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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 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.

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 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 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.

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 Heath Information Team, November 2012.

Updated in December 2013 in line with latest NICE guidelines.

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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