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Varicose veins

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Veins are blood vessels that take blood back to the heart. Varicose veins are veins that bulge under the skin. They are often found in the legs.

What are varicose veins?

The veins just under your skin are called superficial veins. The larger veins that run through your muscles and cannot be seen are called deep veins. Varicose veins are superficial veins that bulge under the skin.

Some people have small veins that can be seen. These veins can have different names. For example, thread veins, spider veins, venous flares or reticular veins. These are not varicose veins. Treatment for them is considered cosmetic, and is not available on the NHS.

Causes of varicose veins

Our veins have valves that keep blood going back to the heart. If these valves weaken, they can let blood go the ‘wrong way’ back through the vein. This is called reflux.

Varicose veins are most commonly caused by reflux in a superficial vein in your thigh or in your calf. This vein puts more pressure on weaker veins further down your leg, and causes them to become varicose.

It is not known why the valves fail in some people. Often varicose veins run in the family.

Other factors that increase the pressure in your leg veins, such as pregnancy, obesity and standing for long periods of time, might speed up the development of varicose veins.

Varicose veins are very common. They affect 1 in 5 people at some time during their lives. 

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Symptoms of varicose veins

If you have varicose veins, you might feel pain in the affected veins, and your legs might feel tired and heavy.

Lumpy veins might be visible, and there might be swelling in your lower legs.

Over time the skin around your ankle can start to look different, and eczema, brown pigmentation and eventually leg ulcers can appear.

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Who can have treatment?

If the pain in your legs is caused by varicose veins, treatment should help.

However, there are many common causes of leg pain, such as arthritis, sciatica and restless legs. It is tempting to link any symptoms in your legs with your varicose veins, but treating your varicose veins will not help any symptoms caused by other conditions.

Your GP or consultant will be able to tell you if your symptoms are caused by varicose veins and if treatment will help.

Things you can do to help your symptoms

Anything that lowers the pressure in the veins of your leg can help your symptoms.

  • Exercise, such as walking, lowers the pressure in your veins. This is because the muscles in your calf pump the blood out of your leg.
  • Raise your legs when sitting, and avoid standing still for long periods of time.
  • Being overweight puts more pressure on your leg veins. Losing weight will help. Your consultant or GP can tell you if you are within the weight range for your height, and give you information and support with eating healthily and losing weight.
  • Compression stockings squeeze the blood out of the veins under your skin into your deep veins. They will also help with any discomfort from your varicose veins.

NHS treatment

If you have pain, aching, discomfort, swelling, heaviness or itching in your legs you should be seen at the hospital to check your veins. 

However, NHS funding for the treatment of varicose veins is closely monitored. Treatments are only for certain people. 

To have NHS treatment for varicose veins, you will have at least one of the following: 

  • varicose eczema
  • lipodermatosclerosis or a venous ulcer
  • a venous ulcer that has taken over 2 weeks to heal
  • one or more episodes of superficial thrombophlebitis
  • a major episode of bleeding from a varicosity

You can only have treatment if you have had a diagnosis of varicose veins, and the consultant can see that there is blood flowing the wrong way through a vein (reflux). You will need to be a healthy weight, or have tried to lose weight over the last year. 

You should be aware that unless you meet these criteria we cannot offer surgical treatment, unless your GP has completed an Individual Funding Request. Ask your GP for more information about this request.

Your hospital appointment

You will be seen by a vascular consultant who will check your symptoms and look at your legs.

A duplex scan will be done in the clinic, or arranged for a later date. A duplex scan is a type of ultrasound scan. It uses sound waves to detect blood flow in your veins. This will show any veins with faulty valves that are causing your varicose veins.

At the clinic, the consultant will look at your notes and check the results of your scan. They will tell you your diagnosis and treatment plan. Your treatment options will be explained to you.

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Treatment options for varicose veins

If you are able to have treatment for varicose veins you might have non-operative or operative treatment. 

Non-operative treatment is using support or compression stockings.

Operative treatments are:

 

  • Asking for your consent

     

    We want to involve you in decisions about your care and treatment. If you decide to have treatment, you will be asked to sign a consent form to say that you agree to have the treatment and you understand what it involves. If you would like more information about our consent process, please speak to a member of staff caring for you.

Radiofrequency ablation (RFA)

This is also known as endovenous ablation technique. The procedure usually takes about 30 minutes.

