Varicose veins they may be small, medium or large. Small spider veins that are asymptomatic can be easily treated with injections to shrink them called sclerotherapy. However, larger or symptomatic veins that cause swelling, itching, pain or pressure, may require larger procedures such as endovenous laser ablation. To clarify whether simple vein injections (sclerotherapy) will work or something more major is needed a leg vein ultrasound is very helpful. In this video Dr. Van Reken performs a leg vein ultrasound. This patient had mild pain with her veins and the doctor was able to clarify that varicose and spider vein injection should work well for her without a larger, costly, procedure. This was done in the office with a portable machine and the patient was delighted that we were able to avoid an endovenous laser ablation. In addition to guiding therapy, an ultrasound confirms the presence or absence of blood clots, which require a different type of treatment when present.