Varicose 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, and are often purple or red.

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What are the causes of varicose veins?

Varicose veins are caused by failure of valves in the veins that normally ensure flow of blood in only one direction; from foot to heart. For patients with definite varicose veins, the commonest treatment required to fix the underlying cause of the veins is EVLA (Endovenous Laser Ablation) followed by Foam Sclerotherapy injections (which treat the blood in the veins on the surface of the legs). Some patients may not need EVLA and will only require the Foam Sclerotherapy Injections. Both these treatments are recommended by NICE. A colour duplex ultrasound scan is required to determine the exact treatment required.

Inside your veins, there are tiny valves that control the direction in which the blood flows. When working properly, these valves ensure the blood flows in one direction only: up your legs from your foot to your heart. However, if these valves fail, it causes the blood to flow backwards (i.e. in the wrong direction), and the blood starts to accumulate in the veins, causing them to swell, enlarge and bulge out of your legs.

This failure of the valves is also referred to as venous insufficiency, which can manifest in many ways. At its most mild, it causes spider veins, which are by and large cosmetic problems only, but can be associated with aching. Slightly larger bluey veins can also result, which lie slightly deeper and are called reticular veins. More severe failure causes the common varicose veins and, in 1-2% of over-65s, skin changes and ulcers will result.

All these are due to high pressure developing in thin-walled veins, which are designed to withstand low pressures only. Venous insufficiency can be caused by the following:

  • Deep vein obstruction
  • Muscle pump failure
  • Valve failure

Deep vein obstruction can be caused by DVT (deep vein thrombosis), e.g. in economy class syndrome or by tumours in the pelvis, compressing the veins. If it persists, it causes valve failure too.

Muscle pump failure occurs in any condition where the calf muscles are very weak. If this persists, it also causes valve failure.

By far the most common reason for venous insufficiency and varicose veins is valve failure, which can result from inherited valve defects (most common), hormones (e.g. in pregnancy), trauma, previous thrombosis or weak calf muscles.

Once one valve is damaged, allowing reflux through it, this causes the vein below to stretch. This causes the next valve down to be pulled apart and also fail, leading to a domino-type effect, with more and more valves failing. Eventually, a varicose vein becomes prominent.

So you can see that the most important factor is your genes.

When the valves fail, blood flows the wrong way through the veins – away from the heart. This is called reflux. The detection, localisation and treatment of reflux are crucial to the effective management of all venous insufficiency problems, including varicose veins, reticular veins, spider veins and ulceration.

Unfortunately, as varicose veins are a genetic problem, there is nothing that you can do to prevent them.


What symptoms are associated with varicose veins?

Varicose veins often cause symptoms in the legs, 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 some patients, actual ulceration of the skin occurs, which can take months to heal without appropriate treatment.

Patients with vein problems often note that they are experiencing at least a few of the symptoms outlined above. However, some patients live with the symptoms for so long that 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 valve failure, can occur with no evidence of visible varicose veins.

How are varicose veins assessed?

The only way to accurately determine the underlying cause of your varicose veins or thread veins is by having a colour duplex ultrasound scan performed on your legs. Without this full and detailed scan, it is impossible to properly 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; it may be a consultant interventional radiologist, a vascular surgeon or a specialist venous nurse practitioner.

Click here for more information regarding the Colour Duplex Ultrasound Scan and Consultation.

Do I need to see my GP to diagnose varicose veins?

Varicose veins are diagnosed by their appearance, and so most patients simply self-diagnose them without needing to see their GP. It is strongly recommended, however, that if you undergo any diagnostic scans or treatment, your GP is informed.

If you seek advice from your GP they are likely to refer you on to see a doctor specialising in varicose veins if your veins are causing you significant distress; regardless of whether they are symptomatic or purely cosmetic.

Due to the lack of NHS funding, it is unlikely that your GP will be able to refer you to a doctor on the NHS, and they will most likely refer you to a private clinic.

Should varicose veins be treated?

This is a good question as the NHS in England has largely given up on treating varicose veins. Varicose veins don’t always need to be treated. If your varicose veins aren’t causing you significant discomfort or cosmetic distress, and if they’re not deteriorating rapidly, there may be no rush to seek treatment.

Varicose veins are, however, an indicator of an underlying valve problem, and the only way to fix this valve problem (and reduce the increased pressure in the legs) is by having appropriate treatment. Varicose veins treatment is advisable, because this increased pressure over time can cause deterioration in the quality of the skin and, if left untreated, may result in a painful varicose ulcer.

Many patients come to us as they remember their grandma suffering over many years with painful ulcers and having to have her legs bandaged all the time. They don’t want to suffer as she did and want to nip the problem in the bud. Very sensible!

There are 3 main reasons not to ignore varicose veins and to get the underlying problem which is causing the increased pressure treated:

  1. Varicose veins are unattractive. Many people are seriously affected by the looks of their veins. They will not show their legs in public and indeed often not even to their partner. This has an adverse effect on sport participation, enjoyment of holidays and plenty of other leisure activities. In some, it can affect their careers, and we have seen many actors and models (both sexes!) who “needed” their legs to look better. Most patients are delighted with the appearance of their legs after our treatments.
  2. Varicose veins hurt. As mentioned above, it’s not the varicose veins themselves that normally cause the symptoms, but the increased pressure. Nevertheless, most patients with varicose veins suffer from various symptoms that can also affect lifestyle. Common symptoms are tired legs, itchiness, throbbing, restless legs and aching. These symptoms usually resolve very quickly after EVLA and RFA.
  3. Varicose veins can lead to serious skin damage and ulcers. Although most patients with varicose veins don’t get ulceration, most leg ulcers are associated with varicose veins and are caused by the same problem that causes varicose veins. Treating the varicose veins properly removes this cause and dramatically reduces the risk of leg ulcers.


Although treatment is the only way to fix the problem and prevent the veins from getting worse, the following may help ease symptoms:

  • Wearing compression stockings
  • Regular exercise
  • Elevating your legs when sat or lay down
  • Avoiding standing up for long periods of time


We do not believe in over-diagnosing. There is absolutely no point in screening for venous problems if you have no visible unsightly veins and no symptoms. Some clinics advertise “Screening for Vein Problems”. Our opinion is that this is just a PR exercise aimed at boosting business, and has no health or cosmetic benefit. Even if it is discovered by such screening scans that you already have venous valve problems, it will do no harm whatsoever to wait until such time as you develop symptoms or develop varicose or thread veins which you want to eradicate.

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. In the female pelvis, they are responsible for much undiagnosed pelvic pain as well as obvious vulvar varices. Both these types of varices are easily treated by an outpatient technique called embolisation.

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