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Since most veins lie deep under the skin's surface, vein disorders are not always visible to the naked eye. As a result, diagnostic ultrasound is often used to determine the cause and severity of the problem. One might imagine a tree with some visibly dry leaves, indicating that it may be affected by disease. However, since you cannot see within the trunk or branches leading to the leaves, it is impossible to know for certain what is causing the leaves to die. The same principle applies to veins. Spider or small varicose veins are often the only outwardly visible signs of a much greater problem in a larger vein; under certain conditions (high venous pressure) there will be a backflow from the larger vessel to the smaller one. Until a diagnosis is made to confirm the presence of deep varicose disease, it would not be recommended to treat the smaller veins, as the 'fix' will be temporary. To fully understand and successfully treat varicose disease the phlebologist uses duplex venous ultrasound to determine the extent of damage to the blood vessels. This type of work-up is different from the one you would receive in a hospital setting, in which a technician would be looking for DVT (deep venous thrombosis), a deep vein blood clot. The ultrasound examination performed by the doctor in our office maps the superficial venous system and identifies sources and levels of reflux (backflow from the leaky valves). From this information, an appropriate course of therapy can be tailored for your specific needs.