For most people, varicose veins don't present a serious health problem. They may have an unpleasant appearance, but should not affect circulation or cause long-term health problems.
Most varicose veins don't require any treatment, but if treatment is necessary, your doctor may first recommend up to six months of self care at home, including:
- using compression stockings
- taking regular exercise
- avoiding standing up for long periods
- elevating the affected area when resting
Surgical treatments may be offered if you have:
- venous pigmentation, varicose eczema or ulceration
- had episodes of superficial thrombophlebitis requiring treatment with low molecular weight heparin, or were found by an ultrasound scan
- experienced a haemorrhage from a varicose vein
If you meet the criteria for referral to see a vascular specialist (a doctor who specialises in veins), varicose veins can be treated in several ways, the most common being:
- endothermal ablation – treatment where heat is used to seal affected veins
- sclerotherapy – this uses special foam to close the veins
- ligation and stripping – this involves surgery to remove the affected veins
It's unlikely you'll receive varicose veins treatment on the NHS for cosmetic reasons - you'll have to pay for this privately.
Read more about treating varicose veins and complications of varicose veins.
Preventing varicose veins
There is little evidence to suggest you can stop varicose veins getting worse, or completely prevent new ones developing.
However, there are ways to ease symptoms of existing varicose veins, such as:
- avoiding standing or sitting still for long periods and trying to move around every 30 minutes
- taking regular breaks throughout the day, raising the legs on pillows while resting to ease discomfort
- exercising regularly – this can improve circulation and help maintain a healthy weight
Compression stockings
Compression stockings are specially designed to steadily squeeze your legs to improve circulation. They are often tightest at the ankle and get gradually looser as they go further up your leg. This encourages blood to flow upwards towards your heart.
Compression stockings may help relieve the pain, discomfort and swelling in your legs caused by your varicose veins. However, it's not known whether the stockings help prevent your varicose veins getting worse, or if theyprevent new varicose veins appearing.
The National Institute for Health and Care Excellence (NICE) only recommends using compression stockings as a long-term treatment for varicose veins if allother treatments are not suitable for you.
If you are pregnant and you have varicose veins, NICE says you may be offered compression stockings for the duration of your pregnancy.
Compression stockings are available in a variety of different sizes and pressures. Most people with varicose veins will be prescribed a class 1 (light compression) or class 2 (medium compression) stocking. They are also available in:
- different colours
- different lengths–some come up to your knee, while others also cover your thigh
- different foot styles– some cover your whole foot and some stop before your toes
Compression tights are also available, but not on the NHS. They can be bought from pharmacies or directly from the manufacturers.
You may need to wear compression stockings for the rest of your life if you have deep venous incompetence. Deep venous incompetence is where you have problems with the valves, or blockages, in the deep veins in your legs.
In these circumstances, you will need to wear compression stockings even if you have had surgery to treat some varicose veins.
Wearing compression stockings
You usually need to put your compression stockings on as soon as you get up in the morning and take them off when you go to bed.
They can be uncomfortable, particularly during hot weather, but it's important to wear your stockings correctly to get the most benefit from them.
Pull them all the way up so the correct level of compression is applied to each part of your leg. Don't let the stocking roll down, or it may dig into your skin in a tight band around your leg.
Speak to your GP if the stockings are uncomfortable or don't seem to fit. It may be possible to get custom-made stockings that will fit you exactly.
If custom-made compression stockings are recommended, your legs will need to be measured in several places to ensure they are the correct size. If your legs are often swollen, they should be measured in the morning, when any swelling is likely to be minimal.
If compression stockings are causing the skin on your legs to become dry, try applying a moisturising cream (emollient)before you go to bed to keep your skin moist.
You should also keep an eye out for sore marks on your legs, as well as blisters and discolouration.
Caring for compression stockings
Compression stockings usually have to be replaced every three to six months. If your stockings become damaged, speak to your GP because they may no longer be effective.
You should be prescribed two stockings (or two sets of stockings if you are wearing one on each leg) so that one stocking can be worn while the other is being washed and dried. Compression stockings should be hand washed in warm water and dried away from direct heat.
Further treatment
If your varicose veins meet the requirements for further treatment, the type of treatment will depend on:
- your general health
- the size of your varicose veins
- the position of your varicose veins
- the severity of your varicose veins
A vascular specialist (a doctor who specialises in veins) will be able to advise you about the most suitable form of treatment for you.
