Modern high resolution ultrasound imaging has profoundly altered the understanding and treatment of vein disease. As a result, a new specialty, phlebologythe diagnosis and treatment of vein disorders, has evolved. The specialty has existed in Europe for a number of years. The American Medical Association recognized the specialty in 2006.

Phlebology vs. Surgery
Varicose vein treatments are now individualized and based on each patients specific anatomy and physiology. Treatments are primarily nonsurgical, minimally invasive, and require expertise in ultrasound. Endovenous ablation, foam sclerotherapy, and microphlebectomy are now the standard of care in varicose vein disease. They have replaced older painful and often disfiguring surgical procedures such as saphenous vein stripping and stab phlebectomy operations. Ultrasound imaging has clearly shown why the old one treatment fits all, saphenous vein stripping surgery approach often fails.

Phlebologists
Current varicose vein treatments require true expertise in ultrasound and noninvasive needle and catheter techniques. Pioneers in this field included radiologists, dermatologists, and a few vascular surgeons who had a special interest in vein disease. They formed the American College of Phlebology (www.phlebology.org). Membership also includes physicians from diverse backgrounds such as internal medicine, OB-GYN, anesthesiology, and general surgery.

American Board of Phlebology
The American Board of Phlebology (www.americanboardofphlebology.org) was formed in 2007 to establish qualifications for certification of physicians as specialists in the practice of phlebology. None of the existing medical specialties previously provided or had specific training guidelines in all phlebology procedures (endovenous ablation, sclerotherapy, and ambulatory phlebectomy) and ultrasound of the superficial venous system. The main purpose of the Board was to 1) help improve the quality of patient care related to the treatment of venous disorders, 2) bring recognition to the field of phlebology and physicians in the field who have the knowledge, skills, and experience to provide quality care, and 3) establish educational standards for teaching and training programs in phlebology. As a new specialty, the Board intends to grant certification in 2008 and 2009 to phlebologists who meet rigorous criteria for providing evidence of experience in phlebology, expertise in venous ultrasound, and who pass an examination process.