First, do no harm.” – Hippocratic Oath
I’d like to know how the standards established by certification boards—and the oversight of regulatory boards—can allow supine-only ultrasound scans, performed purely for the convenience of the technician, to pass as sufficient for diagnosing venous reflux.
People live their lives upright. Our imaging standards should reflect that reality.
Venous disease is gravity-dependent. Reflux, valve failure, incompetent perforators—they all show themselves when a person is standing. Yet across the country, countless vein clinics—many staffed by doctors who may not even be board-certified vascular surgeons—keep performing “reflux studies” with patients lying flat. Even board-certified vascular surgeons can be guilty of this dreadful omission. And the pelvic region? Skipped. Upper body? Skipped. Arms? Skipped. Why?
They skip standing protocols. They skip Valsalva maneuvers. They skip scanning the foot and lower ankle, where many ulcers form. They skip the pelvic region and upper thoracic area and arms. They do less than half the job, collect the fee, and send patients out the door.
It’s medical negligence. Full stop.
And don’t get me started on so-called “board certification.”
Yes, there are boards in vascular medicine. But the problem? The standards aren’t strict enough to require:
- Standing reflux testing for venous insufficiency
- Full-leg imaging performed while patient is standing, including imaging a patient’s varicose veins, ankle, and foot when symptoms exist
- Proper documentation of reflux times
- Competency in differentiating arterial vs venous pathology
- Pelvic area imaging to identify reflux in that region contributing to symptoms
- Evaluation of whether upper body or arm veins need imaging
Board certification means nothing if the boards themselves refuse to enforce protocols that protect patients from misdiagnosis and suffering.
Why This Matters – The Deadly Underestimation of Venous Disease
Let’s be crystal clear: Chronic Venous Insufficiency (CVI) is NOT just “cosmetic.”
Yes, varicose veins might look like an aesthetic issue. But beneath the skin, venous hypertension is literally damaging your tissues from the inside out.
Here’s how it happens:
✅ Faulty valves → blood flows backward (reflux) instead of moving up toward the heart.
✅ This backward pressure builds in your veins (venous hypertension).
✅ Fluid leaks into surrounding tissue → causing swelling, skin discoloration, and inflammation.
✅ Over time, skin can become thin, leathery, and prone to breakdown. Fibrosis can form, a permanent disfigurement.
✅ Eventually, this leads to ulcers that will not heal—because there’s too much pressure for oxygen and nutrients to reach the skin properly.
Those ulcers are not just wounds. They’re open doors for infection. And in severe cases, especially if arterial disease coexists, ulcers can lead to gangrene and loss of limb—and even ischemic stroke.
And, by the way – ulcers can form on the feet, too. It’s unacceptable that some board-certified vascular specialists claim ‘feet don’t get venous ulcers’ when they do. Worse still, some don’t even bother scanning the feet, leaving patients at risk.
This must change.
CVI Is Far More Common Than People Realize
- Varicose veins alone affect up to 40% of women and 25% of men worldwide.
- In the U.S., estimates suggest:
- ~20–25% of adults have some form of venous disease.
- ~6–7 million people have advanced venous disease with skin changes, edema, or ulcers.
- Many people remain undiagnosed because:
- Doctors dismiss symptoms as “cosmetic.”
- Ultrasound studies are poorly performed or incomplete.
- Standing testing is inconvenient for the technician.
- Comprehensive exams take longer and reduce patient throughput in profit-driven clinics.
Did You Know?
- Up to 40–60% of patients with advanced CVI have deep venous abnormalities that can dramatically alter treatment plans.
- Ignoring the deep veins in imaging leaves patients at risk for persistent symptoms, ulcers, and even limb loss. And ischemic stroke.
- Lymphedema affects an estimated 3-5 million Americans and is often under-diagnosed.
- Fibrosis can result from chronic lymphedema or severe chronic venous insufficiency. And, yes, lymphedema can develop secondarily due to chronic venous disease.
None of these conditions should ever be dismissed as “cosmetic.”
