Varicose veins
Varicose veins
Varicose veins are those swollen, twisted veins you often see bulging under the skin, most commonly on the legs. They're quite common, and in most cases there's nothing serious to worry about.
Common Symptoms
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
When to See a Doctor
Contact your GP practice urgently if:
- your skin becomes painful, hot and swollen
Phone 111 if your GP practice is closed.
Contact your GP practice if you have varicose veins and:
- you have symptoms like pain, itching or swelling in your legs
- you get a sore on your leg that has not healed after 2 weeks
Causes
Why do varicose veins happen?
Varicose veins develop when the valves that control blood flow in your vein stop working as they should. Blood then builds up and puts pressure on the vein, making it swell and twist.
Who is most likely to get varicose veins?
Anyone can get varicose veins, but you're more likely to if you:
- are a woman
- are older
- are overweight
- are pregnant
- spend a lot of time sitting or standing
- have family members with varicose veins
- have had deep vein thrombosis (DVT)
Treatment
Treatment for varicose veins
Most varicose veins don’t need to be treated.
A GP may refer you to a specialist for tests and treatment if you have:
- symptoms like pain, heaviness, swollen legs, itching or skin changes
- any complications, like ulcers on your legs
Treatment to improve how varicose veins look isn’t usually available on the NHS if they don’t cause any other problems. You may be able to pay for it privately.
Specialist treatment for varicose veins
If you’re referred to a specialist they’ll usually do a test called a duplex ultrasound. This is a type of scan to check your blood flow. This helps to confirm if you have varicose veins and helps to plan your treatment.
There are different types of treatment that may be offered, including:
- procedures to block blood flow in the veins – like endothermal ablation and foam sclerotherapy
- surgery to remove varicose veins
- compression stockings
The specialist will explain which treatment may be best for you. They’ll also explain the benefits and risks.
Endothermal ablation is usually the first choice of treatment for varicose veins. It blocks blood flow in the veins so that they become less swollen.
There are 2 types of endothermal ablation.
Radiofrequency ablation
Radiofrequency ablation involves heating the wall of your varicose vein using radiofrequency energy.
During the procedure:
- The vein is accessed through a small cut made above or below the knee.
- A narrow tube called a catheter is guided into the vein using an ultrasound scan.
- A device called a probe is inserted into the catheter. It sends out radiofrequency energy which heats the vein until it’s walls collapse. This seals the vein meaning blood will naturally be redirected to one of your healthy veins.
Endovenous laser treatment
Endovenous laser treatment involves heating the wall of your varicose vein using energy from radio waves.
During the procedure:
- The vein is accessed through a small cut made above or below the knee.
- A narrow tube called a catheter is guided into the vein using an ultrasound scan.
- A tiny laser is passed through the catheter and positioned at the top of your varicose vein.
- The laser delivers short bursts of energy that heat up the vein and seal it closed. The laser is slowly pulled along the vein using the ultrasound scan to guide it. This allows the whole vein to be closed.
You’ll usually be awake during these procedures. You’ll have a local anaesthetic so that you don’t feel any pain.
You may need to wear compression stockings for about a week. You may have some pain and bruising, but you should be able to go back to most of your usual activities straight away.
You’ll usually be offered foam sclerotherapy if endothermal ablation is not suitable for you.
You’ll be awake during the procedure. You’ll have a local anaesthetic so that you don’t feel any pain.
During the procedure:
- You’ll have injections into your vein of a chemical mixed with air (foam).
- An ultrasound scan is used to make sure the injections are in the right place.
- The chemical blocks the vein so that blood stops flowing through it.
You’ll have the procedure in a hospital or clinic. You’ll be able to go home the same day.
You may need to wear compression stockings for about a week. You may have some pain and bruising, but you should be able to go back to most of your usual activities straight away.
You may be offered surgery to remove varicose veins if other procedures are not suitable for you. Surgery to remove varicose veins is called ligation and stripping.
You’ll usually be asleep during the operation. You’ll have a general anaesthetic so you won’t feel any pain.
During the procedure:
- The surgeon will mark your legs to show where the vein needs to be removed.
- The surgeon will make 1 cut in your upper leg (groin) and another cut lower down your leg at your knee or ankle.
- The surgeon will find the vein through the first cut and will tie it to stop blood flowing.
- A thin, flexible wire is then passed down the vein to the second cut. The surgeon will use the wire to pull the vein out.
- The cuts are closed using stitches that dissolve so they don’t need to be removed.
You can usually go home the same day. Moving around may be uncomfortable for a few days, and you may have some pain and bruising for a few weeks. You may need to take 1 to 2 weeks off work.
Your leg will be tightly bandaged or you’ll need to wear compression stockings for about a week.
Compression stockings put pressure on your lower legs. This improves blood flow and can help pain and swelling.
You’ll only be offered compression stockings for varicose veins if:
- procedures or surgery are not suitable for you, or
- you do not need other treatments
If you’re pregnant and have varicose veins, you may be offered compression stockings.
Compression stockings are not suitable if you have problems with blood flow in your arteries. A specialist can check for this.
Wearing compression stockings
There are different types of compression stockings. It’s important to talk to a doctor or pharmacist to make sure you get the right type for you.
You’ll usually need to wear compression stockings during the day and take them off at night.
If the stockings make your skin dry, apply a moisturising cream before going to bed.
Compression stockings usually have to be replaced every 3 to 6 months. If your stockings get damaged, speak to your GP practice.
Complications
Most people with varicose veins never go on to have any problems from them. When complications do show up, it is usually many years after the veins were first noticed.
Some of the complications that can develop include:
- bleeding
- varicose eczema, which is itchy, flaky, dry skin over the affected veins
- superficial vein thrombosis, a blood clot that makes the vein hard and painful
- deep vein thrombosis (DVT), a blood clot that forms deeper inside the leg
- venous leg ulcers, sores that take a long time to heal
Living with varicose veins
If you have varicose veins, there are things you can do that will help with your symptoms.
Helpful habits
- stay active regularly to keep the blood flowing well
- rest with your legs raised, using a stool or a cushion
- apply a moisturising cream if your skin is dry, flaky or itchy
- try to maintain a healthy weight
Habits to avoid
- avoid standing for long periods
- avoid sitting for long periods unless your legs are raised
- avoid smoking, since it can damage your veins