Conditions FAQs

Whether you have varicose veins, thread veins or leg ulcers, our UK expert consultants are here to answer your questions.

For questions about treatments, such as endovenous laser ablation (EVLA) or sclerotherapy, check out our treatments FAQs page. For questions about terminology, clinic policies or payment queries, take a look at our general FAQs page.

If you cannot find the answer to your question you can also contact us, and our clinic team will be happy to help.

Varicose veins

Varicose veins are swollen veins, most commonly in the legs, resulting from increased pressure in thin-walled veins designed to withstand low pressures only.

Within the veins in your legs, small valves control the direction of blood flow. When functioning correctly, these valves ensure blood flows only in one direction: upward from the feet to the heart. However, if these valves fail, blood can flow backwards, causing blood to pool in the veins, leading to swelling, enlargement and bulging veins in the legs. 

You can read more about varicose veins on our varicose veins in the legs page.

While some individuals may develop varicose veins without any family history of them, it is often the case that varicose veins have a hereditary component. Genetics play a crucial role; if your mother had varicose veins, you may be predisposed.

Not necessarily. The primary cause of varicose veins is venous insufficiency, a condition where valves within the veins fail, leading to superficial venous reflux and the pooling of blood in the legs.

Concerns about other underlying health issues only usually arise in cases where there is a significant amount of clotting, leading to thrombophlebitis in the superficial leg veins. While this can sometimes be attributed to varicose veins, it might also be associated with other underlying health problems, such as extensive cancer.

It’s essential to note that this scenario is very rare, but if you suddenly experience extensive thrombosis, it warrants investigation to ensure there are no more serious underlying issues.

Unfortunately, it’s challenging to prevent varicose veins as they are often hereditary, passed down from your mother or grandmother.

If you notice varicose veins developing, the best thing to do is to seek treatment as early as possible.

Additionally, incorporating regular exercise, maintaining a healthy diet, and quitting smoking can assist in symptom management while awaiting treatment.

Varicose veins are usually caused by valve failure within the veins in the legs, but in some people, more commonly women, the veins with the faulty valves can be found in the pelvis.

Pelvic venous congestion syndrome (PVCS), also known as pelvic venous insufficiency or pelvic vein incompetence (PVI), is a condition that occurs when the veins in the pelvis are unable to adequately drain blood back to the heart.

The valve failure that causes PVCS normally occurs in the veins that drain the ovaries, especially the left ovary, although sometimes other veins, such as the iliac veins, may be the issue.

Although pelvic varicose veins are not generally dangerous, they can be extremely painful, causing debilitating symptoms such as chronic pain and heavy periods.

In severe cases, pelvic veins can become enlarged and twisted, bulging out of the skin and causing visible varicose veins on the vulva, perineum or buttocks.

Most patients who come to us with pelvic varicose veins or pelvic venous congestion syndrome (PVCS) do so to improve their quality of life and relieve their symptoms.

It is only in extremely rare cases that pelvic veins may rupture, causing a bleed. This usually occurs when the veins are under a great deal of strain, such as during pregnancy. If a vein ruptures, blood will leak into the surrounding tissue, causing severe pain and swelling. If this happens, it is vital to seek medical attention immediately.

Varicose veins commonly result from valve failure within the leg veins, but in certain individuals, particularly women, the faulty valves may reside within the pelvic area. This condition, known as pelvic venous congestion syndrome (PVCS), is observed in around 20% of women who have given birth to at least one child.

To ascertain whether your leg varicose veins originate from the pelvis, your consultant will conduct a comprehensive medical history assessment and discuss your symptoms with you. Presence of pelvic pain and/or varicose veins in the upper thigh region may suggest a pelvic origin for your varicose veins.

In order to precisely identify the location of the faulty valves in your veins and devise an appropriate treatment strategy, your consultant will perform a colour duplex ultrasound scan from your feet up to your pelvis. The results of this scan will accurately pinpoint the source of your venous insufficiency, enabling your consultant to recommend the most suitable course of treatment.

