Varicose Veins
Swollen, twisted veins, usually in the legs. Very common, usually harmless, and often more of a cosmetic nuisance than a medical problem.
Quick answer: Varicose veins are swollen, twisted veins, usually in the legs, caused by leaky one-way valves that let blood pool. About a third of adults have them. They can ache, itch or make ankles swell, but usually aren’t serious. Self-care helps. If they cause symptoms, skin changes or ulcers, the usual first treatment is endothermal ablation, a day procedure that seals the vein.
How common. In the Edinburgh Vein Study, about 1 in 3 adults aged 18 to 64 had varicose veins in the main leg veins. They become more common with age.
Causes and risk factors. Veins have one-way valves that keep blood moving up towards the heart. If they weaken, blood falls back and pools, and the vein stretches. Risk is higher with:
- older age, being a woman, pregnancy
- family history
- being overweight
- standing or sitting for long periods
- a previous deep vein thrombosis (DVT)
Symptoms. Blue or purple bulging, lumpy veins, plus sometimes:
- aching, heavy or throbbing legs, worse after standing
- swollen ankles
- itchy, dry or discoloured skin over the veins
- night cramps
Spider veins (thread veins) are tiny surface veins and are harmless.
How it’s diagnosed. Your GP can usually tell by looking. If treatment is being considered, a specialist uses a duplex ultrasound to see which valves are leaking.
Treatment
Most varicose veins need only self-care. Procedures are for symptoms, skin changes, bleeding or ulcers; cosmetic treatment is usually private.
- Step 1 · Self-careMove and raiseWalk regularly, raise your legs when resting, avoid standing or sitting still for long, and keep a healthy weight.
- Works
- Eases aching and swelling; won’t make veins disappear
- Access
- Free
- Watch for
- Moisturise dry or itchy skin and protect your legs from knocks.
- Step 2 · PharmacyCompression stockingsGraduated stockings worn during the day.
- Works
- Can ease aching and swelling
- Access
- Pharmacy; fitted for size
- Watch for
- Not suitable if you have poor arterial circulation (check with your doctor first, especially with diabetes).
- Step 3 · SpecialistEndothermal ablationHeat (radiofrequency or laser) seals the faulty vein from inside, through a fine tube under local anaesthetic.
- Works
- Usually the first-choice treatment; home the same day
- Access
- Vascular specialist
- Watch for
- Bruising and tenderness; stockings for about a week.
- Step 4 · SpecialistFoam sclerotherapyA foam injected under ultrasound guidance blocks the vein.
- Works
- An option when ablation isn’t suitable
- Access
- Vascular specialist
- Watch for
- Skin staining, tender lumps; veins can return.
- Step 5 · SpecialistSurgery (ligation and stripping)The vein is tied off and removed under general anaesthetic.
- Works
- Used when simpler procedures aren’t suitable
- Access
- Vascular surgeon
- Watch for
- Pain and bruising for a few weeks; 1 to 2 weeks off work.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Creams and supplements that “shrink veins”No good evidence they remove varicose veins.
- Vein “detox” products and massage gadgetsNo evidence they treat varicose veins.
Living with it
- Walk; your calf muscles pump blood back up your legs.
- Put your feet up above heart level for a while each day.
- Stop smoking.
- Check your lower legs for sores or skin changes, especially if you have diabetes.
See your GP if
- Your veins ache, itch or make your legs swell
- The skin over the veins is changing colour, hardening or flaking
- A sore on your leg hasn’t healed within 2 weeks
- A vein is red, hot and tender (possible superficial clot)
- Your veins are getting worse
Get urgent help if a varicose vein bleeds heavily (lie down, raise the leg and press firmly on it), or if one calf becomes painful, warm and swollen, or you have chest pain or sudden breathlessness, which can mean a blood clot: call 000 (Australia) or your local emergency number.
Outlook. Varicose veins usually aren’t serious and worsen only slowly over years. Treatment works well, though new varicose veins can develop later.
Common questions
Are varicose veins dangerous?
Usually not. Complications such as bleeding, skin changes, ulcers or clots are uncommon but need attention.
Do varicose veins go away on their own?
No, but symptoms often improve with self-care, and veins that appear in pregnancy often get better after birth.
What causes varicose veins?
Weak one-way valves inside the veins let blood flow backwards and pool. Genes, age, pregnancy, weight and long periods of standing all play a part.
Do compression stockings get rid of varicose veins?
No. They can ease aching and swelling, but don’t remove the veins.
What is the best treatment for varicose veins?
For veins causing symptoms, endothermal ablation is usually the first choice. Foam sclerotherapy or surgery are alternatives.
Evidence and more information
- NHS: Varicose veins
- NHS: Varicose veins treatment
- Evans et al, J Epidemiol Community Health 1999: Prevalence of varicose veins, Edinburgh Vein Study
- NICE CG168: Varicose veins, diagnosis and management
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