Understanding Varicose Veins: Causes and Treatments

By Mr. Devaraj, Warwickshire Vascular Clinic

Varicose veins are a common vascular condition that affect millions of people worldwide. It is estimated that about 30% of adults in general population can have varicose veins in lower limbs.

1. What are varicose veins ?

Varicose veins are dilated , tortous veins that are seen mainly in legs. They often appear as blue, bulging and tortous or wiggly veins, typically in the legs.

 

2. What symptoms can they cause?

Most varicose veins are unsightly and may not cause a lot of symptoms. People may be concerned about the cosmetic appearance of these varicose veins as they are unsightly.

 

 Common symptoms include:

· Aching in legs- tends to be worse towards the end of the day , especially if you are on your feet for a long time.

 

· Itching : common symptoms assocaited with varicose veins. Itching can be along the distribution of varicose veins or in the lower legs, just above the ankle.

 

· Restless legs – varicose veins can lead to restless legs partcicularly worse at night! Most people are not aware that varicose veins could be the cause of their restless legs. If you have visible, bulging veins in your legs and suffer from restlesss legs, one of the causes for your symptoms could be varicose veins

 

· Eczema : patches of redness in skin with itching, of ten described as varicose excema or venous eczema can appear in lower legs or along the varicose veins. Often there is a brown discoloration in the skin around this eczema

 

· Ankle swelling- particularly above the ankle and often worse at the end of the day and if you are on your feet for prolonged periods.

 

· Interesting fact : 1 in 5 adults ( 20%) can have the above symptoms of venous disease with NO visible varicose veins!

 3. What complications can varicose veins cause?

· Bleeding : An uncommon but a potentially serious complication from varicose veins. Bleeding generrally occurs in small varicose veins around the ankle or foot. Often bleeding occurs whilst in a shower or a bath! This bleeding can be painless but potentailly dangerous.

 

· Phlebitis : This is a painful condition in which the varicose veins suddenly become red, hot, tender and painful to touch. This is due to clots that develop in the varicose veins associated with inflammation.

 

· Leg ulcers : varicose veins result in high pressure in veins ( venous hypertension) that can result in development of a leg ulcer. It is estimated that about 1 in 5 ( 22%) patients with visible varicose veins can develop a leg ulcer over a 6 year period.

 

4. Who can develop varicose veins? What are the risk factors?

 

· Gender : Varicose veins are more common in Women compared to men

· BMI : High BMI or being overweight increases risk of develpoing varicose veins

·  Age : Chances of developing varicose veins increases with age

·  Prolonged standing : varicose veins are more common in people who are standing for long periods of time ( e.g. nurses, postman etc)

· Family history – varicose veins can run in families and can increase risk of developoing varicose veins, if you have family members with veins.

· Multiple pregnancies and child birth : increased risk of varicose veins with multiple pregnancies

 

5. What treatment options are available?

Most varicose veins are treated under local anaesthetic (i.e. you are awake during the procedure).

Most common procedure to treat varicose veins are:

1. Radiofrequency Ablation (RFA) or VNUS ablation

2. Endovenous Laser Ablation ( EVLA)

3. Ultrasound guided foam sclerotherapy (UGFS)

4. Micro-sclerotherapy for thread veins

5. Phlebectomies or multiple avulsions

6. Open Surgery involving high tie and stripping of varicose veins under General Anaesthetic.

Most clients with varicose veins will have an underlying venous insufficiency ( faulty valves in superficial veins). This is diagnosed and confirmed with a doppler ultrasound scan at consultation or with vascular lab.

Clients with varicose veins and underlying superficial venous insufficiency often require a combination of radiofrequency Ablation (RFA)  and foam sclerotherapy (UGFS) or Phlebectomies.

Patients with minor and moderate sized varicose veins with no underlying superficial venous insufficiency/ reflux ( i.e. no evidence of faulty valves in veins) may be offered only foam sclerotherapy as primary treatment option.

Some clients with significantly large varicose veins may require Radiofrequency Ablation (RFA)  and foam sclerotherapy (UGFS) and Phlebectomies in same setting to treat their varicose veins adequately. 

A small number of clients are not suitable for minimally invasive treatment under local anaesthetic, either due to extremely large, tortuous varicose veins or due to anxiety/phobia for local anaesthetic treatment. In these rare instances, we can offer General anaesthetic treatment in the form of RFA and Phlebectomies or open surgery with High tie and stripping of veins.

Clients with thread veins only with no underlying venous insufficiency on scan , can be treated by a procedure called ‘Micro-sclerotherapy’.

National Institute of Clinical Excellence ( NICE) in UK recommends Endovenous Thermal ablation with RFA/EVLA as first line treatment, UGFS as second line treatment and Open surgery and stripping as third line treatment for varicose veins.

RFA/EVLA with either UGFS or Phlebectomies are more effective on a short and long term compared to open surgery/stripping of veins.

 

Below are details of the most common treatment options for varicose veins:

· Radiofrequency ablation( RFA/VNUS ablation)- this treatment is done to treat the superficial truncal vein with faulty valves that is feeding the varicose veins. This is diagnosed with a doppler ultrasound scan at your initial consultation or with a doppler ultrasound scan done by vascular scientist. Sometimes there can be more than one truncal superficial vein in the same leg that could have faulty valves.

RFA/VNUS ablation procedure is done while you are awake, under local anaesthetic, with needles, wires, and injections with no cuts/incisions on skin. This involves placing a long tube with a heated filament into this truncal vein, infiltrating local anaesthetic mixed fluid/saline injections around the entire length of vein and closing off this vein with heat/thermal energy application.

 

 ·  Ultrasound guided Foam sclerotherapy ( UGFS)- this procedures involves injecting foam sclerotherapy into varicose vein branches with small needles using ultrasound guidance . Foam sclerotherapy is created by mixing a liquid chemical called ‘sclerosant’ with air to create the foam.

 

· Multiple avulsions or Phlebectomies- this procedure involves surgically removing/pulling out the large varicose vein branches from your leg under local anaesthetic. Varicose veins are marked with a black marker before the procedure and local anaesthetic injections are injected around these marked veins, small stab incisions (1-2mm) are done over these marked veins and veins are surgical removed. Small stab incisions are then closed with small sticky dressing called ‘Steristrips’. Occasionally it may require closure with an absorbable/dissolvable stitch.

 

 Why Choose Mr. Devaraj at Warwickshire Vascular Clinic?

• Consultant-led care with years of vascular surgery experience

• Access to the latest, evidence-based treatments

• Personalised treatment plans tailored to your condition

• Friendly, professional team offering ongoing support and aftercare

Book Your Consultation Today

If you are experiencing symptoms of varicose veins or are concerned about the appearance of your veins, early assessment can prevent complications. At Warwickshire Vascular Clinic, we’re here to help you regain comfort, confidence, and mobility.

Mr. Devaraj, Warwickshire Vascular Clinic