While prolonged standing can worsen varicose vein symptoms, it is not the root cause. Varicose veins are primarily influenced by genetic factors. If they run in your family there are limited measures you can take to avoid them.

Varicose veins often induce leg pain as a result of blood flowing in the wrong direction within the veins. When the valves in the veins fail it disrupts the efficient flow of blood from your feet to your heart, causing an accumulation of blood and heightened pressure in the veins, resulting in symptoms like pain and discomfort.

While it’s uncommon for varicose veins to trigger blood clots, it is not impossible. The risk is minimal, but certain factors such as long-haul flights can increase the risk. We advise wearing compression stockings during flights to alleviate symptoms and reduce the potential for deep vein thrombosis (DVT).

Eczema on the skin of the legs is often a result of venous insufficiency, a condition associated with varicose veins. To confirm this connection, you would need a colour duplex ultrasound scan of your legs.

Any form of exercise, particularly walking, can help to ease the symptoms of varicose veins. Engaging the muscles in your calves aids blood circulation from your legs back to your heart, preventing the pooling of blood in your leg veins that can lead to the development of varicose veins, and exacerbate the symptoms.

Compression stockings may not directly treat varicose veins, but they can potentially postpone their onset. While the definitive solution for varicose veins is undergoing treatment, compression therapy can also provide relief from symptoms in the interim. If immediate treatment is not feasible, wearing compression socks is recommended.

AT UK Veincentre the primary treatment we recommend for varicose veins in the legs is endovenous laser ablation (EVLA). EVLA is a minimally invasive outpatient procedure that uses laser to destroy the problem veins from the inside.

Before EVLA the traditional treatment for varicose veins in the legs was vein stripping surgery, which is still carried out in more than 50% of cases around the world. The problem with surgery, however, is that it’s an extensive operation, with multiple risks and possible side effects. Vein stripping surgery also has a high chance of recurrence (i.e. the veins are likely to come back again in future).

EVLA is now probably the most common non-surgical technique for dealing with varicose veins, because it is the most simple, effective, safest and cheapest way of dealing with both the varicose veins and the underlying problem of venous insufficiency

Some individuals who visit our clinic have previously been advised that the complexity of their varicose veins renders them unsuitable for laser therapy, leading to suggestions of surgical stripping instead.

Contrary to such practices, our approach dismisses the need for surgery. Our skilled consultants adhere to the esteemed guidelines of the National Institute for Health and Care Excellence (NICE) in the UK. According to NICE, varicose veins are best treated with endovenous laser ablation (EVLA) and/or foam sclerotherapy. These procedures are minimally invasive, conducted under local anaesthesia, with patients typically able to walk in and out on the same day.

Every individual entering our practice can be effectively managed through treatments endorsed by NICE. Specialising solely in vein-related concerns, our consultants possess extensive expertise, having successfully treated thousands of patients with varying degrees of varicose veins. Furthermore, our custom-designed EVLA kits are tailored to address varicose veins, irrespective of their anatomical complexity or ‘twistiness’.

The most qualified medical professionals to treat varicose veins are those specialising in venous insufficiency. In many hospital settings, patients are often directed to consult with vascular specialists rather than specifically with venous (vein) specialists. Vascular specialists may primarily focus on treating arterial disease rather than vein-related issues.

Venous specialists can include either vascular surgeons or interventional radiologists. The key is to consult with someone with a special interest in vein conditions and preferably with extensive experience in treating varicose veins.

All of our consultants at UK Veincentre (UKVC) are venous specialists who have successfully completed over 10,000 vein treatments, ensuring a high level of expertise.

It’s crucial to understand that there are two types of veins in the legs: superficial veins (located just under the skin, such as the saphenous vein) and deep veins, which carry the majority of blood back to the heart.

Varicose veins exclusively impact superficial veins, relying on their one-way valves for proper blood flow. After the ablation (destruction) of varicose veins, blood is redirected through the deep, healthy veins that are functioning effectively, facilitating the continued circulation of blood throughout the body.

Varicose veins and pregnancy

If you were already genetically predisposed to varicose veins it is true that pregnancy can sometimes accelerate their development.

