Your legs are telling you something.

If you have visible varices or persistent capillaries, evening heaviness, restless legs, night cramps, or a single episode of inflamed surface vein (varicophlebitis), an ecocolordoppler-supported vascular consultation is the right next step. For acute symptoms — a hot, painful, swollen calf — assessment is urgent: deep venous thrombosis is the condition to rule out the same day.

Not usually. A visible varicose vein is, in most cases, the surface marker of an insufficient saphenous system upstream. Treating only the surface vein without mapping the underlying reflux is the most common reason varicose veins “come back” after a procedure. The ecocolordoppler maps the system. The treatment follows the map.

The ecocolordoppler is a non-invasive ultrasound examination that visualises the morphology of veins and arteries and measures the direction and speed of blood flow inside them. For venous disease it shows where reflux begins, how far it travels, and which vessels actually need treatment. For arterial disease it identifies stenosis and plaque. A treatment plan without an ecocolordoppler is, in essence, a plan made blind.

Liquid sclerotherapy uses a sclerosing drug in liquid form, injected into small surface vessels such as capillaries and reticular veins. Foam sclerotherapy uses the same drug mixed with air or CO2 to form a microfoam; the foam displaces blood inside larger veins and stays in contact with the vessel wall, which makes it the technique of choice for larger varicose veins. Ultrasound-guided foam sclerotherapy is performed under ecocolordoppler control, ensuring the foam reaches the exact segment that needs treatment.

Endovenous laser ablation (EVLA) is a minimally invasive technique that closes a diseased vein from inside, using a thin laser fibre introduced through a needle puncture. The vein is closed, not stripped, and the patient walks out the same day. Sclerotherapy closes a vein chemically; EVLA closes it thermally. Both are alternatives to the old stripping of the saphenous vein, which today is rarely indicated.

For most grades, yes. Endosclerosis with foam, sometimes combined with elastic ligation, can resolve bleeding and prolapse in the majority of cases without the need for the classic Milligan-Morgan hemorrhoidectomy. Radiofrequency is a further option. The grade of the hemorrhoidal disease, established at the proctological consultation, determines which technique is appropriate.

Lipedema is a clinical diagnosis based on specific signs: symmetrical bilateral involvement of the lower limbs (and sometimes the arms), disproportionate fat distribution with a normal-sized foot (Cuff Sign at the ankle), pain on pressure, easy bruising, and lack of response to caloric restriction. The condition is almost exclusively female. A dedicated lipedema consultation includes the clinical examination, the ecocolordoppler to exclude associated venous insufficiency, and a treatment plan that may include conservative management, compression, lymphatic drainage, carbossiterapia and mesoterapia.

Sonovein is a device that uses high-intensity focused ultrasound (HIFU) to close a varicose vein from outside the skin, without any needle puncture. Prof. Cervi was the first vascular surgeon in Italy to use it (at the Vein Clinic Ippocrate in Parma). It is not yet indicated for every patient, but for selected cases it is a meaningful option. The first consultation establishes whether your venous map is suitable.

It depends on the technique and the volume of disease. Sclerotherapy of varicose veins typically requires two to four sessions spaced about a month apart. Capillary sclerotherapy and transdermal laser typically require two to three sessions. Endovenous laser is usually a single session for the main treated vein, followed in some cases by complementary sclerotherapy. The exact number is established after the ecocolordoppler.

For most venous treatments, yes. Elasto-compressive stockings (typically class II) are worn for the first two to three weeks after a sclerotherapy or endovenous laser procedure, to optimise the adherence of the sclerosing agent to the vessel wall and to support venous return during the healing phase. For lipedema, compression is part of long-term conservative management, not a short post-procedure step.

Istituto Chirurgico Palazzo Manzoni is at Via dei Mille 14 in central Brescia, reachable by car or public transport from anywhere in Lombardy, including Milan (about one hour away). No referral is required to book a vascular consultation. You can book directly by phone, email, or online form.

The vascular and phlebology department at Palazzo Manzoni is led by Prof. Edoardo Cervi (vascular surgery, phlebology, proctology, vascular diagnostics, sclerotherapy, endovenous laser, hemorrhoid treatment), with Dr. Fabio Viotti (phlebology and endovenous laser) and Dr. Andrezza Silvia Guedes (lipedema, aesthetic phlebology, carbossiterapia and mesoterapia). Care is delivered by the team, with continuity from first consultation through follow-up.