The Ramifications of Bad Imaging
So why does it matter if your scan was done lying down instead of standing?
Because:
- Gravity is the entire point of venous testing.
- Your veins have to fight gravity every day to push blood back to your heart.
- Faulty valves may hold up fine lying down—but collapse standing.
- A supine-only scan can completely miss reflux.
- Missed reflux means:
- Ongoing swelling
- Skin changes
- Misdiagnosis (e.g. “neuropathy” instead of venous disease)
- Worsening symptoms
- Eventually, the damage can progress to:
- Chronic wounds and ulcers
- Cellulitis and infections
- Lymphedema and fibrosis – horrific impacts to one’s lifestyle and well-being
- Limb amputation in severe cases
- Ischemic stroke—a life-threatening event
Let me be blunt: People have lost their legs because venous disease was either misdiagnosed or dismissed as “cosmetic.”
And Don’t Expect the AMA to Fix This
It’s an entire platoon of bureaucrats standing by while patients suffer.
Calling Out The Entire System
And to the boards who claim to protect patients:
I’m talking to both of you:
🛑 American Board of Venous & Lymphatic Medicine (ABVLM)
- 101 Village Parkway, Building 4, Suite 202
- Marietta, GA 30067
- Phone: +1 (877) 699-4114
- Email: info@abvlm.org
- www.abvlm.org
🛑 American Board of Surgery – Vascular Surgery Board (VSB)
- 1617 John F. Kennedy Blvd. Suite 860
- Philadelphia, PA 19103-1847
- Phone: +1 (215) 568-4000
- Email: abs@absurgery.org
- www.absurgery.org
Patients are losing limbs and are at risk for ischemic stroke because there are no mandatory standards set and enforced by you, on these boards, for:
- Standing reflux testing – in other words, vein imaging standing up, not lying down
- Full-leg imaging including the ankle and the foot
- Proper documentation of reflux times
- Routine deep venous evaluation
- Evaluation of whether upper body venous imaging should be performed, at a minimum
Board certification is meaningless if it allows clinics to cut corners, miss diagnoses, and leave patients suffering in silence. Or ending up in nursing homes with a horrible, non-healing ulcer, or in ICUs with a stroke.”
What Patients Should Demand
If you’re dealing with:
- Swelling
- Leg pain that worsens when standing
- Skin discoloration (red, brown, purple, or a just a deeper hue)
- Ulcers that won’t heal
- Restless legs or heaviness
Don’t let anyone brush it off as just varicose veins or “cosmetic.”
✅ Demand standing reflux testing.
✅ Demand imaging all the way to the foot, including the foot, if your symptoms are there.
✅ Don’t settle for supine-only scans.
✅ Keep searching until you find someone who takes venous disease seriously.
CVI is a progressive disease. The earlier it’s diagnosed, the more you can do to avoid permanent damage—or even loss of a limb—or your life!
The Hippocratic Oath Means Something
I am tired of medical practitioners hiding behind polite white coats and hollow titles who know they should be doing a better job of assessing the patient’s venous status. I’m tired of boards failing to protect patients. And I’m beyond tired of a system that lets profit-driven clinics bill thousands for incomplete exams.
This has to change. I’m angry enough to start a movement. And I’m inviting every patient who’s been dismissed, misdiagnosed, or harmed by incompetent venous imaging to join me. Let’s hold clinics, doctors—and the boards who license them—to account. – Virginia Hall, The Vein Signal
CVI is serious. It deserves to be treated like the chronic, limb-threatening disease it truly is. And I will not stop speaking out until the system starts treating it that way.
If you’ve suffered medical gaslighting or incomplete venous imaging, I want to hear your story. Share it with me at The Vein Signal here – we’ll share collected feedback on the site and use it to further inform the entities who need to hear from all of us.
Write or call the boards listed above and let them know it’s time for change.
It’s time to expose the truth—and force change.
Join me on X and let’s do something about this – for ourselves, our loved ones, other sufferers, and future generations.