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Varicose veins

Varicose veins are swollen veins that lie under your skin. They look lumpy and dark blue or purple through your skin. They usually affect your legs, particularly your calf and sometimes your thigh.

Varicose veins develop when blood doesn't flow properly through the veins in your legs. There are two main types of veins in your legs:

  • superficial veins – these lie under your skin and include the long and short saphenous veins
  • deep veins

The saphenous veins are connected to the deep veins inside your legs by perforator veins. When blood doesn't flow properly from your superficial veins to your deep veins, pressure can build up. This is often due to problems with the one way valves that stop blood leaking back into your superficial veins. This results in blood collecting or pooling in your superficial veins and these are called varicose veins.

Varicose veins are very common – they affect up to a third of people. They affect more women than men.

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How varicose veins form
Varicose veins are swollen veins that lie under the skin
An image showing the superficial veins of the leg

Details

  • Symptoms Symptoms of varicose veins

    Symptoms of varicose veins can vary. Some people don't have any symptoms at all. If you do have symptoms, they may include:

    • aching or throbbing legs – large varicose veins don't always cause more discomfort than smaller varicose veins
    • itchy or restless legs
    • swollen feet and ankles
    • lumps or bulging veins

    These symptoms may be caused by problems other than varicose veins. If you have any of these symptoms, see your GP for advice.

     

    An image showing large varicose veins on the leg below the knee, with lumps and blue/purple colouring

    Varicose veins

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  • Diagnosis Diagnosis of varicose veins

    Your GP will ask about your symptoms and ask to examine you. He or she may also ask you about your medical history.

    If your symptoms are severe or you have complications, your GP may refer you to a vascular surgeon (a doctor who specialises in blood vessels).

    Varicose veins are easy to see in your leg. However, to work out the position and extent of any valve damage, your doctor may suggest that you have the following tests

    • A Doppler test. Your doctor will use a small probe to listen to the blood flowing in your veins. Your doctor will be able to tell the direction of blood flow in your vein and whether your valves are working properly.
    • An ultrasound scan (duplex). This can produce an image of the veins inside your leg. It allows your doctor to examine your deep veins in more detail, examining the structure and function of your varicose veins.
  • Treatment Treatment options for varicose veins

    There are a number of treatment options for varicose veins, as described below. Which treatments you are offered will depend on your personal circumstances. Your doctor will discuss these with you to help you make a decision that’s right for you. Which treatment you have will be based on your doctor’s expert opinion and your own personal values and beliefs.

    If your varicose veins don't cause you any discomfort, you may decide not to have any treatment. Most varicose veins don’t cause any long-term health problems or cause any threat to circulation.

    Self-help

    Your doctor may suggest some self-help measures you can take to relieve your symptoms. These may include losing any excess weight and doing light to moderate physical activity, such as swimming or walking. Try not to stand for long periods of time as this may make your symptoms worse. If you rest your legs up on a stool, it may ease any discomfort. 

    Non-surgical treatments

    There are a number of non-surgical procedures available to treat varicose veins. If you have complications of varicose veins, you may be able to have these on the NHS. If you want treatment for cosmetic reasons, it’s unlikely you will be able to have this on the NHS. However, you can choose to pay for treatment privately.

    Endothermal ablation

    Endothermal ablation procedures include radiofrequency ablation and endovenous laser ablation. In these procedures, your doctor uses either an electrical current (radiofrequency ablation) or a laser (endovenous laser ablation) to heat the inside of your varicose vein. This damages the vein and causes it to close.

    Endothermal ablation procedures are less invasive alternatives to traditional surgery for varicose veins and for this reason, will now usually be offered to you first. They can be carried out under local anaesthetic and you may have less bruising and swelling after these procedures than after surgery. However, it’s still common to have some side-effects from these procedures, such as bruising and tightness in your legs. Common complications also include some inflammation, darkening or reddening of your skin and pins and needles in your legs.

    There is evidence to show that these procedures may help to reduce your symptoms for up to three years after the procedure. However, as they are relatively new treatments, longer term data isn’t yet available. As with any treatment for varicose veins, you may need to have further treatment if your varicose veins come back.

