Phlebologist: which doctor treats veins and when to see one

2026-10-29

• A phlebologist is a doctor who specialises in vein disease, most often a vascular surgeon with extra training.
• Regular heaviness and swelling, visible veins, cramps and skin changes on the lower legs are reasons to book.
• The main test is a duplex ultrasound scan of the veins, and it is painless.
• Haemorrhoids are treated by a proctologist, not a phlebologist.
• If one leg suddenly swells and hurts, do not wait for an appointment: call 103.

Your legs have been aching by evening for months, a winding bluish vein has appeared on your calf, and your mother keeps telling you to 'get it looked at'. But by whom? A GP, a surgeon, a cardiologist? Many people put off the visit simply because they do not know where to go or what to expect.

Let's take it step by step: who a phlebologist is, which problems they deal with, when it is time to book, how the consultation works and how to choose a specialist you can trust.

Who is a phlebologist?

A phlebologist is a doctor who diagnoses and treats diseases of the veins. The word comes from the Greek 'phleps', meaning vein. Most often a phlebologist is a vascular surgeon (angiosurgeon) with extra training in vein disease, so in clinics and hospitals you may also see the specialty listed under that name.

A phlebologist does not only prescribe conservative treatment but usually also performs minimally invasive procedures, such as sclerotherapy and laser or radiofrequency ablation of veins. If an operation is needed, they either carry it out themselves or refer you to colleagues.

Which conditions does a phlebologist treat?

• Varicose veins in the legs and spider veins (telangiectasias).
• Chronic venous insufficiency: heaviness, swelling, cramps and skin changes on the lower legs.
• Thrombophlebitis, an inflamed superficial vein with a blood clot.
• The after-effects of deep vein thrombosis (post-thrombotic syndrome); acute thrombosis itself is often managed together with a GP or in hospital.
• Leg ulcers of venous origin.
• Pelvic varicose veins, often together with a gynaecologist.

It is just as useful to know what a phlebologist does not treat. Haemorrhoids involve the vascular cushions of the rectum, but they are dealt with by a proctologist (colorectal specialist). Swelling caused by heart, kidney or thyroid disease is a job for a GP, cardiologist, nephrologist or endocrinologist. Calf pain on walking caused by narrowed arteries is also seen by vascular surgeons, but that is a different, arterial problem.

When should you book an appointment with a phlebologist?

There is no need to wait until your veins are visible to everyone. Book a consultation if you notice:

• heaviness, tiredness or a bursting feeling in your legs by evening; we looked at possible causes in Heavy legs in the evening;
• swelling around the ankles and shins, or deep marks from sock elastic;
• enlarged, twisting veins or networks of thread veins;
• night cramps, itching or burning in the legs;
• darkening, hardening or flaking skin near the ankles, or a sore that will not heal.

A preventive check makes sense even without symptoms: if your parents had varicose veins (we wrote separately about the role of heredity), if you are planning a pregnancy and have noticed vein problems before, if you work on your feet or have had a thrombosis in the past.

Where to start: a GP or straight to a phlebologist?

At a state polyclinic it is usually easiest to start with a family doctor or GP. They will assess your general health, rule out other causes of swelling, order basic tests and, if needed, refer you to a vascular surgeon. At private clinics you can book a phlebologist directly. If you already have a recent vein ultrasound report, bring it along to save time.

If only one leg is affected, or the swelling is recent or comes with breathlessness, do not delay: a doctor needs to decide whether you need an urgent check for thrombosis.

What happens at the first appointment?

A first consultation does not usually take long. The doctor will ask about your symptoms, lifestyle, work, pregnancies, any past thrombosis and the medicines you take, then examine your legs, always while you are standing, because veins collapse when you lie down.

To describe the stage of the disease, doctors use the international CEAP classification, from C0, with no visible signs, to C6, an open leg ulcer. You can read more in The CEAP classification in plain words.

The main test is a duplex ultrasound scan of the veins. It is painless, needs no special preparation and shows whether the veins are open and whether the valves work properly. International guidelines regard it as the standard test when vein disease is suspected. We described how the scan works in our article on leg vein ultrasound.

How should you prepare for the visit?

1. Write down your symptoms: what bothers you, since when, and when it is worse, for example in the evening, in the heat or after standing for a long time.
2. List the medicines you take, including hormonal contraceptives and supplements.
3. Bring the results of previous tests: scans, blood tests, hospital discharge letters.
4. Ask relatives whether anyone in the family has had varicose veins, thrombosis or leg ulcers.
5. Wear clothes that are easy to take off or roll up to the groin, and do not put cream on your legs that day.
6. If you already wear compression stockings, bring them along so the doctor can check the fit.

What treatment can the doctor offer?

Treatment is always tailored to the person, and not everyone with enlarged veins needs a procedure. Decisions are made together with you: the doctor explains what to expect, what the risks are and how long recovery takes. The options include:

• lifestyle advice: walking, exercises, weight control, resting with your legs raised;
• compression stockings, with the class chosen by the doctor; compression is not suitable in some arterial diseases;
• venotonic medicines to ease symptoms, where indicated;
• sclerotherapy, an injection of a special medicine that seals the vein;
• endovenous laser or radiofrequency ablation, minimally invasive methods that current guidelines usually prefer to open surgery;
• surgery, in selected cases.

How do you choose a specialist you can trust?

• The clinic is licensed, and the doctor has specialist training in vascular surgery or phlebology.
• Before recommending treatment, the doctor performs a duplex scan or refers you for one.
• Your diagnosis and treatment options, including conservative ones, are explained calmly, and you are not rushed into a decision.
• Be wary if you are promised freedom from varicose veins in a single visit, or pushed into an expensive procedure at the very first appointment.
• Asking for a second opinion is perfectly normal, especially when surgery is being discussed.

Do not put your veins on hold

Seeing a phlebologist is not a cause for worry but a way to get clarity. The sooner a doctor assesses your veins, the more simple and gentle options remain open. Choose a convenient day, take your list of questions and take the first step towards lighter legs.

Sources: 1. De Maeseneer MG, Kakkos SK, Aherne T, et al. ESVS 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg. 2022;63(2):184–267. 2. Lurie F, Passman M, Meisner M, et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord. 2020;8(3):342–352. 3. National Institute for Health and Care Excellence (NICE). Varicose veins: diagnosis and management. Clinical guideline CG168, 2013.

• Varicose veins and excess weight: how extra kilos load your legs
• Are varicose veins hereditary? What to do if your parents had them
• Leg vein ultrasound: why you need a duplex scan and what to expect