Phlebologist consultation and leg vein examination
A phlebologist diagnoses and treats diseases affecting the veins. A consultation is recommended if you have visible varicose veins, heaviness or swelling in the legs, pain, night cramps or skin changes around the ankles.
At Republikas laukuma klīnika in central Riga, consultations are provided by Dr Roberts Rumba. If clinically indicated, a duplex ultrasound examination of the leg veins can be performed during the consultation.
The examination helps assess the deep and superficial veins, the direction of blood flow and the function of the venous valves. The doctor will explain the results and prepare an individual treatment or follow-up plan.
Services include:
- phlebologist consultation;
- duplex ultrasound of the leg veins;
- assessment of varicose veins;
- diagnosis of chronic venous insufficiency;
- assessment of possible causes of leg swelling;
- diagnosis of superficial thrombophlebitis;
- assessment of signs suggesting venous thrombosis;
- assessment of trophic skin changes and venous ulcers;
- evaluation of suitability for compression therapy;
- preparation of an individual treatment and follow-up plan.
Phlebologist consultation: EUR 70.00.
Vascular examinations: from EUR 70.00.
Dr. Roberts Rumba
What is a phlebologist?
A phlebologist is a doctor who specialises in the diagnosis, treatment and prevention of venous diseases. Phlebology covers both visible varicose veins and deeper disorders of venous circulation.
The phlebologist does more than assess the appearance of the veins. During the consultation, the doctor determines whether visible veins are primarily a cosmetic change or whether they are associated with venous valve dysfunction and chronic venous insufficiency.
A duplex ultrasound of the leg veins is often required to identify the underlying cause. It allows the doctor to assess both superficial and deep veins and prepare an appropriate treatment plan.
When should you see a phlebologist?
A consultation is recommended if you notice:
- visible, bulging or twisted veins;
- heaviness or tiredness in the legs;
- swelling of the legs or ankles;
- pain, pressure or burning along a vein;
- night-time leg cramps;
- itching or discomfort in the lower legs;
- spider veins;
- brownish pigmentation around the ankles;
- dry, itchy or inflamed skin on the lower legs;
- a painful, red and hardened vein;
- a wound or ulcer on the lower leg that does not heal;
- sudden swelling of one leg;
- recurrent vein problems following previous treatment.
Symptoms often become worse towards the end of the day, in hot weather or after prolonged standing or sitting. They may improve after walking, resting or elevating the legs.
Varicose veins
Varicose veins are enlarged, twisted superficial veins that most commonly appear on the legs. They may be blue or purple and can protrude above the surface of the skin.
Veins contain valves that help blood flow towards the heart. When these valves do not close properly, some blood flows backwards and collects in the vein. This is known as venous reflux.
As pressure inside the vein increases, the vein gradually enlarges and becomes visible beneath the skin.
Varicose veins do not always cause symptoms. In some patients, however, they may result in:
- pain and heaviness;
- tired legs;
- swelling;
- itching;
- night cramps;
- changes in skin colour and texture;
- inflammation of a superficial vein;
- bleeding from a varicose vein;
- slow-healing venous ulcers.
The appearance of the veins alone does not indicate the severity of the condition. Minor external changes may sometimes be associated with significant venous valve insufficiency, while very prominent veins may cause relatively few symptoms. The need for treatment is therefore determined after a consultation and ultrasound examination.
Chronic venous insufficiency
Chronic venous insufficiency occurs when the veins cannot return blood from the legs to the heart efficiently enough. A common cause is dysfunction of the venous valves, which increases pressure in the veins of the legs.
At first, the patient may experience only heaviness or tiredness. As the condition progresses, the following may develop:
- regular swelling of the ankles and lower legs;
- varicose veins;
- itching;
- venous eczema;
- brown skin pigmentation;
- thickening of the skin and underlying tissues;
- painful, slow-healing ulcers.
Timely diagnosis helps identify which veins are causing the problem and how the symptoms and risk of complications can be reduced.
Why do legs swell?
Leg swelling may be caused by venous insufficiency, but this is not the only possible explanation. It can also be associated with diseases of the lymphatic system, heart, kidneys, liver or joints, as well as certain medicines.
