Overview
Varicose veins are enlarged, twisted veins that most commonly appear in the legs. They develop when the one-way valves inside veins fail, allowing blood to pool and veins to bulge. Most varicose veins are primarily a cosmetic concern, but they can cause aching, heaviness, and skin complications. A small proportion lead to serious venous disease.
How common is it?
Varicose veins affect approximately 20 to 25% of adults, with prevalence increasing with age. Women are more commonly affected, though the gender gap narrows with age.
Causes and risk factors
Faulty vein valves allow backflow of blood under gravity, increasing venous pressure and causing vein wall dilatation and elongation.
Common risk factors
- Family history (inherited valve weakness)
- Female sex and hormonal changes
- Prolonged standing occupations (hairdressers, teachers, surgeons)
- Obesity
- Pregnancy (increased pelvic venous pressure)
- Age (valves weaken over time)
- Previous DVT (post-thrombotic syndrome)
- Sedentary lifestyle
Symptoms
- Visible, bulging, twisted blue or purple veins on the legs
- Aching or heaviness in the legs, especially after prolonged standing
- Swollen ankles, particularly at the end of the day
- Itching around the veins
- Restless legs at night
- Skin changes in advanced disease: discolouration (haemosiderin staining), lipodermatosclerosis, varicose eczema
- Venous leg ulcers in severe longstanding disease
When to see a doctor
See a GP for varicose veins causing significant pain, swelling, skin changes, or venous eczema. Seek urgent assessment for a warm, tender, red cord-like vein (superficial thrombophlebitis) or a venous leg ulcer.
Diagnosis
Clinical examination with Trendelenburg test to identify the site of valve failure. Duplex ultrasound maps the venous anatomy and confirms incompetent valves (essential before treatment).
Treatments
Conservative management
Compression stockings (class II, thigh-length) reduce symptoms and slow progression. Elevate legs when resting. Increase physical activity (exercise pumps blood through the venous system). Maintain healthy weight.
Endovenous thermal ablation
Laser or radiofrequency energy is delivered via catheter into the great saphenous vein, causing it to close. Less invasive than surgery, done under local anaesthetic, with rapid return to normal activity. NICE-recommended first-line interventional treatment.
Foam sclerotherapy
A foam agent is injected into varicose veins, causing scarring and closure. Used for smaller and recurrent varicosities or after ablation to treat residual tributaries.
Surgical stripping
Traditional surgery under general anaesthetic to physically remove the saphenous vein. Now reserved for cases not suitable for endovenous techniques. Higher complication and recurrence rate than thermal ablation.
Self-care and lifestyle
- Walk regularly — the calf muscle pump is the most effective treatment for venous return
- Avoid prolonged standing without moving — shift weight and take walking breaks
- Elevate legs above heart level when resting (for 30 minutes 3 times daily)
- Maintain a healthy weight and wear compression stockings if symptomatic
Prevention
Regular walking, maintaining a healthy weight, avoiding prolonged standing, and wearing compression stockings during long flights or periods of standing reduce risk.