This treatment uses heat to close off the vein that is causing your varicose veins.

It is done under local anaesthetic. This numbs the area so you should not feel any pain. This anaesthetic does not put you to sleep. This means you will recover faster.

  1. After the area is numb, the surgeon will make a small cut, usually near your knee or on your calf.
  2. They will use an ultrasound scan to guide a narrow tube called a catheter into the vein that needs treating.
  3. A fine probe is then passed through the catheter and inside your vein.
  4. Local anaesthetic is injected around the vein.
  5. The catheter is powered by radiofrequency (RF) to deliver heat to the vein wall. This is when the vein wall shrinks and the vein is sealed closed.
  6. The catheter is slowly removed.
  7. An ultrasound scan is used to check that the procedure has worked.
  8. A small dressing and a bandage will be placed over the small cut, and you will have a compression stocking put on.

Ultrasound-guided foam sclerotherapy (UGFS)

Sclerotherapy injects a substance called a sclerosant into the veins. This shrink the veins and closes them off.

The procedure itself usually takes only a few minutes. It is done without an anaesthetic.

  1. The sclerosant is mixed with air to create foam. This is so that it can be seen using an ultrasound scan.
  2. Guided by the ultrasound scan, the foam is injected into the vein that is causing the varicose veins.
  3. A small dressing or a pad, and a bandage will be placed over the area. This is so the treated vein is squeezed flat. 
  4. You will have a compression stocking put on.

Surgery

Surgery will remove the problem vein. It is done under general anaesthetic, which means you will be asleep during the surgery.

This surgery is used less often than the keyhole procedures explained above.

Surgery is different for everybody. It depends on where the faulty valves in the vein are, and the size of your veins.

You might have a vein stripping procedure, or an avulsion. 

Vein stripping procedure

  1. The surgeon will make a cut in your groin.

  2. Through this cut, the top end of the leaky vein is tied off to stop blood flowing through it. This is known as ligation.
  3. A wire is put in to the vein, and passed down to your knee level.
  4. Then, a second cut is made around the knee and the vein is pulled out.
  5. The leg is bandaged from toe to groin at the end of the surgery.

In some cases, the main vein on the back of the knee has a leaking valve and will also need to be tied off to stop blood flow (ligation). If this is the case, an incision will be made on the back of the knee. The vein is then removed. This is not done very often, as the vein at the back of the knee is close to a nerve.

Avulsion procedure

In most cases, the varicose veins are removed through smaller cuts (incisions) that are 2 to 3mm). This is called avulsion. 

There might be a large number of tiny incisions if you have a lot of varicose veins.

Your blood flow (circulation)

Having the vein removed will not affect the blood flow (circulation) in your leg.

The important veins in your leg that take blood to your heart are the deep veins, which are not damaged by this treatment. The vein that is treated has blood flowing the wrong way (reflux).

Some people’s circulation is improved by treating the refluxing vein.

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After radiofrequency ablation or sclerotherapy treatment

If you have radiofrequency ablation (RFA) or Ultrasound-guided foam sclerotherapy (UGFS), you can walk out of the hospital about 30 minutes after your procedure. 

You should not drive yourself home.

Possible problems after RFA or UGFS treatment

  • Most people feel a tightening along their leg after the procedure.
  • Once the local anaesthetic wears off, there might be some pain and bruising along the line of the treated vein. The bruising will go after a few weeks.
  • About 1 in 10 people have swelling that can cause discomfort and lumps around the vein. This is called phlebitis. It usually settles down without treatment, but painkillers might help. When the swelling has gone down, there might be some brown staining on your skin. This fades over time, but it can be permanent. To lower the chances of phlebitis, it is important that the vein is squeezed empty after the procedure. For this reason, you will need to wear compression stockings.
  • The varicose veins can come back after any type of procedure. Weakness in the vein valves might happen in other veins, which can cause varicose veins in the future.
  • There is a small risk of a blood clot (deep vein thrombosis or DVT) after any operation to the legs. To lower the risk of a blood clot, you should return to walking after your treatment. This keeps your blood flowing in the deep veins of your legs. Not being active can increase your risk of a blood clot.
  • There is a small risk of damage to other veins and nerves in the leg, which might lead to a numb area of skin, or tingling.
  • An RFA can cause burns to your skin, but this does not usually happen.
  • Any procedure that cuts the skin has a risk of an infection. 
  • Allergic reactions can happen shortly after injections of sclerosant, but this does not happen often.