Many women notice the onset of varicose veins for the first time during pregnancy. However, pregnancy itself doesn’t cause varicose veins.

Women who experience the emergence of varicose veins during pregnancy often have an underlying genetic issue with their valves. The pressure exerted on the valves in the veins of the pelvis, by the growing baby, also impacts the veins in the legs. This, combined with valve failure in the veins, contributes to the manifestation of varicose veins.

To understand the manifestation of varicose veins and thread veins during pregnancy, it’s essential to understand the nature of both conditions.

Varicose veins occur when the valves inside the veins malfunction, allowing blood to flow in the wrong direction (venous reflux). When the one-way valves, crucial for blood to travel from the feet back up to the heart, fail, the blood returns towards the feet, increasing pressure inside the vein and causing it to bulge.

Thread veins may also result from the same valve failure but are tiny, visible veins just below the skin’s surface. Unlike varicose veins, they do not bulge and exhibit fewer symptoms.

Several factors contribute to the development of varicose veins and thread veins during pregnancy, beyond genetics:

  • Increased blood circulation during pregnancy, to support the growing baby, can strain blood vessels and their valves, potentially leading to superficial venous reflux and venous insufficiency
  • The expansion of the uterus during pregnancy impedes the return of blood from the legs to the heart, straining the veins in the legs and pelvis
  • Hormonal changes during pregnancy can enlarge veins
  • Weight gain and reduced physical activity, common during pregnancy, can also contribute to accelerated venous insufficiency

Thread veins, also known as ‘spider veins,’ predominantly manifest on the legs during pregnancy, with a higher likelihood than varicose veins.

It’s common for women to experience both thread veins and varicose veins during pregnancy as they are symptoms of the same underlying condition; venous insufficiency.

In addition to the legs, varicose veins may also develop on the vulva and around the perineum during pregnancy.

This is a relatively common issue and stems from a slightly different anatomical problem. The veins inside the pelvis, especially those that drain the ovaries, can malfunction (a condition called Pelvic Venous Congestion Syndrome – PVCS), contributing to the development of varicose veins around the vulva.

Although these veins often improve after childbirth, there is an increased likelihood of their recurrence in that position at a later stage.

Similar to most other people who suffer with varicose veins, the symptoms can vary during pregnancy. Some people may experience little to no discomfort, while others may feel that their legs are more heavy and achy during pregnancy. Other symptoms of varicose veins, that may be experienced during pregnancy, include a burning sensation, restlessness, throbbing and itchiness.

Complications such as venous ulcers, thrombophlebitis (a superficial clot in a varicose vein), or deep vein thrombosis (DVT) during pregnancy are very uncommon.

In the majority of cases, varicose veins and thread veins that develop during pregnancy typically improve after childbirth.

The recommended approach for managing varicose veins during pregnancy is conservative treatment, including wearing compression stockings, engaging in regular exercise and maintaining a healthy diet.

Regrettably, contributing factors to the development of varicose veins during pregnancy (such as larger blood volume, increase in uterine mass and hormonal changes) are a normal physiological part of pregnancy.

Nevertheless, there are measures you can take to mitigate the impact of varicose veins during pregnancy. These include elevating your legs, engaging in exercises like swimming, and wearing compression stockings, which can all help to alleviate the discomfort commonly associated with varicose veins.

To alleviate pain and other symptoms associated with varicose veins during pregnancy, including itching and throbbing, consider the following measures:

  1. Engage in regular exercise, such as swimming or taking brisk walks, daily
  2. Avoid prolonged periods of standing or sitting in one position
  3. Wear compression stockings to enhance blood circulation
  4. Elevate the legs to improve blood flow

Varicose veins that arise during pregnancy frequently show significant improvement within the 12 weeks following childbirth. Nevertheless, in certain women, varicose veins may persist after pregnancy and may require treatment for complete resolution.

Unfortunately, treating varicose veins during pregnancy is not advisable due to the lack of safety data on the medications used in the procedures. Additionally, there is a slight increased risk of deep vein thrombosis (DVT) during pregnancy.

