Varicose veins explained
Varicose veins explained: learn from an expert in these FAQs
There’s a lot of information out there about varicose veins, so it can be difficult to know where to start. We asked Professor Timothy Magee, a varicose veins specialist, to break down common misconceptions and answer the questions he hears most. Find out about treatment options, recovery times and how you can book a free, 10-minute mini consultation by calling 01189226888.
Varicose veins are swollen, tight, tender and lumpy veins, just under the surface of the skin. They usually occur on the legs and are what we call “superficial veins”, which have become enlarged because their valves have failed. Veins should have valves to allow blood to go up only, as blood is delivered back to the heart. If the valves fail, then blood hangs around in these veins under gravity. This then creates high pressure and the veins swell and bulge.
These superficial veins just underneath the skin are part of a vast network. Using an analogy, they’re a bit like the B-roads and C-roads you drive on – there are lots of them that feed into more major routes. If these are blocked up then they can be removed and leave the rest of the network.
The deep veins are in the core of your leg, about the size of your little finger, and are very robust with thick valves. If you get a deep vein thrombosis, this is the equivalent of having a major motorway route disrupted so it will require treatment.
You will have large, lumpy veins which are sitting proud of the surface. They may look a bit blue or green in appearance. Varicose veins are different from ‘spider veins’ which are flat and are pink, blue or purple in colour. Spider veins will also blanche when you press them with a finger or thumb. You can get an accurate diagnosis by visiting a vascular specialist who can discuss treatment options with you.
Varicose veins usually affect more women than men, although it can affect any age group – from young teenagers through to the elderly. The appearance of varicose veins is usually the most common reason for why people choose to seek treatment. While not everyone gets symptoms, aching, itching and throbbing are all common. Aching in particular often affects those with active lifestyles who are on their feet all day, and don’t have many opportunities to sit down until they get home in the evening.
Skin problems are also quite common. Dry and flaking skin can sometimes lead to eczema, and some people can develop hard, leathery and red skin. If the skin is severely damaged, this can lead to a breakdown in the surface of the skin which is very difficult to heal. This is by definition an ulcer. Once you have ulcers secondary to varicose veins, you are very much playing catch-up. You may have more difficulty getting rid of the ulcer, than if you’d had varicose veins treated beforehand.
The condition is usually hereditary. Some jobs can aggravate varicose veins, such as those who are standing all day. However it’s usually the case that a member of your family will have previously had it, as it tends to run in the family.
If you have a job which predisposes you to varicose veins, you still need a trigger in order to get them. If you’re on your feet all day, then your veins may get worse quicker than someone doing an office job sitting at a computer for instance.
Varicose veins usually occur on the back of the calf. Evolution has gradually meant we’re on our feet a lot more, which could be linked to the condition. The veins feeding blood from the ground back up to our heart are working very hard, in a vertical column in your leg, so therefore we have a predisposition for valves failing.
Sitting and lying down is much better for your legs if you have varicose veins. If you wear a compression stocking, this only needs to come up to the knee. Although this won’t get rid of them, it will relieve some of the symptoms. The best way to treat varicose veins is by getting rid of them completely.
The reason why we suggest compression stockings is because blood is getting into the leg ok, and the compression stocking is helping to ease it back upwards, therefore helping the valves that aren’t working. They also keep the veins compressed, which means they’re not as tense and tight over the course of the day, meaning they don’t feel as sore and uncomfortable.
You can get these through your practice nurse at your local GP surgery, or a local pharmacy, but make sure you ask to be measured properly before buying them. Compression stockings should go on first thing in the morning, but once you get home and are relaxing, then this is a good time to take them off.
There are several treatment options available for varicose veins. In my opinion, the most effective way to treat varicose veins is to remove them entirely. Here’s a bit more information about the procedure:
Option one: removing varicose veins
The operation is usually a day case procedure using general or local anaesthetic. This means you leave hospital on the same day as your treatment. There used to be a treatment called ‘varicose vein stripping’ which involved making groin cuts and ripping out veins through the thigh. This procedure has now been superseded, using more modern heated catheters and small 3mm cuts in the skin to complete the procedure.
The aim of the operation is to remove the varicose veins entirely and seal the underlying feeding veins to prevent recurrence in the future. We use thin catheters, about 1-2mm across, which have a heating element at the tip. This catheter is passed into the feeding vein (usually from the groin or behind the knee) and is then slowly withdrawn to heat and seal the inside of the vein. You may hear RFA (radio frequency ablation) to describe this treatment – it is simply referring to the type of heating element or catheter used.
This type of surgery has an extremely high success rate. While the risk of recurrence is not zero, it’s pretty close to it. While all surgery carries an element of risk, varicose veins removal surgery (using RFA) is considered to be a safe procedure. It will be completed under local or general anaesthetic and you can leave hospital on the same day. Risks include infection, bleeding or thrombosis, which in total represent about a 0.5% risk.
Option two: sealing feeding veins
A second type of treatment is where you seal the feeding veins using RFA. However the difference is that the actual varicose veins themselves are not removed, so they’re left behind after the treatment. This treatment serves to take the pressure of the varicose veins, but you’re still able to see them afterwards.