    Foam sclerotherapy

    If endothermal procedures are unsuitable for you, your doctor may recommend you have foam sclerotherapy. This treatment involves injecting a foam into your varicose veins. This damages your veins and causes them to close.

    Foam sclerotherapy may help to get rid of your varicose veins. Like the endothermal procedures, it is less invasive than surgery and can be done under local anaesthetic. However, there is a possibility that your varicose veins may come back and you may need further treatment.

    Your doctor will talk to you about the risks involved in this procedure to make sure you are aware of the potential complications. There have been reports of mild complications after foam sclerotherapy, such as chest tightness, headaches, coughing and problems with vision. However, these aren’t common and are usually only temporary. More serious complications such as stroke, nerve damage, seizures and heart attack have occasionally been reported in some people after having sclerotherapy. However these complications are rare and may be due to existing health problems.

    Another type of sclerotherapy, called liquid sclerotherapy, is sometimes used in the treatment of smaller varicose veins. It’s usually used alongside other treatments. However, there is little evidence to confirm how well liquid sclerotherapy works.

    Surgery

    If less invasive procedures are unsuitable for you, your doctor may suggest you have varicose vein surgery. In varicose vein surgery, your surgeon will remove any superficial veins that have become varicose veins. The veins that are situated deep within your legs will take over the role of the damaged veins.

    This most common technique for varicose vein surgery is called ligation and stripping. This is usually carried out under general anaesthesia. In this operation, your surgeon will tie off the faulty vein (ligation) to stop blood flowing through it and then remove it (stripping). You may have a procedure called phlebectomy with ligation and stripping to remove the smaller surface veins that lie under your skin. In this operation, your surgeon will use hooks to pull out your varicose veins through small cuts in your leg.

    Surgery is considered to be beneficial and relatively safe over the long term. However, it’s still common to have some side-effects, such as bruising and pins and needles in your legs. More serious side-effects are uncommon, but can include deep vein thrombosis (DVT) and pulmonary embolism. Although many people won't need any further treatment after surgery, it’s possible that new varicose veins can form.

    Compression stockings

    If the treatments above aren’t suitable for you, your doctor may suggest you try compression stockings. You may also be offered compression stockings to wear after having a procedure or surgery. Compression stockings can help the blood in your veins flow up towards your heart. The stockings may relieve the swelling and aching in your legs. However, there is no evidence to show whether they help to stop your varicose veins getting worse, or more varicose veins from developing.

  • Varicose vein treatment on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including varicose vein treatment.

  • Causes Causes of varicose veins

    The exact reasons why you may develop varicose veins aren't fully understood at present. However, it's thought that if you have varicose veins, then your vein walls are weak. This causes the valves in your veins to expand and separate, which damages them. Blood can’t travel up your veins as well or as easily as it should, and is more likely to pool.

    You're more likely to develop varicose veins:

    • as you get older (because your veins lose their elasticity with age)
    • if you're pregnant (because of the increased pressure on your veins)
    • if you're very overweight (also because of the increased pressure on your veins)
    • if other members of your family have them
    • if you stand for long periods of time, for example you stand all day at work
  • Complications Complications of varicose veins

    Complications of varicose veins include the following.

    • Thrombophlebitis – your superficial veins can become painful and red due to a blood clot forming in the vein.
    • Bleeding – your varicose veins can bleed if you cut or bump your leg.
    • Varicose eczema – your skin can become brown or purple. This is often permanent.
    • Venous ulcers – you can get ulcers when fluid leaks out of the varicose vein into the surrounding tissue.
  • Prevention Prevention of varicose veins

    Although there are no scientifically proven ways to prevent varicose veins, the following suggestions may be useful.

    • Don't stand still for long periods of time.
    • Take regular exercise, such as walking.
    • Maintain a healthy weight.
  • FAQs FAQs

    Are there any medicines that my doctor could prescribe to treat my varicose veins?

    Answer

    No, there is no evidence that creams or medicines are effective at treating varicose veins.

    Explanation

    Over the years, many different medicines and creams have been tested for the treatment of varicose veins. However, there is no evidence to suggest that any of these work.

    A small clinical trial in women with varicose veins showed that a medicine called rutoside can reduce symptoms such as night cramps and feelings of tiredness, but more research is needed in more people to determine if it’s effective.

