Vascular Consultation
Start with the right examination. The right technique follows.
The vascular and phlebology decision-support consultation at Palazzo Manzoni in Brescia. For patients who suspect something is happening with the venous or arterial system but aren’t sure what. Ecocolordoppler in the same visit, then the right pathway.
The vascular consultation at Palazzo Manzoni in Brescia is delivered by the vascular team: Prof. Edoardo Cervi (vascular surgery, phlebology, proctology, ecocolordoppler), Dr. Fabio Viotti (phlebology and endovenous laser), Dr. Andrezza Silvia Guedes (lipedema, aesthetic phlebology, ecocolordoppler). Ecocolordoppler (venous, arterial, supra-aortic vessels, aorta and abdominal vessels where indicated) is performed in the same visit. No referral required.
One visit
Examination and ecocolordoppler together — you leave with the venous map.
Same team, same building
If a specific specialist is needed, the routing happens during the visit.
No referral required
Book directly by phone, email, WhatsApp or online.
Medical first
A vascular surgeon, not a procedure operator — the conversation is medical first.
Who The Consultation Is For
You suspect something, you’re just not sure what.
You’re in the right place if you have visible varicose veins or capillaries and want to understand what is actually happening underneath; if you have heavy legs by evening, restless legs, night cramps or evening swelling and want the venous system properly examined; if you’ve had a single episode of superficial vein inflammation (varicophlebitis) and want a follow-up that includes imaging; or if you have a family history of varicose veins or deep venous thrombosis and want a baseline ecocolordoppler.
It’s also the right visit if you suspect lipedema and have been told for years that the legs are “just heavy” or “you should diet harder”; if you have hemorrhoidal disease that has progressed beyond what creams and lifestyle adjustments can manage; if you’ve been told elsewhere that stripping (safenectomy) is the only option and want a second opinion on minimally invasive alternatives; or if you simply want a periodic vascular check-up, especially after the age of 50 or in the presence of cardiovascular risk factors.
The consultation does not pressure you toward a treatment, does not commit you to a specific technique, and does not require you to have made any decisions in advance. It is an examination, an imaging study, and a recommendation. The decisions are yours, and the right pace is whichever pace fits your life. If you already know your diagnosis and want to read about a specific procedure, the four pathway pages are the better starting point.
What The Consultation Includes
A history, an examination, an ecocolordoppler, and a clear routing recommendation
Phlebology is one of the most over-promised areas of medicine: generic spider-vein packages, one-technique-fits-all approaches, treatments performed without an ecocolordoppler beforehand. Palazzo Manzoni made a different choice. The diagnosis comes first. The technique fits the diagnosis. The same vascular surgeon stays with you from first examination through every session.
The department is led by Prof. Edoardo Cervi, a general and vascular surgeon with phlebology sub-specialisation, supported by Dr. Fabio Viotti and Dr. Andrezza Silvia Guedes.
01
A full history
The story of how the symptoms started, what aggravates them, what helps, what has been tried, and what previous specialists have said. The hormonal milestones (puberty, pregnancies, menopause), the family history, and any previous episodes of varicophlebitis or thrombosis.
02
A thorough examination
Inspection of the legs (and other districts where indicated), palpation, and identification of the recognised clinical signs. For suspected lipedema, the specific markers (symmetry, Cuff Sign, foot sparing, pain on pressure, bruising tendency). For suspected hemorrhoidal disease, a proctological examination with anoscopy where indicated.
03
Ecocolordoppler in the same visit
An ultrasound examination of the venous system, performed in the same visit. It visualises the morphology of the vessels and measures the direction and speed of flow inside them. Where indicated, the ecocolordoppler is extended to the arterial system — lower-limb arteries, supra-aortic vessels, aorta and abdominal vessels.
04
A routing recommendation
You leave with a clear understanding of what the venous (and where indicated arterial) system is doing, the diagnosis, and the right pathway: sclerotherapy, endovenous laser, capillary treatment, lipedema management, proctological pathway, or simply conservative observation. Where appropriate, the consultation routes directly to the specialist within the team.
What To Expect
From first question
to a clear map.
