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Varicose Veins

The below content has been medically reviewed and approved by Consultant Interventional Radiologist Dr. Mark Bratby (MBBS, MRCP, FRCR), Medical Director and Head of the Medical Advisory Committee at Veincentre.

Last reviewed 1st March 2023.

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Varicose veins
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Overview of Varicose Veins

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

Varicose veins are very common, at least 1 in 3 people will be affected during their lifetime. They can cause a wide range of issues from unsightly thread veins to large painful varicose veins and even skin issues including skin ulcers. These issues will affect people in different ways and can range from never wearing shorts in the summer to bleeding and ulcers.

Fortunately, varicose veins treatment has improved significantly over the last 20 years, with the introduction of minimally invasive techniques (walk-in, walk-out procedures) to treat the vein from inside (endovenous ablation) coupled with improved scanning protocols, foam sclerotherapy and avulsion treatments to improve success rates, with much lower complication rates compared to older surgical stripping procedures.

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 valves within the veins results in a condition called venous insufficiency and reflects impairment of drainage through the veins affected, 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.

Varicose Vein Symptoms

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!”.

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

  1. They’re 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. They 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. They 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.

Varicose Veins Causes

Varicose veins occur 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

Deep vein obstruction is most commonly caused by a recent or old DVT (deep vein thrombosis). Common causes of deep vein thrombosis are due to poor flow in the leg veins such as after an operation, being bed-bound due to illness or reduced movement in the leg, e.g. immobilised in a cast after a fracture. DVT can in a minority of patients result in long-term damage to the valves in the deep veins which can be difficult to treat.

Muscle Pump Failure

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

Valve Failure

By far the most common reason for venous insufficiency and varicose veins is valve failure, which can result from the following:

  • Inherited valve defects (most common)
  • Hormones (e.g. in pregnancy)
  • Trauma
  • Previous thrombosis
  • Older age (although varicose veins can affect any age)
  • Being overweight
  • Doing a job that requires long periods of standing without moving or weak calf muscles

Click here to watch Dr Suzie Anthony explain the causes of varicose veins.

Varicose Veins Diagnosis

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 to watch Mr Wissam Al-Jundi explain how to diagnose varicose veins.

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    Varicose Vein Prevention

    Unfortunately, there is no way to prevent the valve problems that cause varicose veins, this can happen at any time in life from 18s to 80s and is often determined by family history. However, the inheritance pattern is not simple, and some family members can have large varicose veins at a young age and other family members have none in their lifetimes.

    If there is an underlying valve problem then pregnancy, hormonal cycles and working in a job on your feet all day can lead to the veins becoming larger more quickly, although the veins do often return to normal after pregnancy.

    The timing to come forward for treatment is an individual one and will be based on whether appearances and/or symptoms are the main concern and balanced against benefits and risks of procedure required. Many patients manage with varicose veins for many years and even large bulgy veins can be surprisingly symptom free.

    The best way of preventing varicose veins is to have the underlying problem treated with one of the modern minimally invasive techniques.

    Although varicose veins 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 to improve drainage from the legs when standing up
    • Regular exercise means your calf muscles pump the blood back toward your heart stopping it pooling within the veins
    • Elevating your legs when sat or lay down
    • Avoiding standing up for long periods of time
    • Controlling your weight puts less pressure on the veins


    Varicose vein treatment is not always necessary and, for this reason, it can be very difficult to get treatment on the NHS in England. 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 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. We manage your vein problems by first treating their underlying root cause. We identify and destroy any veins containing faulty valves in them before treating the visible varicosities. By destroying the root cause, we relieve the symptoms, reduce the visible varicosities and prevent the treated veins from returning.

    In 2014 the National Institute of Health and Care Excellence (NICE) recommends that all patients should have minimally invasive treatment and not surgery. We have been treating patients without surgery for over seventeen years. There is no need for general anaesthetic. All the treatments we offer are minimally invasive (walk in, walk out) and guided by accurate medical imaging such as colour duplex ultrasound. For a detailed description of the treatment options we offer here at Veincentre, take a look at our Varicose Veins Treatment page.

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