While the risk is likely minimal, ethical considerations prevent the treatment of pregnant patients. Since varicose veins may fully resolve after pregnancy and there remains a small risk of DVT in the 6-8 weeks postpartum, we do not advocate treatment at UKVC until at least three months after childbirth.

You will need to wait at least three months post childbirth before attending a consultation or receiving treatment for varicose veins. This waiting period is essential because the pattern and severity of venous insufficiency can change after childbirth.

If you attend a consultation before a subsequent pregnancy, an additional scan following pregnancy will be necessary before any treatment is administered. This ensures there are no new abnormal refluxing veins during or after pregnancy. The second scan will be provided at no additional cost.

The main factor determining treatment post childbirth is whether you are breastfeeding. If you need foam sclerotherapy or microsclerotherapy, any milk expressed within 24 hours following the treatment must be discarded due to the chemicals used. Therefore, you would need to express enough milk to cover this time frame.

Alternatively, you may decide to wait until you have stopped breastfeeding before undergoing treatment, especially if sclerotherapy is required.

Thread veins (spider veins)

Thread veins, also known as spider veins, are small yet noticeable veins situated just beneath the surface of the skin. They often exhibit a spider-like branching pattern, hence their name.

These veins can appear anywhere on the body but are most commonly found on the face and legs. Approximately 80% of adults will encounter thread veins at some point in their lives. While thread veins don’t usually cause any pain or discomfort, they are considered aesthetically unappealing, leading individuals to seek treatment to improve their cosmetic appearance.

Occasionally, patients may experience symptoms such as cramping, burning, or itching, but these symptoms are more commonly associated with the presence of varicose veins.

Whilst thread veins can be a sign of the early stages of venous insufficiency, there is not always an underlying cause associated with thread veins. However, it is essential to check for any underlying cause, because treatment is unlikely to be successful if the underlying cause is not treated first (i.e. the treated thread veins would be extremely likely to return).

A colour duplex ultrasound scan is required to determine whether you have any faulty valves in your veins, and only then are we able to give you an accurate proposed treatment plan.

This is not to say that patients will always have an underlying cause that needs treating, e.g. with endovenous laser ablation (EVLA), because there often isn’t any major reflux in the veins. If this is the case, the visible veins can be treated simply using treatments like foam sclerotherapy or microsclerotherapy, or sometimes with thermocoagulation.

Irrespective of the vein condition that you seem to have, whether prominent varicose veins or simply thread veins (also known as spider veins), it is necessary to have a consultation and colour duplex ultrasound scan prior to undergoing any treatment with us.

A colour duplex ultrasound scan is the only way to accurately determine whether there is an underlying problem causing the veins visible on the outside of the legs, not to mention any associated symptoms, such as throbbing, aching, itching, swelling, etc.

If you have thread veins or minor varicose veins (i.e. no obvious bulging), it is still important to rule out whether there is an underlying cause before commencing treatment. This is because treatment is unlikely to be successful if the underlying cause is not treated first (i.e. the treated thread veins would be extremely likely to return).

Thread veins typically do not resolve on their own and usually require treatment. The most effective treatment for thread veins on the legs is microsclerotherapy, or thermocoagulation for facial veins.

While treating thread veins can be challenging due to their stubborn nature, the procedures for thread vein removal are generally straightforward.

The most effective treatment for thread vein removal in the legs is microsclerotherapy. This procedure involves injecting a chemical sclerosant into the veins. Once administered, the sclerosant damages the vein lining, interrupting blood flow. Blood then redirects itself to other veins, causing the treated veins to wither and be absorbed by the body.

For small red thread veins or burst capillaries, particularly those on the face, thermocoagulation is the preferred treatment. This method employs heat to seal the vein.

It’s important to note that microsclerotherapy is not suitable for face veins due to potential risks of facial nerve damage and skin staining from the sclerosant.

Unfortunately, this is difficult to determine because it depends on a number of factors, including:

  • Who your insurer is
  • Your particular policy details and level of cover
  • Whether there is an underlying medical cause for your thread veins

You will need to contact your health insurance provider directly for advice. They will likely ask you to describe your veins and any symptoms you’re experiencing from them.