Features suggesting a venous cause include:
- swelling that is more pronounced at the end of the day;
- swelling mainly around the ankles and lower legs;
- symptoms that become worse after prolonged standing;
- swelling that improves after a night’s rest or elevation of the legs;
- accompanying varicose veins, heaviness or skin changes.
If only one leg suddenly becomes swollen, particularly when accompanied by pain, redness or warmth, urgent medical assessment is required to exclude deep vein thrombosis.
Superficial thrombophlebitis
Superficial thrombophlebitis, also called superficial vein thrombosis, is inflammation of a vein that may be associated with the formation of a blood clot. It occurs more frequently in varicose veins.
Typical signs include:
- a painful and red area along the course of a vein;
- local swelling;
- warmth;
- a tender, firm area beneath the skin.
Although superficial thrombophlebitis usually differs from deep vein thrombosis, the affected area may occasionally be close to the deep venous system or extend towards it. The doctor may therefore recommend an ultrasound examination to determine the location and extent of the clot.
Deep vein thrombosis
Deep vein thrombosis occurs when a blood clot forms in one of the deep veins. Timely diagnosis and treatment are important because the clot can obstruct blood flow and cause serious complications.
Possible signs include:
- sudden swelling of one leg;
- pain in the calf or thigh;
- warmth in the affected leg;
- redness or another change in skin colour;
- superficial veins that suddenly become more prominent.
The severity of the symptoms can vary. Deep vein thrombosis cannot be reliably confirmed or excluded from external signs alone.
If sudden leg swelling is accompanied by shortness of breath, chest pain, coughing up blood, dizziness or impaired consciousness, call 113 immediately.
Venous ulcers and skin changes
Persistently elevated pressure in the leg veins can damage the skin and underlying tissues. Initially, itching, dryness, redness or brownish pigmentation may develop around the ankles. The skin may later become thicker and more sensitive.
In severe cases, a venous ulcer may form. This is a slow-healing wound usually located on the lower part of the leg or around the ankle.
Successful ulcer treatment requires both appropriate wound care and identification and treatment of the underlying cause. Management may include:
- examination of the venous and arterial circulation;
- appropriate wound care;
- compression therapy prescribed by a doctor;
- treatment of the underlying disease;
- assessment of vein treatment options.
Compression therapy should not be started without medical advice if the condition of the leg arteries is unknown.
Spider veins
Spider veins are small red, blue or purple vessels visible close to the surface of the skin.
They are most often a cosmetic concern, but they may sometimes occur together with deeper disorders of venous circulation.
A phlebologist consultation is particularly advisable if spider veins are accompanied by:
- heaviness in the legs;
- swelling;
- pain;
- larger varicose veins;
- skin changes;
- veins that have reappeared following previous treatment.
A duplex ultrasound may be recommended before cosmetic vein treatment to determine whether insufficiency of the valves in larger veins is present.
Duplex ultrasound of the leg veins
Duplex ultrasound is the main examination used to diagnose venous disease and plan treatment. It combines an ultrasound image of the veins with an assessment of blood flow.
The examination can be used to:
- visualise the deep and superficial veins;
- assess whether the veins are open;
- evaluate the function of venous valves;
- identify the location of venous reflux;
- detect signs of thrombosis;
- assess veins that have previously been treated;
- prepare a vein treatment plan.
The examination does not use ionising radiation and is generally painless. To assess venous function more accurately, part of the examination may be performed while the patient is standing.
What happens during a phlebologist consultation?
The doctor begins by asking about the patient’s symptoms, how long they have been present and any previous treatment. The doctor may also ask about previous thrombosis, surgery, pregnancy, current medication and a family history of venous disease.
The phlebologist may:
- examine the legs while the patient is standing and lying down;
- assess varicose veins and swelling;
- examine skin colour and texture;
- assess wounds or ulcers;
- check the arterial pulses in the legs;
- perform a duplex ultrasound examination;
- explain the examination findings;
- prepare a treatment or follow-up plan.
After the consultation, the patient receives information about the diagnosed venous condition, its severity and the most appropriate treatment options.
Treatment options for varicose veins
Treatment is selected individually, taking into account the patient’s symptoms, ultrasound findings, general health and vein anatomy.
