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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.

Animation - How varicose veins develop

About varicose veins

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.

Illustration of the deep and superficial veins of the leg

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.

 

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

Varicose veins

Complications of varicose veins

Complications of varicose veins include the following.

  • Thrombophlebitis – your superficial veins can become painful and red due to inflammation or a blockage in your veins.
  • 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.

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

Diagnosis of varicose veins

Your GP will ask about your symptoms and 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 perform the following tests.

  • A Doppler test. This is an ultrasound technique that uses sound waves to produce an image of the inside of your leg. It will give your doctor information about the direction of blood flow in your vein and whether your valves are working properly.
  • An ultrasound scan (duplex). This will allow your doctor to examine your deep veins in detail.

Treatment of varicose veins

If your varicose veins don't cause you any discomfort, you may decide not to have any treatment. If you want treatment for cosmetic reasons, it’s unlikely you will be able to have this on the NHS. However, you will be able to have private treatment. You may be able to have NHS treatment if you have complications of varicose veins. Your doctor will explain the options to you and help you decide which treatment is best for you.

Self-help

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

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, but it isn’t known if they prevent more varicose veins from developing.

Surgery

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.

There are many types of operation. The operation you have will depend on which veins need treatment – ask your surgeon for advice on which operation is best for you.

A common operation is ligation and stripping. 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 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.

Although many people won't need any further treatment after surgery, it’s possible that new varicose veins can form.

Sclerotherapy (liquid or foam)

This treatment involves injecting a chemical into your varicose veins. This will damage the veins and close them. Liquid sclerotherapy is often used to treat smaller varicose veins. For larger veins, foam sclerotherapy is used. After you have you procedure, your doctor will put a compression bandage over the area. You may be asked to wear compression stockings for up to two weeks.

Studies have shown that this treatment is effective at treating varicose veins in the short-term. However, the long-term benefits aren't yet known. The procedure also has serious potential complications (problems that occur during or after the procedure), such as a stroke or damage to nerves. It's important to tell your surgeon if you have a history of deep vein thrombosis (DVT) to discuss the safety of ultrasound guided foam sclerotherapy.

Endovenous laser treatment

In this treatment, your surgeon will pass a fine laser inside your varicose vein. The laser will heat the inside of your vein and damage the vein wall, which will cause the vein to close.

Radiofrequency ablation

In radiofrequency ablation, your surgeon will use a high frequency electrical current to heat the wall of your varicose vein. This will damage the vein and cause it to close.

Transilluminated powered phlebectomy

In transilluminated powered phlebectomy (TIPP), your surgeon will place a special light under your skin and remove the varicose vein by suction. This treatment is relatively new so less is known about its long-term effectiveness.

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.

 

Produced by Rachael Mayfield-Blake, Bupa Health Information Team, November 2012. 

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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