Some insurers will cover the cost of the consultation to determine any underlying cause, such as venous insufficiency, but you may need you to get a doctor’s referral first.

If you do not have any symptoms from your thread veins, then your treatment costs may not be covered by your health insurance, as many providers will view this as cosmetic.

Please contact our clinic team if you’d like any further advice. We’ll be able to advise regarding our experiences with your insurer and whether they are likely or unlikely to cover treatment. 

Leg ulcers

There are different types of leg ulcers, but venous leg ulcers are the most common, accounting for 60% of all leg ulcers.

Venous leg ulcers are caused as a result of the skin breaking down due to severe venous insufficiency. The valve failure which causes leg ulcers is the same valve failure that causes varicose veins, so most venous ulcers are also associated with varicose veins.

Whilst leg ulcers are more common in the elderly, they can affect anyone at any age.

Typically, leg ulcers form as a result of venous issues. The valve failure responsible for venous leg ulcers is the same valve failure linked to varicose veins, making it common for people to have both conditions. However, varicose veins are not the cause of the leg ulcers, merely another symptom of the underlying cause of chronic venous insufficiency.

It’s also worth noting that some patients may develop venous ulcers due to valve failure without displaying any evidence of varicose veins.

Older people are more likely to get leg ulcers as a result of increased inactivity and mobility issues, often linked to conditions such as arthritis. This diminished activity can exacerbate issues with blood circulation, leading to skin changes that may progress into venous ulcers.

Depending on the severity of your venous ulcer, you may be required to have it dressed regularly by a nurse, who will use whichever dressings are most suitable.

You will also likely be given compression bandages or stockings to help manage your condition whilst you wait for the ulcer to heal. These help to reduce leg swelling and improve blood flow and circulation, speeding up the healing process.

If you suffer with leg ulcers and want more information on what dressings to use, please speak to your usual physician. 

Certainly, as eczema is frequently another manifestation of underlying venous valve failure. Endovenous laser ablation (EVLA) is considered the primary choice for addressing both eczema and venous leg ulcers stemming from faulty leg valves. To accurately identify the underlying cause of any symptoms (including eczema), a colour duplex ultrasound scan is necessary.

Leg ulcer treatment traditionally involves a process of regularly cleaning and dressing the affected area, committing the patient to a lengthy period in compression bandages, which theoretically help improve circulation and treat swelling.

It is a time consuming process usually undertaken weekly by a nurse, over a period of several months.

Whilst compression therapy is an essential part of leg ulcer management, it doesn’t address any underlying issues, such as superficial vein reflux, venous insufficiency and hypertension

That’s why, at UK Veincentre (UKVC), we believe the best way to prevent the development and recurrence of venous leg ulcers is to treat the underlying cause with endovenous laser ablation (EVLA).

In most cases, after the ulcer has healed post-EVLA, it will not be necessary to wear compression stockings, which means that you can get on with normal life.

If you develop leg ulcers, seek medical advice. If your ulcers prove to be venous in origin, you will need both compression bandages and a referral for a colour duplex ultrasound scan, to address any underlying vein issues. We can help with both of these at UKVC.

Once the ulcer heals, you would still benefit from wearing compression stockings periodically, as they help reduce leg swelling by helping blood flow back to the heart. Try to keep your legs elevated while sitting, keeping your legs above your heart, to help blood flow out of your leg and prevent pooling. Propping your legs up on a pillow or cushion is perhaps the simplest way to achieve the appropriate elevation.

EVRA stands for ‘Early Venous Reflux Ablation’. There have been a number of studies published in recent years, including in the prestigious New England Journal of Medicine, showing the effectiveness of EVRA in both improving healing times and lowering recurrence rates for leg ulcers.

This supports our approach at UK Veincentre (UKVC) of treating leg ulcers with endovenous laser ablation (EVLA) and foam sclerotherapy, rather than with compression therapy alone. We look forward to further advances in research and the wider adoption of laser therapy for leg ulcer treatment in the future.