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Varicose Veins

Varicose Veins - Diagnosis & Treatment

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  2. Jump to: Symptoms, Causes, Assessment, Prevention, Treament 

What are Varicose Veins?

Varicose veins are common, affecting a third of the population. They are dilated and tortuous veins. They can be painful and unsightly. Varicose veins usually develop in the legs but can be present in the groin also.  They occur due to dilation or enlargement of veins. Varicose veins are usually blue soft lumps that are more prominent on standing. They can be red and tender if associated with complications such as inflammation, this is called phlebitis. Varicose veins are common in both men and women, especially as we get older. They can be more troublesome in women because of the association with hormone changes and pregnancy.
Varicose veins are the result of failure of the normal valve function in leg veins. This leads to abnormally high pressure within the veins. This raised venous pressure leads to dilation of the veins and the visible varicosities as well as the common symptoms of varicose veins which are mostly related to leg swelling.
Varicose veins, if untreated, can continue to get worse with time. As valve function fails, the veins dilate making the problem worse. Consultation with a vascular specialist is advisable for patients with large varicose veins, especially if associated with symptoms. The National institute for Health and Care Excellence (NICE) recommends consultation with a Vascular specialist for patients with symptoms from their varicose veins. Typical symptoms of varicose veins include pain, aching, discomfort, swelling, heaviness and itching. Additionally there is a strong recommendation from NICE that patients with skin complications of varicose veins should be reviewed. These include increased pigmentation or thickening of the skin in the lower legs. Varicose eczema and current or healed ulceration.

Symptoms of Varicose Veins

  • Throbbing and pulsating pain in legs
  • Swollen, bulging or enlarged veins in legs
  • Colour changes in veins (getting darker)
  • Cramps
  • Pain in legs
  • Difficulty standing and sitting for extended periods of time
  • Pain in legs while exercising or working out

What causes Varicose Veins

  • Pregnancy
  • Change in lifestyle
  • Weight gain
  • Aging
  • Hereditary (family history of varicose veins)
  • Sitting or standing for long periods of time
  • Menopause

Assessment for proper treatment of Varicose Veins

A Consultant Vascular Surgeon will check for a variety of symptoms starting with a visual check-up. An ultrasound scan is performed on the leg with varicose veins for proper diagnosis. The ultrasound procedure is necessary to map the source of varicose veins and allow treatment to be planned safely.
The ultrasound scan uses sound waves to procedure a visual picture of soft tissues and blood vessels. In the case of varicose veins, this scan will help your doctor know the condition of your veins and valves of the veins by observing blood flow, blood clots swelling or inflammation. This information is key for your doctor to decide the best suitable treatment.
The ultrasound procedure can take 30-60 minutes depending on the severity and density of varicose veins. Please carry a pair of shorts to change into before the scan. For your scan, the imaging specialist will apply a gel on your legs and then run the ultrasound scanner over the veins. You will be able to see the on-going scan of your veins on the monitor. It will show the flow of blood and structure of your veins. Your results will be shared with your doctor to decide the treatment.

Can Varicose Veins be prevented?

Varicose veins can develop for several reasons. There are no certain measures to pre-empt this condition. However, a good and healthy lifestyle can help you achieve better circulation in your legs, necessary muscle strength and healthy veins. You can start with
  • Regular exercise
  • Maintaining your weight
  • Taking breaks during long stretches of sitting or standing
  • Avoiding clothes that can limit the circulation such as tight hosiery or high heels
  • Low-salt and fibre-rich diet
  • Compression stockings can help with blood circulation

What are the treatment options for Varicose Veins

Medical treatment can help you with varicose veins. The procedures will either remove or close the veins that show symptoms of varicose veins.

1. Sclerotherapy

This treatment is best suited for smaller varicose veins and spider veins. These veins are closed using a chemical injection in the veins. The chemical causes scarring within the veins that leads to reduction in blood flow and eventual cut-off of circulation. Once the blood circulation is reduced in those veins, their swelling and other symptoms fade away.
This treatment does not require anaesthesia. Each vein may require multiple treatments.

2. Vein Stripping and Ligation

Doctors often recommend vein stripping and ligation for severe and prominent varicose veins. In this surgical procedure, a small incision is made to completely remove the veins from the affected area. The removal of veins does not affect the blood circulation as other veins, deeper in the tissue manage the flood flow and distribution.
This treatment is done as an out-patient under general anaesthesia. Recovery time is usually between 3-4 weeks.

3. Endovenous surgery

A key-hole procedure performed to destroy large veins from the inside. Ultrasound is used to gain access to the veins and a catheter is introduced. A range of options can be used depending on preference. Most commonly a heat source is used to destroy the vein (endothermal ablation) using a Laser or radiofrequency ablation (VNUS or closurefast procedure). Glue and mechano-chemical ablation are alternatives.
Book an appointment with our dedicated Consultant Varicose Surgeon – Mr Simon Neequaye. Mr Neequaye is a hybrid specialist capable of performing both open and endovascular treatment for all aspects of vascular surgery. Pall Mall Medical offer a specialist service including Ultrasound assessment by a full time specialist vascular ultrasound specialist providing a comprehensive vascular assessment. To book an appointment call 0330 058 44 55 or email at