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Varicose veins

Varicose veins are  swollen and enlarged veins that are usually purple or blue and may bulge and look twisted. They usually develop in the legs.

Up to a third of the UK adult population are affected by varicose veins. They become more common as people get older, and women are up to 50% more likely to develop them than men.

A person with varicose veins may also experience aching uncomfortable legs, muscle cramps, swollen feet and ankles.

For women, symptoms may become worse during certain parts of the menstrual cycle.

Causes of varicose veins

Varicose veins develop after small valves inside the veins become weakened and damaged and stop working properly.

A number of factors predispose a person to varicose veins. These include:

  • Age
  • Genetics.
  • Jobs that involve a lot of standing.
  • Obesity.
  • Hormonal influences during  pregnancy, puberty and  menopause.
  • The use of  contraceptive pills and hormone replacement therapy (HRT).
  • A history of blood clots.
  • Conditions that cause increased pressure in the abdomen including pregnancy, tumours,  constipation and externally worn garments like girdles.

Diagnosis of varicose veins

If varicose veins are not causing discomfort, there may not be a need to get them looked at by a doctor as they do not usually need to be treated.

A diagnosis of varicose veins is made by a doctor looking at their appearance and talking to the person about their symptoms, including any pain.

If the doctor thinks further investigation is needed, a referral to a vascular specialist may be recommended, and tests may be arranged including Doppler ultrasound and a colour duplex ultrasound scan.

Treatment options for varicose veins

Treatment of varicose veins may be needed to ease pain or discomfort, or if there are complications, including leg ulcers or swelling or skin discolouration. Other people may request treatment for cosmetic reasons,

There are a number of forms of treatment for varicose veins. Some treatments for varicose veins are available on the NHS if there is a medical need.

  • Compression stockings or tights. The most conservative approach is simply to wear properly-fitting support stockings, especially when the veins cause painful or uncomfortable symptoms. These stockings can generally be purchased at pharmacies, but sometimes can be prescribed by your GP. They come in below-the-knee, above-the-knee and tights styles. Compression tights are not available on prescription.
  • Lifestyle changes. Good skin hygiene,  weight loss (if needed) and  walking can help to improve varicose veins and spider veins.
  • Sclerotherapy. This procedure, which has been available since the 1930s, is another treatment option for some people with varicose veins. This technique uses a chemical solution that is injected directly into the vein. Pressure pad dressing and compression bandages or stockings are then applied, obliterating the vein, which will gradually disappear over three to six weeks. The procedure is simple and can be performed in an outpatient setting.
  • Endovenous laser treatment. A procedure in which a small laser fibre is inserted into the vein. Pulses of laser light are delivered inside the vein, which causes the vein to collapse. The procedure is done as an outpatient under local  anaesthesia and you may notice some  bruising.
  • Radiofrequency ablation. A small catheter is inserted into the vein which delivers radiofrequency energy to the vein wall, causing it to heat, collapse and seal shut. The procedure is generally done as an outpatient or in a specialist’s consulting room and may be done under local anaesthesia.
  • Surgery. Surgical techniques to treat varicose veins include ligation (tying off of a vein) and stripping (removal of a long segment of vein). Another procedure, ambulatory phlebectomy, allows for the removal of large surface veins through very small incisions that do not need stitches. Surgery may be performed using local, spinal or general anaesthesia. Most patients return home the same day as the procedure. Surgery is generally used to treat large varicose veins. In July 2013, The National Institute for Health and Care Excellence (NICE) recommended that people with severe varicose veins should be offered heat energy and laser treatment as an alternative to surgery. NICE recommends that surgery should only be considered if neither of these treatments is suitable.
  • Transilluminated powered phlebectomy. During this procedure, one or two small incisions are made in your leg. Your surgeon will place a special light, called an endoscopic transilluminator, underneath your skin to see which veins are to be removed. The affected veins are cut and removed through the incisions using a suction device. Transilluminated powered phlebectomy can be carried out under general or local anaesthetic. You may notice some bruising afterwards.

Not all patients need treatment for their varicose veins or spider veins. Many people have no pain or other symptoms. For these individuals, no treatment is necessary, unless they want the veins removed for cosmetic reasons.

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