The examination begins with the physician taking a medical history that includes the patient’s current symptoms and family history. The physician will perform a physical examination, which may include certain noninvasive tests that measure the circulation. Patients might be asked to lie with their legs elevated or walk during the examination.

Depending on what is revealed by these initial observations, the patient may be referred to other physicians, including a phlebologist (specializes in vein conditions) or a dermatologist (specializes in skin conditions). To help determine the extent of the condition, physicians may order a Duplex ultrasound or a Doppler ultrasound. These noninvasive tests use high-frequency sound waves to take clear pictures of the veins. The test also gives information about the rate of blood flow and any leaking (regurgitation) of blood in the vein. The presence of venous clots will also be determined, especially when swelling (edema), darkening (pigmentation) of the skin and ulceration of the skin around the ankle are present.

The ultrasound is now used much more commonly than the venogram – a catheter-based procedure in which a special dye (contrast medium) is injected into the affected vein to take x-rays of blood flow.