Varicose veins

Animation - How varicose veins develop

About varicose veins

Varicose veins develop when blood doesn't flow properly through the veins in your legs. There are two main types of veins in your legs:

  • superficial veins – these lie under your skin and include the long and short saphenous veins
  • deep veins

The saphenous veins are connected to the deep veins inside your legs by perforator veins. When blood doesn't flow properly from your superficial veins to your deep veins, pressure can build up. This is often due to problems with the one way valves that stop blood leaking back into your superficial veins. This results in blood collecting or pooling in your superficial veins and these are called varicose veins.

Varicose veins are very common – they affect up to a third of people. They affect more women than men.

Symptoms of varicose veins

Symptoms of varicose veins can vary. Some people don't have any symptoms at all. If you do have symptoms, they may include:

  • aching or throbbing legs – large varicose veins don't always cause more discomfort than smaller varicose veins
  • itchy or restless legs
  • swollen feet and ankles
  • lumps or bulging veins

These symptoms may be caused by problems other than varicose veins. If you have any of these symptoms, see your GP for advice.


Varicose veins

Complications of varicose veins

Complications of varicose veins include the following.

  • Thrombophlebitis – your superficial veins can become painful and red due to inflammation or a blockage in your veins.
  • Bleeding – your varicose veins can bleed if you cut or bump your leg.
  • Varicose eczema – your skin can become brown or purple. This is often permanent.
  • Venous ulcers – you can get ulcers when fluid leaks out of the varicose vein into the surrounding tissue.

Causes of varicose veins

The exact reasons why you may develop varicose veins aren't fully understood at present. However, it's thought that if you have varicose veins, then your vein walls are weak. This causes the valves in your veins to expand and separate, which damages them. Blood can’t travel up your veins as well or as easily as it should, and is more likely to pool.

You're more likely to develop varicose veins:

  • as you get older (because your veins lose their elasticity with age)
  • if you're pregnant (because of the increased pressure on your veins)
  • if you're very overweight (also because of the increased pressure on your veins)
  • if other members of your family have them
  • if you stand for long periods of time, for example you stand all day at work

Diagnosis of varicose veins

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

If your symptoms are severe or you have complications, your GP may refer you to a vascular surgeon (a doctor who specialises in blood vessels).

Varicose veins are easy to see in your leg. However, to work out the position and extent of any valve damage, your doctor may perform the following tests.

  • A Doppler test. This is an ultrasound technique that uses sound waves to produce an image of the inside of your leg. It will give your doctor information about the direction of blood flow in your vein and whether your valves are working properly.
  • An ultrasound scan (duplex). This will allow your doctor to examine your deep veins in detail.

Treatment of varicose veins

If your varicose veins don't cause you any discomfort, you may decide not to have any treatment. If you want treatment for cosmetic reasons, it’s unlikely you will be able to have this on the NHS. However, you will be able to have private treatment. You may be able to have NHS treatment if you have complications of varicose veins. Your doctor will explain the options to you and help you decide which treatment is best for you.

Self-help

Try not to stand for long periods of time as this may make your symptoms worse. If you rest your legs up on a stool, it may ease any discomfort.

Non-surgical treatments

Compression stockings can help the blood in your veins flow up towards your heart. The stockings may relieve the swelling and aching in your legs, but it isn’t known if they prevent more varicose veins from developing.

Surgery

Varicose vein surgery

In varicose vein surgery, your surgeon will remove any superficial veins that have become varicose veins. The veins that are situated deep within your legs will take over the role of the damaged veins.

There are many types of operation. The operation you have will depend on which veins need treatment – ask your surgeon for advice on which operation is best for you.

A common operation is ligation and stripping. In this operation, your surgeon will tie off the faulty vein (ligation) to stop blood flowing through it and then remove it (stripping). You may have phlebectomy with ligation and stripping to remove the smaller surface veins that lie under your skin. In this operation, your surgeon will use hooks to pull out your varicose veins through small cuts in your leg.

Although many people won't need any further treatment after surgery, it’s possible that new varicose veins can form.

