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Stages of Varicose Veins: Symptoms and Treatment

Varicose veins are usually a progressive condition, that starts with small, often asymptomatic veins, but over time can worsen due to the increased pressure in the veins caused by the faulty valves. Here, Mr David Lewis, Consultant Vascular Surgeon at Veincentre, explains the four different stages that you may experience over time, without undergoing treatment to fix the underlying cause.

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Stage 1: Mild varicose veins

As varicose veins begin to develop, you may not necessarily notice the veins, but they may appear blue in colour and be slightly raised. At this stage, there usually wouldn’t be any symptoms, apart from the potential of some slight discomfort or heaviness affecting the leg.

Self-care measures, such as exercise, to get the blood pumping, as well as compression stockings and leg elevation to ease any discomfort can help at this stage. Walking is particularly important because the faulty valves mean that the blood finds it harder to flow in the right direction (from the feet back up to the heart). Getting up and moving will help to encourage the blood to keep flowing properly.


Stage 2: Moderate varicose veins

As function of the valves in the superficial veins gets worse over time, you may see the veins start to become more tortuous and enlarged. The increase in pressure inside the veins will cause the vein to bulge outwards, and this is what causes the veins to become more visible.

At this point, you may begin experiencing symptoms such as mild aching, tired/heavy legs, itching and cramp. These symptoms may begin to bother you more, but at this point wouldn’t usually stop you from doing your usual daily activities.

We would still recommend exercise, compression stockings and leg elevation. These tips are all key in managing varicose veins at this stage, however intervention may be required or indicated, usually in the form of endovenous laser ablation (EVLA). This would be dependent on the results of a consultation and colour duplex ultrasound scan.


Stage 3: Severe varicose veins

By now, you will be seeing very swollen, bulging veins. The veins have been under high pressure for months or years, causing the veins to become more visible and also leading to more severe symptoms.

You may now be experiencing pain, aching, burning, swelling of the ankle, restlessness, throbbing and itching. Some people may begin to develop skin changes, such as varicose eczema. The skin can be discoloured and become itchy.

The most common treatment at this point is endovenous laser ablation (EVLA) to fix the underlying cause, combined with foam sclerotherapy or avulsions to treat the visible veins.


Stage 4: Chronic venous insufficiency

This is the most severe of the stages and is when varicose veins are at their absolute worst. They are usually extensive, with widespread visible varicose veins. The majority of people will have had their varicose veins successfully treated before they reach this stage. Venous ulcers do affect a small number of people.

Symptoms are often debilitating and may affect your day-to-day life in a negative way, with severe leg pain, swelling, skin changes like discolouration and varicose eczema. At this point, venous ulcers are possible if there is no medical intervention undertaken to treat the underlying cause.

Endovenous laser ablation is recommended, alongside foam sclerotherapy or avulsions. If venous ulcers have developed, wound care will be required.


How We Can Help

We have been treating varicose veins for over 20 years, and have performed over 50,000 treatments. Our 50+ team of specialist consultants strive to help you achieve your desired outcome, by relieving you of your symptoms and improving the cosmetic appearance.

If you are struggling with varicose veins, our patient advisory team are on hand Monday to Friday 8am-5pm and Saturday 9am-4pm and are ready to answer your vein related queries. Contact the team today on 01782 753960 for further advice and support.

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