Option three: foam treatment
A third treatment option is what we call foam treatment. Foam is an injection of sclerosant, which means it gums up the varicose vein and makes it clot up, taking the pressure of the veins. The varicose veins are not actually removed, so there is a higher risk of recurrence in the future. The drawback with this is it can cause staining of the skin which may be permanent. Local anaesthetic will be used and you’ll either be in hospital as an outpatient, or you’ll have a short stay during the day in our ambulatory care unit.
If you decide to get treatment to remove varicose veins, you will still be able to leave hospital on the same day. When you are ready to be discharged, you will leave with your leg still bandaged. Over the course of the next day or so the local anaesthetic will wear off. You’ll be feeling a bit achy and you’ll see bruising appear on the back of your leg. You will also see and feel some small lumps and bumps, which is slightly deeper bruising. This can be tender for the first week or two.
You will then take off your bandage the next day and wear your long supported stocking (thigh length) you’re given when you’re discharged. You should then wear this for the next week to 10 days. This helps to give support to the bruised leg and gently compresses it to ease the bruising over time.
As you feel more comfortable, you can start to do more active activities. If you over-do it, the worst that will happen is your leg will ache, hurt or puff-up, but you won’t do any damage to the operation. Over time the bruising and cuts in the skin will fade.
Within one to two weeks you can expect to be back to most normal activities. The treatment is a bit like getting a bruising injury to your leg. You don’t have the unpleasantness of receiving the injury, but you have the after effects. This will be the main part of your recovery.
You don’t have to stay in bed following the procedure, so you will be out and about when you feel up to it. Similarly, with a more active job you can expect two to three weeks for recovery time.
To get back to sport, recovery may take between three to four weeks. Sport and exercise is in general a good thing, as it gets the blood pumping much faster. As soon as you’re comfortable, you can return to any activity. However you should not fly for four weeks after the operation, as there is a slight increased risk of a deep vein thrombosis.
You will have a follow-up appointment a few weeks after surgery, to make sure you’re happy with how your recovery is progressing and to answer any questions you may have.
I still hear this misconception quite a bit, which is probably due to historical methods used in treatments. Modern procedures to remove varicose veins are extremely effective meaning recurrence is also very low.
This is also why it’s important to explain why I recommend an ultrasound as this will pick up the underlying causes of the problem. If the feeding veins can be found and treated, this is what reduces the risk of recurrence. If you have a procedure to remove varicose veins, you would have to develop entirely new problems to develop them again.
Yes, most insurance companies will cover treatment for varicose veins. However it’s best to check directly with your insurer to determine exactly what is and isn’t covered with your policy.
Unfortunately, varicose veins will not go away or get better on their own - they may only progress over time. Some people are at risk of ulcers, deep vein thrombosis and other skin problems in the future if they’re left untreated.
You should get your veins treated for what you have, rather than what might happen. In other words, don’t just get treatment because you’re worried you might get ulcers, as this may never happen to you. Not everyone who has varicose veins will get the same symptoms, such as skin changes and ulcers. In fact, some people have very marked varicose veins but do not cause them any trouble.
We can nearly always treat the condition, however long you have had them for. It’s extremely uncommon for varicose veins to be untreatable. Some people will have extensive varicose veins, but their skin is largely unaffected and they don’t have ulcers. Others may have minor varicose veins, but their skin is damaged with ulcers. It’s unclear why damage to the skin happens more to some people and not to others.
I can offer you a free, 10-minute mini consultation before you commit to any private consultations or treatment. This is a chance to ask any questions you have and decide if you would like a full consultation. If you then book a full private consultation, this will last for around 30 minutes. This involves a thorough look through your past history and previous treatments, along with a detailed assessment of your varicose veins. This will usually be done standing up, as this is when the veins are full - showing them at their worst.
Within this consultation I will ultrasound scan the veins before deciding on the most appropriate treatment. This is extremely important to accurately assess the underlying causes of varicose veins, which you wouldn’t be able to see without it. If these underlying causes aren’t addressed during treatment, this unfortunately could lead to recurrence of the condition further down the line. I can complete this ultrasound in your first full consultation. This means you can then leave with a diagnosis, suggested treatment plan and recovery times. Simply get in touch with the team who will happily confirm all the costs in advance with you.
Of course, surgery is only one potential outcome from the consultation. We will discuss the best treatment options based on your needs. If you do decide to proceed with your treatment privately, this can usually be booked in very quickly over the coming weeks. We recommend seeking independent medical advice from your GP, but you can book a private consultation without a referral if you’d like to. Many private insurance providers will require a GP referral however, so it’s best to check with your insurer in advance.
Book a private consultation with Professor Magee
Do you have some questions? You can book a free, 10-minute mini consultation with Professor Magee completely free of charge at Circle Reading Hospital. Please get in touch using the details below:Find out more about varicose veins treatment at our other locations
Read more about Professor Magee by viewing his profile here.