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The following is a brief introduction to what varicose veins are, the symptoms, the causes and how they are best diagnosed and treated.

What are varicose veins and thread veins?

Varicose veins are twisty, bulging veins on the legs and feet which tend to get larger and more swollen with time. Varicose veins are an indicator of an underlying valve problem in the veins underneath the skin which are feeding the visible varicosities.

Thread veins, often referred to as spider veins, are tiny veins just below the skin surface which are often purple or red in colour.

What are the causes of varicose veins?

Varicose veins are caused by a rise in the normal venous pressure in the veins in the legs, which in turn is caused by failure of valves that normally ensure flow of blood in only one direction; from foot to heart. Varicose veins are a genetic problem that you inherit and so there is nothing that you can do to prevent them occurring.

What symptoms are associated with varicose veins?

Varicose veins can cause symptoms in the legs that aren’t just cosmetic including swelling, itching, throbbing, restlessness, aching, burning, cramping, tiredness and varicose eczema. They can bleed, especially in the elderly, after relatively minor trauma. The increased pressure often causes skin damage and in many patients actual ulceration of the skin occurs which takes months to heal without appropriate treatment.

Patients who present to us with vein problems often note that they are experiencing at least a few of the symptoms above, however some patients have had problems for so long they only become aware of the fact that their veins have caused symptoms when they return following treatment and say their legs feel far less tired and commonly state "it is like having a new pair of legs!".

Can someone have the symptoms associated with varicose veins but no visible varicosities?

It is important to note that occasionally the symptoms normally associated with varicose veins, and caused by the valve failure, can occur with no evidence of visible varicose veins.

How are varicose veins diagnosed?

The only way to accurately determine the underlying cause of your varicose and thread veins is by having a colour duplex ultrasound scan performed on your legs. Without this full and detailed scan, it is impossible to expertly assess your veins or determine the exact treatment you require. The best person to undertake the scan is the person who will undertake your treatment. This may be a consultant interventional radiologist, a vascular surgeon or a nurse practitioner. 

What is the best way to treat varicose veins?

If you present with definite varicose veins, the modern varicose veins treatment recommended to fix the underlying cause of varicose vein problems is EVLA (Endovenous Laser Ablation treatment) followed by Foam Sclerotherapy injections to treat the blood in the veins on the surface of the legs. These are both gold standard minimally invasive techniques performed under local anaesthetic on an outpatient basis. Other techniques include Phlebectomies/ Avulsions, RF Ablation, VNUS Closure, Sapheon Superglue, ClariVein, Perforator Ablation (TRLOP) and Embolisation. See our Standard Patient Pathway which outlines how we manage all types of leg veins. 

Our treatment plans follow NICE (National Institute of Health and Care Excellence) guidelines. It is vital that the underlying cause of the varicose veins is treated before treating the visible varicosities. If the visible varicose veins are treated prior to treating the source, then rapid recurrence is likely.

Treatment by EVLA usually makes symptoms disappear quickly and most patients are symptom free by the time of their follow up appointment approximately 6 weeks later.

Traditional varicose veins treatment methods: Treatment by surgery, most commonly tying and stripping, is no longer the recommended treatment option for varicose veins. Shockingly, despite this, surgery is often the only option given to patients and there is either no mention of the modern techniques or patients are incorrectly told they are not suitable for them.

Can varicose veins occur in other parts of the body?

Prominent veins can occur in other parts of the body, not just the legs. In the scrotum, for example, they cause a “bag of worms” swelling called a varicocele which can be painful and reduce fertility and in the female pelvis they are responsible for much undiagnosed pelvic pain as well as obvious vulval and clitoral varices. Both these types of varices can be easily treated by an outpatient technique called embolisation.