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After surgery to treat varicose veins

In most cases, you can leave hospital on the same day of your surgery.

It is important that you rest for the day, to recover from the anaesthetic. You will need someone to help you get home and to stay with you for at least 24 hours.

You should be able to eat and drink again a few hours after surgery.

Most people describe the feeling in their leg as stinging or burning. It should not be painful. Any discomfort usually gets better about 2 weeks after the surgery.

Some of the cuts (incisions) made during surgery might bleed a little over the first day or 2. This is why it is best to keep your leg covered with bandages for the first 48 hours.

The bruising will last for 3 to 4 weeks. The incisions made will become almost invisible in 9 to 12 months.

The bandages need to be removed after 48 hours and replaced with stockings (T.E.D stockings) that you are given by your nurse. Wear the stocking during the day for 12 days. You do not need to wear it at night.

You can have a bath or shower 48 hours after surgery. You can then remove the strips placed on the incisions. Make sure you remove your stocking before getting in the bath or shower.

Try to go for 20 minute walks at least 3 times a day after your surgery.

Possible problems after surgery

If you have surgery to treat varicose veins, you should be aware of the following potential problems. Find more information of things to be aware of after treatment in the RFA and UGFS section.

  • Bleeding. Sometimes a little bit of blood oozes from the wound sites during the first 12 to 24 hours. This usually stops on its own. If you need to, press on the wound for 10 minutes. If the bleeding continues after doing this twice, contact your GP or the hospital.
  • Wound infection. Wounds sometimes get infected, and this might need to be treated with antibiotics. This is not very common and bad infections are rare. Sometimes, hard and tender lumps appear near the scar or along the line of the removed veins. These can appear some weeks after surgery. These are not a cause of concern. However, if you have lumps and swelling, redness and severe pain, you might have a wound infection. You should see your GP or go to the hospital straight away.
  • Chest infection. This can happen after surgery under general anaesthetic, particularly in smokers. You might need treatment with antibiotics and physiotherapy.

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Returning to normal activities

You can carry out your normal day-to-day activities straight after your treatment for varicose veins.

However, you should not exercise for the first few days. After this, slowly build up the amount you do. Do what you feel able to do.

Do not swim in public swimming pools until your wounds have healed. 

Going back to work

You can go back to work when you feel well enough and comfortable.

We usually advise taking between 2 days to 1 week off work, depending on the type of work you do. If your job involves standing for a long period of time, driving, or if you have had both legs treated at the same time, you might need to take longer off work.

Please check with your employer if they need a fit note (sometimes called a sick note). It is usually okay to self-certificate for up to 7 days. If you are off work for a longer period of time you will need to see your GP for a fit note.

Driving

Do not drive for at least 48 hours after your procedure.

You should only drive again when you are free of pain and can do an emergency stop comfortably. You should check with your insurance company to make sure you are covered to start driving again.

If you are taking painkillers, please check with a pharmacist if it is safe for you to drive.

Flying

Sitting down for a long time with your knees bent increases the risk of a blood clot in your leg. Avoid long-haul travel (over 4 hours long) for at least 4 weeks after your procedure.

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Follow-up appointment

In most cases, the consultant will be happy for your follow-up to be done by your GP. If you do need to see your consultant, you will be sent a letter in the post with appointment details.

It is important to understand that not every visible vein will disappear after your treatment. Treatment is done to help your symptoms, not for cosmetic purposes. 

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What to do in an emergency

If you have any of the following symptoms, get medical help straight away. You should call 999 for an ambulance or go to your nearest Emergency Department (A&E).

  • You are finding it hard to breath, which gets worse when you take a deep breath.
  • You have a sudden cough, or you cough up blood.
  • You have sudden chest pain.
  • You have pain in your calf and you cannot put your foot down.

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Ref number: 2883/VER5

Date published: May 2021 | Review date: May 2024

© 2021 Guy’s and St Thomas’ NHS Foundation Trust

A list of sources is available on request

 


Where next?

 Contact us

If you have any concerns about your varicose veins treatment, contact your GP or the vascular department

phone 020 7188 0766 or 020 7188 7335 Monday to Friday, 9am to 5pm

email gst-tr.vascular@
nhs.net

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