Interestingly there is no dictionary definition of what constitutes a varicose vein but it is generally accepted that if a vein is “raised” above the surface then it is a varicose vein. What is critical in the management of varicose veins is the determination of the underlying anatomy. Almost all significant varicose veins are associated with an underlying vein that has valves that do not work and allow back pressure (with standing and gravity). This back pressure “forces” its way to the skin as varicose veins. The best and least invasive way to determine the state of the underlying anatomy is to have a Duplex Ultrasound examination. This examination gives a clear understanding of which veins are working (competent valves) and which veins have valves that are not working (incompetent valves / veins). It is only with this information that the treatment options be considered. There are many doctors who can look at veins but the special interest group called Phlebologists are playing an increasing role in assessment and management of all vein conditions.