Varicose veins

Varicose veins are swollen, enlarged veins. You can see and often feel them lying just under the surface of your skin, usually in your legs.

Although some people don’t like how varicose veins look, for most they don’t cause any symptoms or problems. If you do have symptoms, there is a range of treatments that can help.

Animation: How varicose veins form https://youtu.be/Ce2TjGY-r1o 

About varicose veins

Varicose veins develop when blood doesn’t flow properly through the veins in your legs. In healthy veins, blood flows from superficial veins near the surface of your legs, to deep veins within your muscles and from there back up to your heart. Normally, valves inside the veins keep your blood flowing in the right direction.

In varicose veins, the valves stop working as they should. This leads to the blood pooling in the superficial veins in your legs, increasing the pressure inside the veins and causing them to swell. You’re more likely to develop varicose veins as you get older. They’re also more common in women.

Symptoms of varicose veins

Varicose veins appear as bulging, twisted veins or lumps on your leg. You may not have any other symptoms at all, but if you do, they may include:

• aching or heaviness in your legs
• cramps in your legs, especially at night
• restless legs
• brown or purplish patches of skin over your ankles and lower legs
• itching or burning over the veins
• swollen feet and ankles 
• itchy, red, scaly or flaky skin on your legs, known as venous or varicose eczema

These symptoms often get worse after standing for a long time. For women, symptoms can be worse during periods or pregnancy. It’s possible for varicose veins to bleed, but in most people they don’t. 

If you have any of these symptoms, and they’re causing you discomfort, contact your Doctor for advice. You should also see your Doctor if a varicose vein is bleeding.

Diagnosis of varicose veins

Your Doctor will usually be able to tell if you have varicose veins from asking about your symptoms and examining you. They may want to look at your legs both while you’re sitting down, as well as while you’re standing up. They may also ask you about your medical history.

If your varicose veins are causing symptoms or you have complications, such as bleeding or skin changes, your Doctor may refer you to a vascular surgeon for assessment and treatment. A vascular surgeon is a doctor who specialises in conditions affecting your blood vessels.

If you’re referred, as well as examining you, your doctor may suggest that you have a special type of ultrasound scan called a duplex ultrasound. This uses sound waves to produce an image of the veins inside your leg and the flow of blood through them. It allows your doctor to see your deep veins in more detail, and find out more about the position and extent of your varicose veins. 

Self-help for varicose veins

Your doctor may suggest some self-help measures to relieve your symptoms. These may include:

• losing any excess weight
• doing light to moderate physical activity, such as swimming or walking
• trying not to stand for long periods of time as this may make your symptoms worse
• sitting with your legs raised and resting on a stool to help keep them elevated
• wearing compression stockings, if you’re not having other treatments for your varicose veins

If your job involves a lot of standing, try to change position frequently and move around as often as you can. Moving your feet and legs will help to pump your blood through your veins. Try to take regular breaks throughout the day and, if possible, keep your legs raised on something comfortable while you’re resting.

Treatment for varicose veins

Most varicose veins don’t cause any long-term health problems. You’ll usually only be offered treatment if your varicose veins are causing you discomfort or more serious complications.

There are a number of options for treating varicose veins, with the main ones listed below. Your doctor will discuss what is suitable for you. It’s worth considering that whatever treatment you have, there’s a risk that your varicose veins may come back. You may be offered a further procedure if this happens. Ask your doctor what the chance is of this happening.

Endothermal ablation

Endothermal ablation involves using either radiowaves (radiofrequency ablation) or a laser (endovenous laser ablation) to seal the affected vein.

These procedures can be carried out under local anaesthetic, which means you’ll be awake, but the area around your vein will be numb. Your doctor will make a tiny cut in your vein and insert a fine tube (catheter). They’ll then insert the radiofrequency electrode or laser through the catheter, which will seal off your varicose vein as it’s slowly withdrawn. You’ll usually be encouraged to be up and about afterwards, and go home the same day. 

Endothermal ablation is a less invasive alternative to traditional surgery for varicose veins (see below). The treatments work as well as surgery and you’re likely to recover more quickly with less pain, so doctors usually offer these treatments first. 

You may still get side-effects after these procedures, including pain and bruising, pins and needles and tightness in your legs, although they generally pass quickly. 