    There is no evidence to suggest that herbal creams, lotions and other medicines for poor circulation are effective for the treatment of varicose veins.

    Always ask your doctor or pharmacist for advice and read the patient information leaflet that comes with your medicine.

    What changes can I make to my diet and lifestyle to reduce my risk of developing varicose veins?

    Answer

    You can't always prevent varicose veins from developing but there are steps you can take to make them less likely to develop. If you improve your circulation and muscle tone it may help. For example, don't sit or stand still for long periods of time, particularly if you're pregnant.

    Explanation

    Regular exercise is a great way to improve your circulation and general health. If you’re unsure, ask your GP for advice on the best types of exercise for you.

    If your job involves a lot of standing, try to change position frequently and move around as often as you can. Gently moving your feet will help to stretch your calf muscles and increase your circulation. When you sit down, don't cross your legs because this can restrict your circulation. Try to take regular breaks throughout the day and, if possible, keep your legs raised on something comfortable while you’re resting. Ideally, raise your legs above the level of your heart.

    If you’re overweight, it can increase your risk of getting varicose veins so try to lose excess weight by eating healthily and taking regular exercise. This will take any extra pressure off your circulatory system and your heart will find it easier to pump blood around your body. Ask your GP for advice on the best ways to lose weight.

    If you're pregnant and have developed varicose veins, they will often improve after you give birth. Compression stockings may also help to relieve any swelling and aching in your legs. They work by putting pressure on your veins to improve your circulation.

    I have varicose veins. Does this mean I'm more likely to develop a deep vein thrombosis (DVT)?

    Answer

    There is some evidence to show that people who have varicose veins may be at increased risk of developing DVT. However, most people with varicose veins won’t develop this complication. There are a number of things that can increase your risk of DVT.

    Explanation

    Deep vein thrombosis (DVT) is a condition in which a blood clot forms in a deep vein, normally in your leg. This can lead to serious complications. There are a number of risk factors for DVT. These include having previously had a DVT, having cancer, getting older, being overweight or obese, smoking and being immobile. You may be immobile if you are bed-bound for some time, for instance if you are ill or have had an operation.

    Having varicose veins has also been associated with an increased risk of developing a DVT. However, most people who have varicose veins will not develop a DVT. You are more likely to get a DVT if you have varicose veins in addition to some of the other risk factors mentioned above.

    If you have varicose veins and are worried about your risk of developing DVT, talk to your doctor.

  • Pros and cons Pros and cons

    The table below summarises the benefits and risks (pros and cons) for each of the treatment options for varicose veins. When looking through these, think about what matters most to you. Your doctor will discuss these with you to help you make a decision that’s right for you.

    Pros Cons
    No treatment or self-help measures only
    You don’t have to worry about getting any side-effects. Your varicose veins won’t go away on their own.
    If you’re in pain or don’t like the look of your varicose veins, this might not be an option for you.
    Radiofrequency ablation
    This isn’t a major operation and you’re likely to recover quicker than normal surgery.

    You won’t need to be put asleep under general anaesthetic for this procedure. Instead, you can just have a local anaesthetic which will block pain from the area you need treating.

    You’re likely to have less bruising and swelling than if you have normal surgery.
    Not everyone will be able to have this procedure. Your doctor will be able to advise you on whether this treatment is suitable or not.

    This is a new treatment so we don’t know how well it works yet.
    You might get some swelling and pins and needles but this doesn’t usually last for long.
    Endovenous laser ablation
    This isn’t a major operation and you’re likely to recover quicker than normal surgery.

    You won’t need to be put asleep under general anaesthetic for this procedure. Instead, you can just have a local anaesthetic which will block pain from the area you need treating.

    You’re likely to have less bruising and swelling than if you have normal surgery.
    Not everyone will be able to have this procedure. Your doctor will be able to advise you on whether this treatment is suitable or not.

    This is a new treatment so we don’t know how well it works yet.
      
    You may get some darkening or redness of your skin as well as some swelling and pins and needles. However, this doesn’t usually last long.
    Foam sclerotherapy
    This isn’t a major operation and you’re likely to recover quicker than normal surgery.