The treatment plan may include:
- regular physical activity;
- taking breaks from prolonged standing or sitting;
- maintaining a healthy body weight;
- elevating the legs while resting;
- compression therapy selected by a doctor;
- treatment of symptoms and skin changes;
- endovenous thermal closure of the affected vein;
- foam sclerotherapy;
- miniphlebectomy;
- surgical treatment;
- regular follow-up.
Not every patient with visible veins requires a procedure. Compression stockings may reduce symptoms, but they do not necessarily correct the underlying venous valve dysfunction. The most suitable approach is determined after duplex ultrasound.
Compression stockings
Medical compression stockings apply graduated pressure to the leg and may help reduce swelling, pain and heaviness.
Compression stockings are available in different compression classes and sizes. An incorrectly selected product may be ineffective or apply inappropriate pressure.
It is particularly important to consult a doctor before starting compression therapy if the patient has:
- suspected arterial disease in the legs;
- diabetes;
- cold or numb feet;
- wounds that do not heal;
- severe leg pain;
- a history of thrombosis.
How should you prepare for the consultation?
No special preparation is normally required.
Please bring:
- results of previous vein ultrasound examinations;
- hospital discharge summaries;
- information about previous vein procedures;
- a list of current medicines;
- reports from other doctors;
- information about previous thrombosis.
Avoid applying a thick layer of cream or oil to the legs on the day of the consultation, as this may interfere with the ultrasound examination. Wear clothing that allows the entire leg being examined to be uncovered easily.
Phlebologist or vascular surgeon?
A phlebologist consultation is more appropriate when the main concerns are:
- varicose veins;
- spider veins;
- leg swelling;
- heaviness in the legs;
- inflammation of a vein;
- skin changes around the ankles;
- venous ulcers.
If the primary problem is leg pain while walking, cold feet, a weak pulse or suspected narrowing of an artery, a vascular surgeon consultation is required.
When is urgent medical attention required?
Seek immediate medical assistance if:
- one leg suddenly becomes significantly swollen;
- the swelling is accompanied by pain, redness or warmth;
- a varicose vein begins to bleed;
- sudden shortness of breath develops;
- chest pain occurs;
- you cough up blood, faint or experience severe weakness.
In the event of shortness of breath, chest pain or other severe symptoms, call 113 immediately.
Phlebologist in central Riga
Republikas laukuma klīnika is located in central Riga at Republikas laukums 3–18, on the ground floor of the Centra nams building. The entrance is on the side facing the Ministry of Agriculture.
Address: Republikas laukums 3–18, Riga
Phlebologist consultation: EUR 70.00
Vascular examinations: from EUR 70.00
Telephone: 28002363
Frequently asked questions
Do I need a referral to see a phlebologist?
A referral is generally not required for a private consultation. Please bring the results of previous examinations and a list of your current medicines.
Can the phlebologist perform an ultrasound during the consultation?
If required for diagnosis, a duplex ultrasound of the leg veins can be performed during the consultation. When making your appointment, describe your symptoms and ask whether additional time should be reserved for the examination.
Is duplex ultrasound of the veins painful?
No. It is a non-invasive ultrasound examination. Gel is applied to the skin, and the doctor examines the veins using an ultrasound probe.
Do varicose veins always require an operation?
No. The need for treatment depends on the symptoms, venous function and ultrasound findings. Some patients require only monitoring or symptom management, while a minimally invasive procedure may be appropriate for others.
Can varicose veins be dangerous?
Varicose veins usually develop gradually, but they can cause swelling, skin changes, thrombophlebitis, bleeding or venous ulcers. A consultation should not be delayed if these symptoms appear.
Do compression stockings cure varicose veins?
Compression stockings may reduce swelling, pain and heaviness, but they do not usually correct dysfunction of the valves in the affected vein. The compression class and size should preferably be selected following medical consultation.
Can a phlebologist help with swollen legs?
Yes, if the swelling may be caused by impaired venous circulation. If the examination does not confirm a venous cause, the doctor may recommend further assessment by another specialist.
Do spider veins indicate venous insufficiency?
Not always. Small visible vessels are often a cosmetic change, but they may occur together with deeper venous dysfunction. This can be assessed during the consultation and duplex ultrasound examination.
