Initial evaluation is with one of our board-certified vascular physicians. Many patients require an ultrasound which is often performed at the same setting in our accredited vascular lab. Treatment options and alternatives are discussed at this visit. Most patients with bulging varicose veins can be treated with a laser that is inserted like an IV using numbing medicine. Some patients may require additional procedures to treat larger veins. Patients with spider veins are typically treated with sclerotherapy (tiny injections of a medication directly into the small spider veins).