    You won’t need to be put asleep under general anaesthetic for this procedure. Instead, you can just have a local anaesthetic, which will block pain from the area you need treating.
    This is a new treatment so we don’t know how well it works in the long term.
    You may have some bruising, swelling and notice some changes to the colour of the skin over your veins. This is common − more than half of people having this procedure get these side-effects.

    There is a small chance that you may develop a serious health condition after the procedure. Although this is rare, you may be at risk of having nerve damage, seizures, heart attacks or mini-strokes. If you would like more information about this, speak to your doctor.
    Surgery
    We know this treatment works well – it’s the most ‘tried and tested’ way to remove varicose veins. You will have to be put to sleep during this operation with a general anaesthetic.

    This is a major operation, so you’re likely to take longer to recover from it (one to three weeks).
    You may have some bruising, swelling and pins and needles after the operation.

    Sources

    • Varicose veins. Map of medicine. www.mapofmedicine.com, published 18 October 2013
    • Varicose veins in the legs. National Institute for Health and Care Excellence (NICE), July 2013. www.nice.org.uk 
    • Radiofrequency ablation of varicose veins. National Institute for Health and Care Excellence (NICE), September 2003. www.nice.org.uk
    • Endovenous laser treatment of the long saphenous vein. National Institute for Health and Care Excellence (NICE), March 2004. www.nice.org.uk
    • Ultrasound-guided foam sclerotherapy for varicose veins. National Institute for Health and Care Excellence (NICE), February 2013. www.nice.org.uk
  • Resources Resources

    Further information

    Sources

    • Varicose veins. Map of Medicine. www.mapofmedicine.com, published 13 October 2011
    • Varicose veins and spider veins. eMedicine. www.emedicine.medscape.com, published 7 July 2010
    • Shingler S, Robertson L, Boghossian S, et al. Compression stockings for the initial treatment of varicose veins in patients without venous ulceration. Cochrane Database of Systematic Reviews 2011, Issue 11. doi:10.1002/14651858.CD008819.pub2
    • Tisi PV, Beverley C, Rees A. Injection sclerotherapy for varicose veins. Cochrane Database of Systematic Reviews 2006, Issue 4. doi:10.1002/14651858.CD001732.pub2
    • What causes varicose veins? National Heart Lung and Blood Institute. www.nhlbi.nih.gov, published 1 February 2011
    • Varicose veins – operation explained. Circulation Foundation. www.circulationfoundation.org.uk, accessed 12 November 2012
    • Varicose vein surgery. Better Health Channel. www.betterhealth.vic.gov.au, published April 2011
    • Varicose veins – injection treatment or sclerotherapy. Circulation Foundation. www.circulationfoundation.org.uk, accessed 12 November 2012
    • Ulltrasound-guided foam sclerotherapy for varicose veins. National Institute for Health and Clinical Excellence (NICE), February 2013. www.nice.org.uk
    • Transilluminated powered phlebectomy for varicose veins. National Institute for Health and Clinical Excellence (NICE). www.nice.org.uk, published 7 March 2011
    • Joint Formulary Committee. British National Formulary. 64th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2012
    • Bamigboye AA, Smyth RMD. Interventions for varicose veins and leg oedema in pregnancy. Cochrane Database of Systematic Reviews 2007, Issue 1. doi:10.1002/14651858.CD001066.pub2
    • Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2011; 53(5):2S–48S. doi:10.1016/j.jvs.2011.01.079
    • Ten questions about thrombosis. Lifeblood. www.thrombosis-charity.org.uk, accessed 12 November 2012
    • Thrombophlebitis – superficial. Prodigy. www.prodigy.clarity.co.uk, published March 2009
    • Varicose veins in the legs. National Institute for Health and Care Excellence (NICE), July 2013. www.nice.org.uk
    • Varicose veins. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published October 2008
    • Radiofrequency ablation of varicose veins. National Institute for Health and Care Excellence (NICE), September 2003. www.nice.org.uk
    • Endovenous laser treatment of the long saphenous vein. National Institute for Health and Care Excellence (NICE), March 2004. www.nice.org.uk
    • Varicose veins. BMJ Clinical Evidence. clinicalevidence.bmj.com, published 5 January 2011
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    Produced by Rachael Mayfield-Blake, Bupa Heath Information Team, November 2012.

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