Aside from the obvious signs of external varicose veins found at physical examination, the most accurate method of diagnosing underlying venous insufficiency is duplex ultrasound. When performed by a qualified registered vascular technologist, one can precisely determine the location of the leaky veins and formulate a logical and effective treatment plan to cure the problem. In addition to evaluating the superficial set of veins (saphenous system), the veins within the muscles (deep veins) are also examined to determine their status with respect to valve function and presence of clots. In addition, there are a variety of other types of leg veins which may be leaky and which less experienced technologists may overlook. These veins include the posterior thigh vein of Giacomini, the anterior and posterior medial saphenous veins and a number of perforating or connecting veins (Hunter’s, Dodd’s and Cockett’s). The importance of the role of an experienced registered vascular technologist in performing the venous insufficiency study cannot be overstated. This is an outpatient examination, which takes approximately 30 minutes per leg, and is best performed at the direction of the Physician Vein Specialist who will be responsible for making the treatment decisions.