Varicose veins are veins that have become enlarged and contorted. Varicose veins are most common in the superficial veins of the legs. A range of treatments - surgical and non-surgical - are available, depending on the severity of the symptoms and a person's circumstances and preferences.
Veins are blood vessels that carry blood from the body, to the heart. Arteries, on the other hand, carry blood from the heart to the body. Unlike arteries, veins have very little muscle tissue. To prevent blood flowing backward, veins have a series of one-way valves that keep the blood flowing in one direction towards the heart.
Varicose veins occur when, as a result of various causes, the valves within the veins become inefficient (incompetent) and allow blood to backflow. The blood pools in the area below the affected valve causing the vein to enlarge and stretch. Varicose veins appear under the skin as bluish-green lines, which may bulge out or appear twisted and contorted.
Veins that lie just beneath the skin surface are referred to as “superficial veins” while the veins found deep inside the muscles are referred to as “deep veins”. Other veins, called "communicating veins", connect the superficial and deep veins, allowing blood to flow between them.
The superficial veins in the legs are the most common place for varicose veins to occur – due mainly to incompetent vein junctions in the upper thigh, behind the knee and in the calf muscle. However they can occur in other areas of the body such as the pelvic region and the rectal area (haemorrhoids
). Varicose veins usually develop between the ages of 30 and 60 years and tend to worsen with age.
Signs and symptoms
Common symptoms can include:
- Bulging or twisting of the affected vein(s)
- Aching of the affected area, especially after sitting or standing for lengthy periods
- Swelling in the legs
- A feeling of heaviness and muscle fatigue in the legs
- Itching around the affected veins
- Leg cramps at rest
Some women experience a worsening of symptoms during menstruation.
Complications due to varicose veins may include:
- The skin above the affected veins may become thin making it susceptible to cuts, nicks and ulcers
- Inflammation of the affected veins (phlebitis)
- A slightly increased risk of developing blood clots in the deep veins connected to varicose veins.
A number of factors contribute to the development of varicose veins. These include:
- A genetic predisposition to develop varicose veins
- Hormonal factors
- Excess weight
- Circulatory problems, such as blood clots (thrombosis)
- Injury or inflammation of the veins
- Chronic constipation may contribute to the development of rectal varicose veins (haemorrhoids)
Lifestyle factors also play an important role and people who have jobs that involve standing for prolonged periods of time are at greater risk of developing varicose veins eg: nurses, flight attendants and teachers. Varicose veins are more common in women than in men and have a tendency to run in families.
Varicose veins are usually easily visible so it is possible to make a diagnosis simply from their appearance. The doctor will perform a physical examination to assess the extent of the varicose veins. They may also order an ultrasound test called a Doppler. This test enables the blood flow and structure of the veins to be seen on a monitor. It can also show if any blood clots are present. A Duplex ultrasound may also be performed. This is a more advanced scan and displays the image in colour.
Another test, known as air plethysmography (APG) may be performed to better identify the function of the affected veins. For this test pressure cuffs are placed on the leg and are connected to a computer. The cuffs are pumped up and released at predetermined rates and intervals, while the computer measures how the blood flows through the veins and arteries in the leg.
Treatment may not be medically necessary unless symptoms are problematic. However, some people may want treatment for cosmetic reasons, because they are unhappy with the appearance of varicose veins.
If varicose veins are small and not too uncomfortable, elastic compression stockings may be recommended. These are worn during daily activities and help to compress the veins, keeping them from stretching and limiting any discomfort or pain.
Sclerotherapy involves using a fine needle to inject a special solution into the affected vein. The solution irritates the lining of the vein causing it to harden (sclerose) and seal off. Blood is therefore prevented from entering that portion of the vein and is forced to flow through other, healthier veins. Sclerotherapy has the advantage of being able to be performed without the need for an anaesthetic.
After injection of the sclerosing solution compression bandages are applied. This prevents blood from re-entering the treated vein. The doctor will determine how long the bandages are to be worn for and will set activity and exercise guidelines. Over a period of weeks the varicose veins fade until they are barely visible. Occasionally, varicose veins may require more than one sclerotherapy treatment.
Deeper varicose veins can be treated with ultrasound guided sclerotherapy (UGS). The doctor is able to use a duplex ultrasound to see the vein on a screen, thus enabling them to accurately guide the fine needle within the vein. This technique also makes it possible to locate and treat the often hidden origin of the varicose vein. However, as ultrasound guided sclerotherapy is a relatively new technique, its long term effectiveness is as yet unknown.
