Varicose veins

Published by Bupa's health information team, May 2009.

This factsheet is for people who have varicose veins, or who would like information about them.

Varicose veins are swollen superficial veins (veins that lie under the skin) that look lumpy and dark blue or purple through the skin. They usually affect the legs, particularly the calf and sometimes the thigh. Varicose veins don't always need treatment as not everyone will get symptoms.

• Animation - How varicose veins develop
• About varicose veins
• Symptoms of varicose veins
• Complications of varicose veins
• Causes of varicose veins
• Diagnosis of varicose veins
• Treatment of varicose veins
• Prevention of varicose veins
• Questions and answers
• Related topics
• Further information
• Sources

How varicose veins develop

About varicose veins

Blood is pumped from your heart to your legs through arteries. Once it has supplied oxygen and nutrients to your legs, blood returns to your heart through your veins. To do this, the blood in your veins must flow upwards, against gravity. The muscles in your legs help this upward blood flow. Each time your calf and thigh muscles contract when you're walking, veins deep inside your leg are squeezed. One-way valves help prevent blood from flowing back down your veins.

Blood from the outer layers of your legs flows into superficial veins, which are connected to deeper veins inside your leg by perforator veins. When blood doesn't flow properly from your superficial veins to your deep veins, pressure can build up in your superficial veins. This results in blood collecting (pooling) in your veins, and these are called varicose veins.

Varicose veins are very common and affect up to three in 10 people at some time in their lives. They are slightly more common in women. For most people they are a problem mainly because of the way they look.

The deep and superficial veins of the leg

Symptoms of varicose veins

Symptoms of varicose veins may vary from person to person. They can include:

• aching or discomfort in your legs
• itchy or restless legs
• swelling of your ankles
• lumps and blue or purple colouring under your skin

Large varicose veins don't always cause more discomfort than smaller varicose veins, and some people don't have any symptoms at all.

These symptoms may be caused by problems other than varicose veins. You should visit your GP for advice.

Complications of varicose veins

Having varicose veins doesn't always mean that you will get complications. However, your varicose veins won't get better without treatment, and they will get worse over time.

Complications of varicose veins include the following.

• Thrombophlebitis - your superficial veins can become painful and reddened due to inflammation or blockage of your veins.
• Bleeding - your varicose veins can bleed if you cut or bump your leg. You should raise your leg above the level of your heart and apply pressure to the bleeding area to help stop the bleeding.
• Varicose eczema - this is brown or purple discolouration of the skin that often becomes permanent.
• Venous ulcers - you can get ulcers when fluid leaks out of the varicose vein into the surrounding tissue.

Causes of varicose veins

The reason varicose veins develop isn't fully understood. If you have varicose veins, it's thought that your vein walls are weak, and that this causes the valves in your veins to expand and separate, damaging them. This damage to your valves means that 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 if you're older or if you have a job requiring a lot of standing. Women are more likely to develop varicose veins because the female hormones (chemical messengers) relax the walls of the veins. Women who are pregnant or very overweight are much more likely to develop varicose veins. This is because of the increased pressure on your veins.

Diagnosis of varicose veins

Your GP will ask you 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 any complications your GP may refer you to a vascular surgeon (a doctor specialising in blood vessels).

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

• A Doppler test is an ultrasound technique that uses sound waves to produce an image of the inside of your leg. This gives your doctor information about the direction of blood flow in your vein and whether your valves are working properly.
• Colour duplex ultrasound scanning is used to look for any abnormalities in the structure of your vein, and to look at the bloodflow through it.
• The Trendelenburg test involves you lying down and lifting one leg up in the air. Your doctor then uses his or her hand, or a tourniquet (a medical device which your doctor can use to compress your leg) to block off the bloodflow in your veins temporarily. When you stand up again, your doctor can watch your varicose veins refilling with blood - this gives an indication of which part of the veins in your leg have faulty valves.

Treatment of varicose veins

If your varicose veins don't cause you any discomfort, you may decide not to have any treatment. If you do decide to have treatment, your doctor will explain your options to you and help you decide which treatment is best for you. The most common treatment options are listed below.

Non-surgical treatments

Compression stockings

Compression stockings may relieve the swelling and aching of your legs but they won't prevent more varicose veins from developing. Compression stockings can help the blood in your veins to flow up towards your heart, and some people won't need any other treatment.