Foam sclerotherapy

If endothermal procedures are unsuitable for you, your doctor may recommend you have foam sclerotherapy. In this treatment, a chemical foam is injected into your varicose veins. This damages the inside of the veins, causing them to close up. Sometimes you may need more than one injection to block each vein.

Like the endothermal procedures, foam sclerotherapy is less invasive than surgery and can be done under local anaesthetic. Although helpful for some people, it’s not thought to be as effective as surgery and endothermal ablation. 

Side-effects of foam sclerotherapy can include headaches, chest tightness, problems with vision and changes to the colour of your skin. There have been rare reports of more serious complications after this treatment too, including heart attacks, seizures and strokes. These problems may not be linked to the procedure itself, but it’s important to be aware of them. 

Surgery for varicose veins

If less invasive procedures are unsuitable for you, your doctor may suggest you have surgery to remove your varicose veins. The most common technique for varicose vein surgery is called ligation and stripping. This is usually done under general anaesthesia, which means you’ll be asleep during the procedure. 

Your surgeon accesses the faulty vein via a small cut in your groin, or sometimes behind your knee. Using special equipment, they’ll tie off the vein (ligation) to stop blood flowing through it and then remove it with a long wire (stripping). Your surgeon may also remove veins on the surface of your leg using a technique called phlebectomy. This involves your surgeon making small cuts over the veins and using hooks to pull them out. You usually go home the same day after varicose vein surgery, although sometimes you may have to stay overnight. 

Surgery is the most ‘tried and tested’ way to remove varicose veins – there’s a lot more long-term evidence to show how well it works compared to other options. But as it involves an operation with general anaesthesia, it does take longer to recover. Your leg may feel sore and uncomfortable for a couple of weeks after your operation and you may need to be off work for up to three weeks. 

As with any type of surgery, there is the potential for complications, including infections, bleeding and blood clots, but these are uncommon. The surgery can also cause damage to your nerves, which may result in reduced sensation in areas of your leg; but this usually gets better with time. It’s also possible that new varicose veins can form later on. 

Newer treatments

Sometimes your doctor may suggest newer procedures to treat your varicose veins. These include:

• glue occlusion, which uses a special glue to seal the vein
• mechanochemical ablation, which uses a combination of a wire and a chemical inserted into your vein to close up your vein

There isn’t so much long-term evidence for how well these treatments work, and they may not be available everywhere. Your doctor will tell you if it’s something they’re able to offer. 

Compression stockings

If the treatments above aren’t suitable for you, or you decide not to have them, your doctor may suggest you try compression stockings to help relieve the swelling and aching in your legs. Your doctor may also suggest compression stockings if you have varicose veins and are pregnant.

If you have a procedure to treat your varicose veins, your doctor may also recommend you wear compression stockings afterwards to prevent blood clots forming in the veins of your legs. Follow your doctor’s advice on how long to wear them for. 

Causes of varicose veins

Varicose veins can develop when valves in your veins don’t work properly. It’s not clear exactly why this happens. But there are certain factors that seem to put you at greater risk. These include:

• having a family history of varicose veins
• being a woman
• getting older
• being very overweight or obese

Varicose veins may also be secondary to other problems or circumstances. You may get varicose veins if:

• you’ve had damage to leg veins or a blood clot (deep vein thrombosis) in the past
• you stand for long periods of time in one position, for example you stand all day at work
• you’re pregnant (this is because of higher hormone levels and more blood circulating during pregnancy)

If you get varicose veins during pregnancy, the good news is that they often improve after your baby is born.

Complications of varicose veins

Varicose veins can get worse over time, but this usually happens slowly, over a period of years. Complications are rare but can include the following.

• Superficial vein thrombosis (thrombophlebitis) – this is when a blood clot forms in your superficial veins, causing them to become hard, red and painful.
• Bleeding – your varicose veins can bleed if you cut or bump your leg. You might be able to control this by applying firm pressure, but you should seek advice from a Doctor straightaway – your vein may need to be treated to stop it happening again.
• Ulcers (open wounds) – these may develop on your legs. 
• Deep vein thrombosis (DVT) – you may be more at risk of DVT if you have varicose veins; and certain treatments for varicose veins can also increase your risk. If your leg becomes painful and swollen, seek medical help right away. See our FAQs below for more information.