Varicose veins

What are varicose veins?

Varicose veins are abnormal swollen veins on the surface of the skin. They are normally found in the legs but can sometimes occur around the buttocks and bottom.

Varicose veins that look bad may not always cause symptoms, whereas ones that are less obvious can often cause quite severe symptoms. If you are worried about varicose veins you should consult your GP, who may refer you to a specialist vascular surgeon.

Who gets varicose veins?

Varicose veins affect about a third of the adult population, and men and women are affected in the same proportion. They often appear first between the ages of 30 and 40, but can also occur in teenagers.

There seems to be an inherited predisposition to developing varicose veins as many people who suffer from them have a close family member who is also affected.

Symptoms

Varicose veins can cause many symptoms. These include:

• Aching of the calf, particularly at the end of the day or after standing for long periods of time. At night they can cause cramps and a feeling of a ‘restless leg’
• Swelling of the ankles because fluid cannot drain as well in the presence of varicose veins
• Itching of the leg because some varicose veins are associated with inflammation
• Eczema or scaling of the skin because of damage which is not fully understood
• Bleeding because the veins are close to the skin and in severe cases the pressure in them can cause the skin to erode
• Discolouration of the skin because of the trapping of blood cells that have leaked from the veins
• Hardness or thickening of the skin and fat beneath the skin. This is called lipodermatosclerosis
• Ulceration where the damage to the skin is so bad that it cannot heal.

Causes and risk factors

Varicose veins occur when some of the valves in the veins of the leg stop working properly. Normally, these valves ensure that blood flows upwards from the feet back to the heart. When they stop working properly, blood accumulates in the vein and it becomes a varicose vein.

It is not known why this happens but it is thought that inflammation or an inherited weakness in the vein walls might be involved.

Some people think that standing for long periods of time, being overweight, pregnancy, or frequently crossing the legs can cause varicose veins. There is little evidence to support these theories. However, for those with a tendency to suffer from varicose veins, standing for long periods of time, or being pregnant, may make them worse.

Treatment and recovery

In the vast majority of cases it is not possible to repair the damaged valves so treatments are aimed at symptom-relief or the removal of the varicose vein.

Stockings are sometimes offered to relieve the symptoms of varicose veins, but they do not prevent the condition from getting worse.

There are a variety of methods for removing varicose veins. Modern techniques mean that these can often be performed on a ‘walk in – walk out’ basis, with a local anaesthetic. Keyhole and ultrasound techniques are less painful than previous methods, and many people are able to return to normal activities within a day or two.

After the vein is removed, the blood naturally finds a different route back to the heart via other veins, much like a car taking a diversion around a closed road.

Are there any risks to treatment?

The risks associated with the removal of varicose veins are small. There will be some bruising after the procedure, but this normally disappears after a few weeks. As with any cut, there is also the risk of infection.

Sometimes, very fine veins known as ‘spider veins’ can develop at the site of treatment. These can be treated with injections (a process known as micro-sclerotherapy) or in some cases by the use of lasers.

One rare complication is deep vein thrombosis. If you or members of your family have a history of deep vein thrombosis then you should discuss this with your surgeon.

The vascular surgeon should talk you through all the risks before you have any procedure.

Will the NHS pay for the treatment of varicose veins?

Funding varies around the UK, but most patients with unsightly veins, aching or itching, are not eligible for treatment. This accounts for about 80 per cent of people with varicose veins. It is also worth noting that some private medical insurance companies do not pay for simple varicose veins to be treated.

You may wish to pay for treatment for your varicose veins. For further advice on this, talk to your GP.

What happens when you see the doctor?

If you are worried about varicose veins, you should consult your GP. They may refer you to a specialist vascular surgeon, who will ask you questions about your veins, the symptoms they cause and general questions about your health. They should examine your legs to look at the veins and any complications they might have caused. The surgeon may arrange some tests using a pencil-like device called a hand-held Doppler, or a more sophisticated ultrasound test called a venous duplex scan.

Do varicose veins come back?

After the removal of varicose veins, about a third of people will find that they develop more varicose veins within five years. It is not possible to cure varicose veins, so treatments are aimed at reducing their cosmetic impact and relieving the symptoms.

In some cases, varicose veins are left behind or return quickly after treatment, but modern procedures are making this much less common.