Step 01
Book the consultation
Call, email, WhatsApp, or book online. No referral is required. Bring any prior ultrasound or ecocolordoppler reports (ideally the images on a CD/USB, not just the written report), photographs of the legs taken in symptomatic moments, previous specialist reports, a list of treatments you’ve tried, and your usual compression stockings if you wear them. If you don’t have any of the above, come anyway.
Step 02
History and examination
The consultation begins with the full history and a thorough physical examination — inspection, palpation, the recognised clinical signs, and, where indicated, the specific markers for lipedema or a proctological examination. The visit takes the time it needs.
Step 03
Ecocolordoppler, on the day
In almost every case the venous ecocolordoppler is performed in the same visit. Where the arterial system also needs examination — vascular risk assessment, suspected peripheral arterial disease, supra-aortic check, abdominal aorta — it is added on the day where the schedule allows, or planned for a second visit. The exam maps the actual circulation, not just the surface.
Step 04
The routing recommendation
You leave with the diagnosis, an explanation of what the circulation is doing, and the right pathway — medical management, sclerotherapy, endovenous laser, capillary treatment, lipedema management, proctology, or conservative observation. The trade-offs are explained. Nothing is pushed.
Step 05
Decide at your own pace
The consultation produces a map and a recommendation, not an obligation. If a treatment is the right next step, the same specialist who examined you carries it out, with continuity from first consultation through follow-up. The time to decide is yours.
Patient Stories
Three people who
started with a question
Different starting points, the same first step — an examination and an ecocolordoppler before any decision.
Real experiences from people who walked in unsure of what they needed
I went in thinking I needed surgery on a vein. The ecocolordoppler showed the deeper system was competent, and the recommendation was conservative management for now. Walking out reassured, instead of scheduled for a procedure, was not what I expected.
I’d been sent for stripping at another clinic and wanted a second opinion. The consultation mapped the reflux properly and explained the minimally invasive options. The plan that fitted my venous map was nothing like what I’d been told.
For years no one named what was happening with my legs. In the first visit Dr. Guedes recognised lipedema, explained the signs, and set out a conservative pathway. Finally having a name, and a plan, was worth the wait.
Who Leads the Department
Prof. Edoardo Cervi
Vascular surgeon and phlebology lead. General and vascular surgery, ultrasound-guided sclerotherapy, endovenous laser, hemorrhoid treatment, proctology and vascular diagnostics.
Vascular surgeon
general and vascular surgery with phlebology sub-specialisation
Full minimally invasive range
ultrasound-guided sclerotherapy, endovenous laser, radiofrequency, and hemorrhoid treatment by foam and radiofrequency
Vascular diagnostics
ecocolordoppler of venous, arterial, supra-aortic, aortic and abdominal vessels
One specialist, start to finish
supported by Dr. Fabio Viotti (phlebology, endovenous laser) and Dr. Andrezza Silvia Guedes (lipedema, aesthetic phlebology)
“A varicose vein is rarely just a varicose vein. It is, very often, the visible tip of an insufficiency that started further upstream. The ecocolordoppler is what turns the conversation from ‘how do we make the surface look better’ into ‘how do we fix what is actually causing it.’ That is why this consultation starts with a map, not a procedure.”
Where The Consultation Leads
The visit’s purpose is the map, and then the right pathway
Once the ecocolordoppler has mapped your circulation, the recommendation points to one of the vascular pathways — or simply to conservative observation. Each pathway has its own page, with the techniques explained in full.
If your problem turns out to be outside vascular medicine — a musculoskeletal cause for “heavy legs,” or a non-vascular cause for rectal bleeding — we say so and direct you to the appropriate specialty. The consultation is a fair and common way to get a second opinion before a procedure elsewhere: bring the existing recommendation and the imaging it was based on.
→Varicose vein treatment
For cord-like veins, evening heaviness, or an inflamed surface vein (varicophlebitis): ultrasound-guided foam sclerotherapy and endovenous laser, chosen from your ecocolordoppler map.
→Capillaries and aesthetic phlebology
For spider veins, reticular veins, and capillary networks — sometimes the visible tip of a deeper reflux: transdermal laser, liquid sclerotherapy and cryosclerotherapy.
