Overview

Veins are blood vessels that take blood back to your heart. The veins just under your skin are called superficial veins. The larger veins that run through your muscles and cannot be seen or felt are called deep veins.

The term varicose veins only applies to superficial veins bulging under the skin. 

Some people have highly visible small veins that have a number of names, such as thread veins, spider veins, venous flares or reticular veins. These are not varicose veins, and as treatment for them is considered cosmetic, it is not available on the NHS.

Causes of varicose veins

Veins have valves within them to 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 (the long or great saphenous vein), or in your calf (the short saphenous vein). This vein then puts more pressure on weaker veins further down your leg and causes them to become varicose.

It is not known why the valves fail and the veins lose their elasticity in some people. Often varicose veins run in the family, meaning that they could be hereditary.

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

Problems caused by varicose veins

If you have varicose veins, you may feel pain in the affected veins and your legs may feel tired and heavy. Lumpy veins may be visible and there may 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.

Reducing pain in your legs

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

If the pain in your legs is caused by your varicose veins, treatment should help to relieve it. However, there are many other common causes of leg pain, such as arthritis, sciatica and restless legs. 

It is tempting to link any symptoms in your legs with highly visible varicose veins. However treating your varicose veins will not improve any symptoms caused by other conditions. Your GP or consultant will be able to tell you if your symptoms are caused by varicose veins or another condition.

Improving your symptoms

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

Exercise, such as walking, reduces the pressure in your veins because the muscles in your calf pump the blood out of your leg. 

You can also raise your legs when sitting and avoid standing still for long periods of time.

Being overweight puts more pressure on your leg veins, so losing weight will help. Your consultant or GP will be able to tell you if you are within the normal weight range for your height. They can advise you on eating healthily and losing weight.

Compression stockings squeeze the blood out of the veins under your skin (your superficial veins) into your deep veins. They will also reduce discomfort from your varicose veins.

Duplex scan

Before we see you in clinic, we will arrange for you to have a duplex scan. A duplex scan is a type of ultrasound scan which uses sound waves to detect blood flow in your veins. It is used to identify the veins with faulty valves that are the underlying cause of your varicose veins.

Your first hospital appointment

You will be seen by a vascular consultant, or clinical nurse specialist, who will assess your symptoms and examine your legs. They will also look at your notes and assess the results of your duplex scan. They will talk to you about your diagnosis and treatment plan. Your treatment options will be explained to you in detail.

What is treatable on the NHS?

Everyone with symptomatic primary or symptomatic recurrent varicose veins should be referred. These are veins causing troublesome lower limb symptoms such as: 

• pain
• aching 
• discomfort 
• swelling 
• heaviness 
• itching 

However, NHS funding for the treatment of varicose veins is closely monitored and surgical treatments are restricted to people with documented evidence of the following criteria:

1. At least one of the following:

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

AND

2. The patient has followed the pathway described above.

AND

3. The diagnosis of varicose veins has been confirmed and there is evidence of truncal reflux (reflux in the great saphenous vein or short saphenous vein).

AND

4. The patient has a normal body mass index (BMI), or there is evidence that NICE guidance on measures to lose weight have been followed over a period of at least 1 year.

Unless you meet these criteria we will be unable to offer surgery. Your options will be limited to non-surgical treatment, unless your GP has completed an Individual Funding Request.

Treatment options

The consultant, or clinical nurse specialist, will discuss your treatment options with you in detail.

• support or compression stockings
• radiofrequency ablation (RFA)
• ultrasound-guided foam sclerotherapy (UGFS)
• surgery (stripping and, or multiple avulsions)
• a combination of the above