Who this service is for
This phlebology and lymphology consultation is appropriate for adults with:
- Symptomatic or progressing varicose veins, with or without a previous Doppler ultrasound
- Already diagnosed chronic venous insufficiency that needs a treatment plan
- Spider veins and telangiectasias, to assess whether sclerotherapy is appropriate and in what order
- Skin changes of venous origin: ochre dermatitis, lipodermatosclerosis or eczema at the ankle
- A healing venous ulcer that needs its compression plan reviewed
- Post-thrombotic syndrome after a deep vein thrombosis
- Primary or secondary lymphoedema — after cancer surgery, lymph node dissection or radiotherapy
- Suspected lipoedema, often mistaken for obesity or lymphoedema for years
- Chronic swelling of one or both legs with no clear cause
- Recurrent cellulitis in a limb with lymphoedema, to review the prevention strategy
- A second opinion on a recommendation for varicose vein surgery or an endovenous procedure
- International residents and expats who need a phlebology consultation in Spanish
What this service is — and what it is not
This consultation covers:
- Medical assessment of venous and lymphatic disease
- Staging of chronic venous disease and lymphoedema, and an explanation of what it means
- Differential diagnosis between lymphoedema, lipoedema, venous oedema and systemic oedema
- Review and interpretation of Doppler ultrasound and other previous investigations
- Recommendation of compression therapy: type of garment, compression class, size and how to wear it
- Treatment planning — sclerotherapy, endovenous laser or radiofrequency ablation, surgery, complex decongestive therapy
- Requests for tests when those needed to make a decision are missing
- Coordination of in-person referral for the recommended procedure
This service does not cover:
- Performing the procedure. Sclerotherapy, endovenous ablation and varicose vein surgery are done in person: this consultation recommends and plans them, it does not perform them
- Manual lymphatic drainage and decongestive therapy, which are carried out by a specially trained physiotherapist; the consultation recommends and coordinates them
- Emergencies. Suspected acute deep vein thrombosis — sudden pain and swelling in one leg, with warmth or redness — requires assessment the same day, and if it is accompanied by chest pain or difficulty breathing, call 112
- Acute cellulitis with fever, which needs antibiotics and in-person assessment without delay
- Active bleeding from a varicose vein, which requires pressure, elevation and urgent care
Conditions commonly assessed
- Truncal varicose veins and great or small saphenous vein reflux
- Telangiectasias and reticular veins
- Chronic venous insufficiency at its different clinical stages
- Post-thrombotic syndrome and residual venous obstruction
- Active or healed venous ulcers
- Primary and secondary lymphoedema
- Lipoedema and its differential diagnosis
- Superficial phlebitis at the follow-up stage
- Oedema in pregnancy and venous disease during pregnancy
- Recurrent varicose veins after surgery or a previous endovenous procedure
What the consultation includes
Focused medical history
How symptoms have developed, the pattern of swelling, response to elevation, history of thrombosis, pregnancies, previous cancer surgery or radiotherapy, episodes of cellulitis, medication and previous venous treatments.
Guided examination by video call
The doctor guides you in showing both legs: distribution of varicose veins, extent of oedema, involvement of the top of the foot and the toes, skin condition and symmetry. You can send photographs and limb circumference measurements before your appointment.
Review of tests and requests for any that are missing
Doppler ultrasound and previous investigations are interpreted, and the tests needed to complete the diagnosis — venous Doppler ultrasound, blood tests or others — are requested.
Correctly prescribed compression
Poorly chosen compression is the most common reason people give up treatment. The specific garment, compression class, length and wearing schedule are prescribed, with contraindications checked — peripheral arterial disease among them.
Written treatment plan
You receive a plan setting out the sequence of treatment, which procedure is indicated and for what purpose, what result can be expected and what follow-up you will need afterwards.
Coordinated referral
When sclerotherapy, endovenous ablation, surgery or in-person decongestive therapy is appropriate, referral is coordinated with the full clinical report.
Lymphoedema and lipoedema — why diagnosis comes late
Lymphoedema secondary to cancer treatment is often detected late, when the tissue has already become fibrotic and decongestive therapy is less effective. Early detection and properly prescribed compression change the course of the disease.
Lipoedema has an even longer diagnostic delay: for years it is put down to obesity, with the added burden of blaming the patient for a condition that does not depend on diet. Distinguishing it from lymphoedema and venous oedema — by its symmetrical distribution, sparing of the feet and pain on pressure — is the first step towards treating it correctly.
Phlebology in Spain — the access problem
Venous care in Spain is concentrated in private practices in the large cities, and specialist lymphology is even scarcer. Patients with lymphoedema or lipoedema see several professionals before receiving a correct diagnosis, and many patients with varicose veins are only assessed once the skin has already changed.
This consultation brings that assessment to anywhere in Spain, with test review, properly prescribed compression and a written treatment plan, coordinating the in-person part only when it is essential.
