Varicose veins are tortuous, widened veins in the subcutaneous tissues of the legs and are often easily visible. Their valves are usually incompetent so that reflux of blood occurs, and the resulting venous hypertension can cause symptoms. Varicose veins are widely seen as medically unimportant and deserving low priority for treatment. They are common, affecting many of the adults and few people with varicose veins are ever harmed by them. However, they cause concern and distress on a large scale, most of which can be dealt with by good explanation and reassurance, or by a variety of treatments which are evolving rapidly at present. Patients can now be referred for more precise assessment and a greater range of therapeutic options than ever before.

What Problem can varicose veins cause?

Cosmetic concern

Dislike of their appearance is a common complaint, particularly for women.

Fears about future harm

A questionnaire study found that many people are worried about the possible harm their varicose veins might cause, but these fears are usually inappropriate—particularly in relation to bleeding, ulcers, and deep vein thrombosis

Discomfort

Varicose veins can cause a variety of symptoms of discomfort in the legs, but it is important to try to differentiate these from the many other reasons for leg pains.

Vein study found that the symptoms significantly associated with varicose vein were itching, heaviness, and aching, but the relation of these with varicose veins was inconsistent, particularly in men

Leg swelling

This is an uncommon symptom of varicose veins—other causes are much commoner.

Thrombophlebitis

Superficial thrombophlebitis (“phlebitis”) can complicate varicose veins. The risk of deep vein thrombosis is remote, but in a case series, it occurred very occasionally if phlebitis extended above the knee.

Treatments

Patients for whom discomfort is the main problem should be advised that wearing support hosiery can provide good relief. Elevation of the legs may relieve symptoms. Advice about regular exercise sounds sensible but is not supported by any evidence. For people who are obese, weight loss may reduce symptoms and would make any intervention easier and safer.

For patients with symptomatic veins and substantial venous incompetence, surgery has been the optimal treatment for many years. Inadequate assessment and operations done to mediocre standards gave varicose vein surgery a suspect reputation, but in recent years thorough treatment by interested specialists has become more widespread. Evidence from a recent UK based randomized controlled trial has shown that varicose vein surgery is both clinically and cost-effective.

These are alternatives to the stripping of the long saphenous vein. If done without any other kind of treatment they may cause some varicose veins to disappear, but usually varicose veins need to be dealt with by phlebectomies or sclerotherapy. Radiofrequency and laser ablation each involve passing a probe up the long saphenous vein from knee level to the groin under ultrasound guidance and then ablating the vein in sections. This avoids a groin incision and may lead to less bruising and quicker recovery.

It is not yet clear just how the various treatments will fit into the management of varicose veins. It may well be that some are more suitable for certain kinds of patients (for example, those with large varicosities or obese legs), and patients may have personal preferences. Most specialists will offer all the possible treatment modalities, but they ought to be able to give good advice about treatment choices and to provide a range of options.