Surgery

Varicose vein surgery

This involves removing any superficial veins which have become varicose veins. There are many types of operation you can have, depending on which veins need treatment. The most common is called ligation and stripping.

The operation is usually done as a day case under general anaesthesia. This means you will be asleep during the procedure.

Although many people won't need any further treatment after surgery, around three in 10 will develop more varicose veins within the next 10 years.

Sclerotherapy (liquid or foam)

This involves injecting a chemical into your varicose veins which damages the veins, causing them to close. Liquid sclerotherapy is often used to treat smaller varicose veins. For larger veins, foam sclerotherapy is sometimes used.

The operation is usually done as a day case under local anaesthesia. This completely blocks feeling from the treatment area and you will stay awake during the operation.

You will be given compression stockings to wear after your treatment. Your doctor will advise you on how long you will need to wear them for.

Studies have shown that this treatment is effective at treating varicose veins in the short-term. However, the long-term benefits of this treatment aren't yet known.

A US study showed that in some people, foam bubbles escaped from the leg veins and reached the heart. Sometimes the bubbles crossed into the oxygen-carrying blood that is pumped round the body, including to the brain. It's important to discuss the safety of ultrasound guided foam sclerotherapy with your doctor.

Endovenous laser treatment

This uses a fine laser which is passed inside your varicose vein. The laser heats the inside of your vein causing damage to the vein wall. This causes the vein to close.

The operation is usually done as a day case under general anaesthesia. This means you will be asleep during the procedure.

Radiofrequency ablation

This involves using a high frequency electrical current to heat the wall of your varicose vein. This damages the vein causing it to close.

The operation is usually done as a day case under general anaesthesia. This means you will be asleep during the procedure.

Other approaches

You may be offered other less common treatments at some hospitals including the following.

• Phlebectomy uses hooks to pull out your varicose veins through small cuts in your leg.
• Transilluminated powered phlebectomy (TIPP) removes your varicose vein by suction.
• External laser therapy can be used to remove small varicose veins. A laser is used to damage your varicose vein causing it to close.
• Saphenous valvuloplasty is rarely used. It involves placing a patch of material around your varicose vein.

Your surgeon will explain your options to you and help you decide which treatment is best for you.

Self-help

You should try to lose any excess weight and take regular walks.

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
• wear properly fitted compression stockings to prevent your varicose veins from getting worse

Related topics

• Compression stockings
• Deep vein thrombosis
• Varicose vein surgery

Further information

• Circulation Foundation
  020 7304 4779
  www.circulationfoundation.org.uk

Sources

• Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2004;362-363, 640-641
• Thrombophlebitis. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 13 May 2008
• London NJ, Nash R. ABC of arterial and venous disease. Varicose veins. BMJ 2000; 320:1391-1394. www.bmj.com
• Campbell B. Varicose veins and their management. BMJ 2006; 333:287-292. www.bmj.com
• Hirsch SA, Dillavou E. Options in the management of varicose veins. J Cardiovasc Surg 2008; 49:19-26. www.minervamedica.it
• Ultrasound-guided foam sclerotherapy for varicose veins. National Institute for Health and Clinical Excellence (NICE), 2006, Interventional Procedure Guidance 217. www.nice.org.uk
• Subramonia S, Lees TA. The treatment of varicose veins. Ann R Coll Surg Engl 2007; 89:96-100. www.rcseng.ac.uk
• Endovenous laser treatment of the long saphenous vein. National Institute for Health and Clinical Excellence (NICE), 2004, Interventional Procedure Guidance 52. www.nice.org.uk
• Radiofrequency ablation of varicose veins. National Institute for Health and Clinical Excellence (NICE), 2003, Interventional Procedure Guidance 8. www.nice.org.uk
• Transilluminated powered phlebectomy for varicose veins. National Institute for Health and Clinical Excellence (NICE), 2004, Interventional Procedure Guidance 37. www.nice.org.uk
• Personal communication, Dr Wendy Simpson, General practitioner, Shaw House, Shaw, 5 August 2008
• Longmore M, Wilkinson IB, Rajagopalan S. Oxford Handbook of Clinical Medicine. 6th ed. Oxford: Oxford University Press, 2004:528-529
• Pathogenesis of varicose veins and implications for clinical management. Medscape. 2007. www.medscape.com

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: May 2009