Varicose Veins
Date issued: November 2023
Review date: November 2025
Ref: A-99/S/V/CC/varicose veins v5
PDF: Varicose veins final November 2023 v5.pdf[pdf] 222KB
What are varicose veins?
Varicose veins are veins under the skin, which have become widened, bulging and tortuous. They are very common and do not cause medical problems in most people.
Blood flows down the legs through the arteries, and back up the legs through veins.
There are two main systems of veins in the legs: deep veins (which carry most of the blood back up the legs to the heart) and superficial veins (under the skin), which can form varicose veins.
All these veins contain valves, which should only allow the blood to flow towards the heart. Failure of the valves allows blood to flow backwards down the veins and produces swelling and bulging. The excess pressure leads to the appearance of varicose veins.
What causes varicose veins?
There may be a hereditary component. Women are more likely to suffer from varicose veins and up to 50% of women may be affected. Hormonal factors including puberty, pregnancy, menopause, the use of birth control pills and HRT affect the disease. Other predisposing factors include ageing, DVT, standing occupations, obesity and leg injury.
What do varicose veins look like?
Many people have no symptoms at all from their varicose veins, except for the fact that their appearance can be unsightly and cause concern. Simply having varicose veins is not a good reason for going to a doctor or having treatment.
Other than cosmetic appearance, the commonest symptoms from varicose veins are aching, discomfort and heaviness of the legs, which are usually worse at the end of the day. Sometimes the ankle can swell too. These symptoms are not medically serious but can be treated if they are sufficiently troublesome. Some people develop skin changes and notice a brown discolouration around the ankle.
If these changes are allowed to progress, or if the skin is injured, an ulcer may result. Skin changes are therefore a good reason for going to see your GP and for referral to a specialist.
Other problems, which varicose veins can occasionally produce, include phlebitis and bleeding. Phlebitis (sometimes called thrombophlebitis) means inflammation of the veins and is often accompanied by some thrombosis (clotting of blood) inside the affected veins, which become hard and tender.
The risk of bleeding as a result of knocking varicose veins worries many people, but this is very rare. It will always stop with firm pressure and the veins can then be treated to reduce the risk of further bleeding.
What tests can be used to investigate varicose veins?
Most varicose veins originate from leaking valves at groin level or behind the knee. It is important to accurately locate the site of the valve leaks.
At your outpatient appointment the doctor or nurse will use a small probe to assess your veins. It indicates where the veins have come from and helps in the planning of any treatment that might be required.
Sometimes a more detailed ultrasound scan, called a Duplex scan, will be undertaken. This is usually done by an appointment on a different day. It looks in detail at the skin veins and deep veins. It can detect leaking valves and evidence of previous blood clots in the deep veins.
What treatment options are available?
Compression Stockings/Socks: These may be all that is required if aching and swelling are the main problems. Properly fitted knee-length Class II compression stockings usually work best.
Ultrasound-guided Foam Sclerotherapy: This is performed under local anaesthetic. It involves the injection of a liquid sclerosant, under ultrasound guidance, that has been mixed with air, to make foam, in order to block the vein. This is followed by the application of a compression stocking to the treated leg (see separate information sheet).
Surgery: More severe varicose veins may require surgery. The visible varicose veins are removed through a series of small cuts. More importantly, the leaky valves are tied off in the groin or behind the knee. The vein in the thigh may also be removed to reduce the risk of varicose veins returning.
How good is the treatment?
No treatment can completely remove every visible varicose vein and there is no such thing as an “invisible mend”, as surgery may leave some scarring. New varicose veins may reappear even after satisfactory treatment. However, it may be many years before they return.
How can I help myself?
Elevate your legs at least 3-4 times each day for at least 15 minutes each time: This means raising your legs to a level above your heart, placing your legs on a pillow, chair or other object.
Exercise daily: Walking, climbing stairs, cycling and swimming all help to pump the blood back up the veins towards the heart and help to reduce ankle swelling.
Avoid standing or sitting for long periods: During periods of prolonged sitting or standing, flex your ankles 10 times and repeat this every 10 minutes. This will pump the blood back up the veins towards the heart.
Avoid crossing your legs: This stops the blood flowing back up the legs towards the heart as normal.
Eat a low salt diet: This will help to reduce any swelling at the ankles.
Stop smoking: Smoking can damage the lining of the veins.
Avoid wearing high-heel shoes: The calf pump cannot work correctly.
Achieve and maintain the proper weight for your height and build.
Apply moisturising lotion to your legs in the evening to prevent the skin from becoming dry and itchy. Never apply moisturisers to your legs in the morning before putting on your compression stockings.
Wear compression stockings daily except when in bed, bathing or swimming. Put them on when you first get up. Arrange with your GP for a prescription for new compression stockings every 3 months.
Contact details
Vascular Surgical Unit
Surgical Directorate
Plymouth Hospitals NHS Trust
Derriford Hospital
PL6 8DH
Tel 01752 202082
Consultant Vascular Surgeon and Lead Clinician
Mr Devender Mittapalli
Secretary: 01752 431822
Consultant Vascular and Transplant Surgeon
Mr Jamie Barwell
Secretary: 01752 431822
Consultant Vascular Surgeon
Surgeon Commander Cris Parry RN
Secretary: 01752 431822
Consultant Vascular Surgeon
Miss Catherine Western
Secretary: 01752 431805
Consultant Vascular Surgeon
Lt Col Robert Faulconer
Secretary: 01752 431805
Consultant Vascular Surgeon
Mr Hashem Barakat
Secretary: 01752 431822
Vascular Scientists
- Mrs J George
- Mr A Ellison
- Mr R Craven
01752 439228
Vascular Nurse Specialist
Mr Alan Elstone
01752 431805
Matron
Judy Frame
01752 431847