Sclerotherapy can also be used to treat “spider veins” – very small veins that are enlarged and appear as fine red/purple lines just under the surface of the skin.
Side effects of sclerotherapy treatment may include:
- Irritation and damage to the tissue surrounding the affected vein
- Trapping of blood within the treated vein (this is usually absorbed by the body after 2 – 3 months)
- Light brown streaks or discolouration over the treated vein (these will fade over a period of months)
However, the majority of people who have had sclerotherapy treatment achieve good results with minimal side effects.
Sclerotherapy is not suitable for all people. Factors such as pregnancy, pre-existing clotting disorders and allergy to the sclerotherapy solution are contraindications for this treatment.
EndoVenous Laser Treatment (EVLT):
A small incision is made at one end of the affected vein and ultrasound is used to guide a laser catheter into the vein. The laser is activated and, after approximately 60 seconds, the vein is destroyed. As the entire vein is destroyed, rather than just the lining (as occurs with sclerotherapy) compression stockings are not required and the recovery time is rapid (usually a return to work can be achieved the next day). This technique is relatively new but appears effective. Minimal side effects and low complication rates are claimed.
If the vein junction where the varicose vein originates has been shown by an ultrasound scan to be incompetent, then the most common surgical treatment is to tie off the varicose vein at this junction - most commonly the upper thigh, behind the knee or in the calf muscle. Surgery involves making a small incision in the leg, locating the vein junction and tying off the varicosed vein. The vein is left in place, however blood is prevented from flowing into it.
Another common surgical technique for treating superficial varicose veins is “vein stripping” - where the affected vein is completely removed. A small incision is made in the skin at either end of the affected vein and the junction where the affected varicose vein joins a larger vein is tied off. A flexible wire is then inserted into the varicose vein and withdrawn – removing the vein in the process.
Both types of surgery can be performed under general or spinal anaesthetic and a stay in hospital may be required. This will be determined by the surgeon performing the surgery.
At the completion of surgery, the incisions in the skin are closed with small stitches to minimise scarring. Bandages or elasticised stockings are then applied to gently compress and support the leg and to reduce swelling. These may need to be worn for up to six weeks, depending on the preference of the surgeon who performed the surgery. The stitches are usually removed seven – 10 days after surgery and a return to work can usually be achieved one to two weeks after surgery. Again, these timeframes will be determined by the surgeon who performed the surgery.
Other surgical treatments for varicose veins:
This technique involves removing the veins through a series of tiny skin incisions. It is suitable for smaller varicose veins. Specialised surgical instruments are used to remove the affected veins and the incisions are so small that they do not usually require stitches.
Endoscopic vein surgery:
This technique may be used for more severe cases of varicose veins. It involves making several small incisions in the leg. A thin tube containing a tiny camera (endoscope) is inserted through one of the incisions, into the affected vein, and small surgical instruments are inserted through the other incisions. The camera enables the surgeon to see the inside of the vein on a television monitor and perform the necessary surgery.
Transilluminated Powered Phlebectomy:
During this technique a small incision is made in the skin at one end of the affected vein and a thin tube with a bright light is introduced under the skin and behind the vein, thus showing the shadow of the vein. Another small incision is made at the other end of the affected vein and a specialised instrument attached to a suction unit is positioned under the skin. Guided by the strong light, the specialised instrument destroys and removes the affected vein. This technique is performed as a day stay procedure. Bandages need to be worn for approximately 48 hours after the procedure and there is less discomfort, recovery is quicker, and scarring is less than other surgical techniques.
Prevention of varicose veins
As varicose veins cannot be cured, the best course of action is prevention. Factors that can help in the prevention of varicose veins:
- Avoiding crossing the legs when sitting.
- Exercising regularly.
- Maintaining a healthy body weight.
- Avoiding tight clothing that constricts the legs, groin or waist eg: knee high pantyhose.
- Avoiding constipation.
- When standing for long periods, shifting weight from one leg to the other every few minutes.
Anderson, K.N., Anderson, L.E. & Glanze, W.D. (eds.) (2006) Mosby’s medical, nursing, & allied health dictionary (6th ed.) St. Louis: Mosby-Year Book, Inc.
Clinical Reference Systems (2006) Varicose Veins (Disease/Disorder Overview). McKesson Health Solutions LLC. In Thompson Gale Health and Wellness Resource Centre.
Lohr, J.T (2006) Varicose Veins. In Gale Encyclopaedia of Medicine. Third Edition. Longe, J. L. (editor). Farmington Hills, MI. Thompson Gale
Last Reviewed - 15 February 2013