Sclerotherapy (liquid or foam)

This treatment involves injecting a chemical into your varicose veins. This will damage the veins and close them. Liquid sclerotherapy is often used to treat smaller varicose veins. For larger veins, foam sclerotherapy is used. After you have you procedure, your doctor will put a compression bandage over the area. You may be asked to wear compression stockings for up to two weeks.

Studies have shown that this treatment is effective at treating varicose veins in the short-term. However, the long-term benefits aren't yet known. The procedure also has serious potential complications (problems that occur during or after the procedure), such as a stroke or damage to nerves. It's important to tell your surgeon if you have a history of deep vein thrombosis (DVT) to discuss the safety of ultrasound guided foam sclerotherapy.

Endovenous laser treatment

In this treatment, your surgeon will pass a fine laser inside your varicose vein. The laser will heat the inside of your vein and damage the vein wall, which will cause the vein to close.

Radiofrequency ablation

In radiofrequency ablation, your surgeon will use a high frequency electrical current to heat the wall of your varicose vein. This will damage the vein and cause it to close.

Transilluminated powered phlebectomy

In transilluminated powered phlebectomy (TIPP), your surgeon will place a special light under your skin and remove the varicose vein by suction. This treatment is relatively new so less is known about its long-term effectiveness.

Prevention of varicose veins

Although there are no scientifically proven ways to prevent varicose veins, the following suggestions may be useful.

  • Don't stand still for long periods of time.
  • Take regular exercise, such as walking.
  • Maintain a healthy weight.

Are there any medicines that my doctor could prescribe to treat my varicose veins?

Answer

No, there is no evidence that creams or medicines are effective at treating varicose veins.

Explanation

Over the years, many different medicines and creams have been tested for the treatment of varicose veins. However, there is no evidence to suggest that any of these work.

A small clinical trial in women with varicose veins showed that a medicine called rutoside can reduce symptoms such as night cramps and feelings of tiredness, but more research is needed in more people to determine if it’s effective.

There is no evidence to suggest that herbal creams, lotions and other medicines for poor circulation are effective for the treatment of varicose veins.

Always ask your doctor or pharmacist for advice and read the patient information leaflet that comes with your medicine.

What changes can I make to my diet and lifestyle to reduce my risk of developing varicose veins?

Answer

You can't always prevent varicose veins from developing but there are steps you can take to make them less likely to develop. If you improve your circulation and muscle tone it may help. For example, don't sit or stand still for long periods of time, particularly if you're pregnant.

Explanation

Regular exercise is a great way to improve your circulation and general health. If you’re unsure, ask your GP for advice on the best types of exercise for you.

If your job involves a lot of standing, try to change position frequently and move around as often as you can. Gently moving your feet will help to stretch your calf muscles and increase your circulation. When you sit down, don't cross your legs because this can restrict your circulation. Try to take regular breaks throughout the day and, if possible, keep your legs raised on something comfortable while you’re resting. Ideally, raise your legs above the level of your heart.

If you’re overweight, it can increase your risk of getting varicose veins so try to lose excess weight by eating healthily and taking regular exercise. This will take any extra pressure off your circulatory system and your heart will find it easier to pump blood around your body. Ask your GP for advice on the best ways to lose weight.

If you're pregnant and have developed varicose veins, they will often improve after you give birth. Compression stockings may also help to relieve any swelling and aching in your legs. They work by putting pressure on your veins to improve your circulation.

I have varicose veins. Does this mean I'm more likely to develop a deep vein thrombosis (DVT)?

Answer

Varicose veins happen in different veins to the ones where a blood clot or deep vein thrombosis (DVT) can occur. If you have varicose veins, you don’t normally have an increased risk of DVT, but this risk may increase slightly if you have a complication of varicose veins called thrombophlebitis.

Explanation

Many people with varicose veins worry about blood clots forming in their leg veins (DVT). However, the superficial veins in your legs that can develop into varicose veins are different to the ones deeper within your leg where DVT can occur.

However, if you have a complication of varicose veins called thrombophlebitis, you may be at increased risk of DVT but this risk is very small. Thrombophlebitis is a complication where the superficial veins can become painful and red due to inflammation or a blockage in the veins.

Although they aren't related, varicose veins and DVT can still occur in the same person and, on rare occasions, varicose veins may form as a result of DVT. Talk to your GP if you’re concerned about varicose veins and DVT.