatment.
Does Medical Vein Clinic treat chronic venous insufficiency?
Yes. Chronic venous insufficiency is the underlying cause of most vein disease. It develops when faulty vein valves let blood pool in the legs, leading to swelling, aching, heaviness, skin discoloration, and varicose veins. We confirm it with diagnostic ultrasound and treat it with minimally invasive, no-surgery procedures including radiofrequency ablation, Varithena, and VenaSeal. Most patients walk out the same day, and treatment is covered by most insurance plans.
At Medical Vein Clinic, Healthy Legs Take You Further™
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Medical Vein Clinic has two San Antonio locations:
Stone Oak at 18831 Meisner Drive, San Antonio, TX 78258 and Alamo Ranch Northwest San Antonio at 5742 W. Loop 1604 N., San Antonio, TX 78251.
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18831 Meisner Drive
San Antonio, Texas 78258
5742 W. Loop 1604 N.
San Antonio, TX 78251
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