Endothermal ablation
One of the first treatments offered will usually be endothermal ablation. Thisinvolves using energy either from high-frequency radio waves (radiofrequency ablation) or lasers (endovenous laser treatment) to seal the affected veins.
These treatments are described in more detail below.
Radiofrequency ablation
Radiofrequency ablation involves heating the wall of your varicose vein using radiofrequency energy. The vein is accessed through a small cut made just above or below the knee.
A narrow tube called a catheter is guided into the vein using an ultrasound scan. A probe is inserted into the catheter thatsends out radiofrequency energy.
This heats the vein until its walls collapse, closing it and sealing it shut. Once the vein has been sealed shut, your blood will naturally be redirected to one of your healthy veins.
Radiofrequency ablation can be carried out under eitherlocal anaesthetic (you are awake) or general anaesthetic (you are asleep). The procedure may cause some short-term side effects, such as pins and needles (paraesthesia).
You may need to wear compression stockings for up toa week after having radiofrequency ablation.
Endovenous laser treatment
As with radiofrequency ablation, endovenous laser treatment involves having a catheter inserted into your vein and using an ultrasound scan to guide it into the correct position. A tiny laser is passed through the catheter and positioned at the top of your varicose vein.
The laser delivers short bursts of energy that heat up the vein and seal it closed. The laser is slowly pulled along the vein using the ultrasound scan to guide it, allowing the entire length of the vein to be closed.
Endovenous laser treatment can be carried out under local or general anaesthetic. After the procedure you may feel some tightness in your legs, and the affected areas may be bruised and painful. Nerve injury is also possible, but it's usually only temporary.
Ultrasound-guided foam sclerotherapy
If endothermal ablation treatment is unsuitable for you, you'll usually be offered a treatment called sclerotherapy instead.
This treatment involves injecting special foam into your veins. The foam scars the veins, which seals them closed. This type of treatment may not be suitable if you have previously had deep vein thrombosis.
The injection is guided to the vein using an ultrasound scan. It's possible to treat more than one vein in the same session.Both standard sclerotherapy and foam sclerotherapy are usually carried out under local anaesthetic, where a painkilling medication will be used to numb the area being treated.
After sclerotherapy, your varicose veins should begin to fade after a few weeks as stronger veins take over the role of the damaged vein, which is no longer filled with blood. You may require treatment more than once before the vein fades, and there is a chance the vein may reappear.
Although sclerotherapy has proven to be effective, it's not yet known how effective foam sclerotherapy is in the long term.NICE found, on average, the treatment was effective in 84 out of 100 cases. However, in one study, the varicose veins returned inmore thanhalf of those treated.
Sclerotherapy can also cause side effects, including:
- blood clots in other leg veins
- headaches
- lower back pain
- changes to skin colour–for example, brown patches over where the treated veins were
- fainting
- temporary vision problems
You should be able to walk and return to work immediately after having sclerotherapy. You will need to wear compression stockings or bandages for up toa week.
In rare cases, sclerotherapy has been known to have serious potentialcomplications, such as strokes or transient ischaemic attacks.
Surgery
If endothermal ablation treatments and sclerotherapy are unsuitable for you,you may be offered a surgical procedure called ligation and strippingto remove the affected veins.
Varicose vein surgery is usually carried out undergeneral anaesthetic, which means you will be unconscious during the procedure.
Youcan usuallygo home the same day, but an overnight stay in hospitalis sometimes necessary, particularly if you are having surgery on both legs.
Ligation and stripping
Most surgeons use a technique called ligation and stripping, which involves tying off the vein in the affected leg and then removing it.
Two small incisions are made, approximately 5cm (2in) in diameter. The first cut is made near your groin at the top of the varicose vein. The second cut is made further down your leg, usually around your knee or ankle. The top of the vein (near your groin) is tied up and sealed.
A thin, flexible wire is passed through the bottom of the veinand then carefully pulled out and removed through the lower cut in your leg.
The blood flow in your legs will not be affected by the surgery. This is because the veins situated deep within your legs will take over the role of the damaged veins.
Ligation and stripping can cause pain, bruising and bleeding. More serious complications are rare, but could include nerve damage or deep vein thrombosis, which is where a blood clot forms in one of the deep veins of the body.
Afterthe procedure, you may needup tothree weeks to recover before returning to work, although this depends on your general health and the type of work you do. You may need to wear compression stockings for up to a week after surgery.