Varicose Vein Treatment Overview
This page explains what varicose veins are and provides a summary of the best treatment options available.
What are 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 which are often purple or red in colour.
What are the causes of varicose veins?
Varicose veins are caused by increased venous pressure, weak vein walls and faulty valves in the legs. 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 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’. Venous insufficiency 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 the population over 65 years, 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:
1. Deep vein obstruction
2. Muscle pump failure
3. Valve failure
Deep vein obstruction can be caused by DVT (Deep Venous 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 commonest 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 and eventually a varicose vein becomes prominent.
So you can see the most important factor is your genes; did your mother have varicose veins?
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 is crucial to the effective management of all venous insufficiency problems including varicose veins, reticular veins, spider veins and ulceration.
As varicose veins are a genetic problem unfortunately there is nothing that you can do to prevent them.
To help explain this in more detail it is useful to explain how normal (healthy) veins function. Click here to read more.
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 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 assessed?
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 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. This 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 on NHS funding, it is unlikely they will be able to refer to you 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 they’re not deteriorating rapidly then 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 having appropriate treatment. Treatment is advised as 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 three main reasons not to ignore varicose veins and to get the underlying problem which is causing the increased pressure treated:
- 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 even to their partner. This has an adverse effect on sport participation and enjoyment of holidays and 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.
- Varicose veins hurt. As mentioned above it isn't actually the varicose veins that normally cause the symptoms but the increased pressure. Nevertheless, most patients with varicose veins suffer from various symptoms which 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.
- 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 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 getting worse, the following may help ease symptoms; wearing compression stockings, regular exercise, avoiding standing up for long periods of time, elevating your legs
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 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.
Treatments for Varicose Veins
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. See our Standard Patient Pathway which outlines the four stages involved in diagosing and treating 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.
EVLA (Endovenous Laser Ablation) has been endorsed by the National Institute of Health and Care Excellence (NICE) as the Gold Standard treatment for varicose veins.
EVLA is used to treat the underlying cause of the visible varicosities on the surface of the legs.
Prior to treatment, a colour duplex ultrasound scan is required to determine which veins have faulty valves (venous reflux) in them. The most commonly affected veins are:
Great Saphenous Vein (GSV), previously known as the Long Saphenous Vein. This vein runs all the way from the ankle to the groin and is the major superficial blood vessel in the leg.
Small Saphenous Vein (SSV). This vein is smaller than the GSV and is considered the second major superficial blood vessel in the leg.
Other veins that can be affected are the Anterior Accessory Great Saphenous Veins (AAGSV), Posterior Accessory Great Saphenous Veins (PAGSV), Giacomini Veins and Perforator Veins. It is vitally important the all the veins are assessed for venous reflux. Any vein found to contain reflux must be treated in order to achieve effectively treat the cause of the vein problems. Failure to treat the underlying cause, however small, will likely result in early recurrence.
What does the EVLA procedure involve and how does it work?
EVLA is minimally invasive and carried out on an outpatient basis under local anaesthetic. EVLA is a safe, proven procedure which takes around an hour.
EVLA is always performed using ultrasound guidance which gives the consultant a live view of your veins during the procedure. Through a small needle puncture, a thin laser fibre is carefully inserted directly into the veins which contain the faulty valves. Once the fibre is in right position, laser light is delivered and the fibre is slowly pulled along the vein, which heats up the vein wall and destroys it in situ. Once the vein has been destroyed, it is then absorbed by your body.
Prior to the vein being destroyed, local anaesthetic is injected around the vein to numb the leg and ensure that the tissues surrounding the vein are not damaged when the vein is heated up. As such, the lasering is virtually painless however you are likely to experience some discomfort from the local anaesthetic injections.
The blood that used to flow in the destroyed veins is subsequently diverted to healthy veins improving the circulation of blood within the legs.
Following EVLA the varicosities may shrink in size, however it is normal for these varicosities to need treatment by additional methods such as foam sclerotherapy and phlebectomies/ avulsions.
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.
Visit our dedicated EVLA page for more information regarding the EVLA procedure including a detailed description of what to expect when you attend for treatment.
Ultrasound Guided Foam Sclerotherapy injections are most frequently used to treat smaller varicose veins.
The solution, sclerosant, in the foam sclerotherapy injection consists of a chemical which is injected directly into the veins with the faulty valves. It works by displacing the blood in the vein, causing the wall of the vein to contract and sealing it off from the healthy veins. The veins then shrink and the body gradually breaks down the vein and absorbs it. As with EVLA, once the veins have been destroyed, the blood is naturally rerouted to healthy veins improving your circulation.
We find foam very effective at dealing with any small varicose veins still remaining after the superficial veins (e.g. the GSV and SVV) and the reflux has been destroyed by EVLA.
The requirement for ultrasound guidance during foam sclerotherapy depends on the size of the veins being treated. Ultrasound guidance is used when treating large varicose veins however for smaller veins closer to the surface, it is not often necessary for the ultrasound to be used as visual inspection is sufficient.
Traditional surgery for varicose veins involves tying off and stripping the main truncal veins (the underlying cause) under general anaesthetic. At the same time the varicosities (the branches of the truncal veins) that most patients are concerned about are removed through small incisions using a small crochet hook. This is called avulsions or phlebectomies.
With endovenous techniques, like EVLA, the varicosities are usually dealt with by foam sclerotherapy injections after 6 weeks. This works well in most patients. Some patients and some doctors however prefer avulsions rather than injections. Avulsions can be performed under local rather than general anaesthetic. A needle is used to make tiny incisions over the varicosities and then they are teased out using miniature “crochet” hooks. The nicks in the skin require no stitches but are sealed with bits of sticky tape. Stockings are applied for 1 week.
Avulsions cannot be performed at the same time as EVLA on all patients as there is a limit to the amount of local anaesthetic that can be used on one patient at one time. It is more likely to be possible if only one leg is treated.
Other techniques include Phlebectomies/ Avulsions, RF Ablation, VNUS Closure, Sapheon Superglue, ClariVein, Perforator Ablation (TRLOP) and Embolisation.
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 varices. Both these types of varices can be easily treated by an outpatient technique called embolisation.
TOP Frequently Asked Questions:
Does anything increase the risk of developing varicose veins?
The main thing that increases your chance of getting varicose veins is if your parents or grandparents had them. They may be made worse during pregnancy and so our advice is to have treatment before you get pregnant.
How can I prevent Varicose Veins?
Unfortuantely, as they are a genetic problem there is essentially nothing you can do to prevent them.
What is the cost of varicose vein treatment?
The vast majority of our patients pay a total of £2245 for consultation, treatment and follow-up on one leg and £2545 for both legs. See detailed prices here.
|BASIC PRICE LIST|
|Consultation/ Treatment||Fixed Cost||London|
including colour duplex ultrasound scan
|EVLA Unilateral |
|Initial follow up appointment|
inc ultrasound guided foam sclerotherapy injections if required
|PRICES FOR ALTERNATIVE TREATMENTS|
View all FAQs here.