→Hemorrhoid treatment
For bleeding, prolapse, tenesmus or pain that won’t settle: endosclerosis with foam, radiofrequency and a proctological pathway. Today the hemorrhoid that once required surgery often does not.
→Lipedema and body phlebology
For symmetrical bilateral leg enlargement, the Cuff Sign at the ankle and pain on pressure — a diagnosis missed for years: naming it correctly, then a conservative pathway with carbossiterapia and mesoterapia where indicated.
Your ecocolordoppler will clarify which pathway fits your case.
Common Questions
Common questions
about the vascular consultation
How long is the consultation?
The vascular consultation, including the ecocolordoppler, typically takes thirty to forty-five minutes. Complex cases — extensive bilateral disease, suspected lipedema with a full clinical examination, or a multi-district arterial assessment — may take longer.
Do I need a referral?
No. You can book directly by phone, email, WhatsApp or online.
Will I have the ecocolordoppler on the day?
Yes, in almost every case. The venous ecocolordoppler is part of the first visit. Where the arterial system also needs examination — for vascular risk assessment, suspected peripheral arterial disease, a supra-aortic check, or the abdominal aorta — it is added on the day where the schedule allows, or planned for a second visit.
What if my problem turns out to be outside vascular medicine?
We say so, and direct you to the appropriate specialty. A non-vascular cause for symptoms that were suspected to be vascular — for example a musculoskeletal cause for “heavy legs,” or a non-vascular cause for rectal bleeding — is identified during the consultation and routed appropriately.
What if I want a second opinion before a procedure elsewhere?
That is a fair and common use of the consultation. Bring the existing recommendation and any imaging it was based on. The ecocolordoppler maps your venous system independently, so you leave with an assessment of your own circulation, not a competitive sale.
What is the ecocolordoppler, and why does every plan start there?
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. A treatment plan without an ecocolordoppler is, in essence, a plan made blind.
Do I need to know my diagnosis before booking?
No. This consultation is built precisely for patients who suspect something but aren’t sure what. If you already know your diagnosis and want to read about a specific procedure, the four pathway pages — varicose veins, capillaries and aesthetic phlebology, hemorrhoid treatment, and lipedema — are the better starting point.
What should I bring to the consultation?
Any prior ultrasound or ecocolordoppler reports (ideally the images on a CD/USB, not just the written report), photographs of the legs taken in symptomatic moments, previous specialist reports, a list of treatments you’ve tried and how each went, your usual compression stockings if you wear them, and any specific questions you want answered. If you don’t have any of these, come anyway.
How much does the consultation cost?
A transparent fee, including the ecocolordoppler, is communicated when you book. It covers the examination, the imaging study, and the routing recommendation.
Will the consultation pressure me into a treatment?
No. It does not pressure you toward a treatment, does not commit you to a specific technique, and does not require you to have made any decisions in advance. The consultation is an examination, an imaging study, and a recommendation. The decisions are yours, and the right pace is whichever pace fits your life.
Where is Palazzo Manzoni located, and do I need a referral?
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.
Who conducts the consultation?
The decision-support consultation is conducted by one of the vascular specialists — Prof. Edoardo Cervi (vascular surgery, phlebology, proctology, ecocolordoppler), Dr. Fabio Viotti (phlebology and endovenous laser), or Dr. Andrezza Silvia Guedes (lipedema, aesthetic phlebology, ecocolordoppler) — with the appropriate pathway lead routed as the clinical picture becomes clearer.
Take the Next Step
Start with a conversation and a map,
not a procedure.
At Palazzo Manzoni in Brescia, your vascular consultation is thorough, honest, and built around the ecocolordoppler map of your specific venous and, where indicated, arterial system.
Address
Via dei Mille 14, 25122 Brescia, Italia
Phone
Hours
Mon-Fri 8:30-18:30 · Sat 9:00-13:00
01
Get in touch
Call, email, WhatsApp, or book online.
02
Be examined with ecocolordoppler
Sub-specialised assessment of your specific venous and arterial picture.
03
Move forward, with a plan
A plan built around the map of your circulation.
Content reviewed by Prof. Edoardo Cervi, head of Vascular Surgery.