Varicose veins in the legs
Varicose veins are a common problem, usually caused by venous insufficiency.
Our minimally invasive varicose vein therapy addresses the cause, not just the symptoms, of varicose veins, giving you better long-term results.
Contents
Overview and definitions
Varicose veins are a common problem, affecting 1 in 3 people in the course of their lifetime. They vary from unsightly thread veins (also known as spider veins), which are primarily a cosmetic issue, to twisted, bulging and painful varicose veins, which become more swollen over time.
Varicose veins can cause a variety of issues depending on their stage and severity. At their mildest, they are a cosmetic inconvenience which may prevent someone from being comfortable baring their legs, even to their partner. Reticular veins are slightly larger, bluey coloured veins, which lie deeper in the legs. More severe issues cause large, unsightly, bulging varicose veins, which can become painful due to mounting pressure from insufficient blood flow. In approximately 1-2% of over 65s, severe varicose veins can lead to skin changes and leg ulcers.
At UK Veincentre (UKVC), our expert consultants have over 17 years of experience in treating varicose and thread veins, gained through their work at Veincentre Ltd in the UK. Using minimally invasive varicose vein therapy techniques, such as endovenous laser ablation (EVLA) and foam sclerotherapy, we are now able to provide this ‘walk-in, walk-out’ service to patients in Dubai.
Causes
Normal veins are largely invisible, being either very small or residing deeper within the legs.
Varicose veins are caused by venous insufficiency – problems with the veins in your legs that cause blood to travel more slowly back to your heart. High pressure in thin-walled veins, which are only designed to withstand low pressure blood flow, causes the veins to bulge and swell.
Varicose veins most commonly come from an issue with the veins / valves in the legs. However, in some people, they can arise from an issue with the pelvic veins.
Venous insufficiency can be caused by:
- Deep vein obstruction
The most common cause of deep vein obstruction is deep vein thrombosis (DVT) – a blood clot resulting from poor blood flow in the leg veins, such as after an operation, being bed-bound due to illness or reduced movement in the leg, e.g. immobilised in a cast after a fracture.
- Muscle pump failure
Muscle pump failure occurs in any condition where the calf muscles are very weak. Each time you take a step, your calf muscle squeezes and helps your veins pump blood back up to your heart. This ‘calf muscle pump’ is known as your ‘second heart’. It helps blood in your legs defy gravity, and is vital for your circulation.
- Valve failure
This is by far the most common reason for venous insufficiency and varicose veins. Inside your veins there are tiny valves, which ensure that blood only flows one way – up your legs from your feet to your heart. Failure of these valves means the blood tries to travel in the wrong direction, pooling in your veins and causing them to bulge and swell.
Once one valve is damaged it causes the vein below it to stretch. This pulls apart the next valve below, leading to a domino type effect with more and more valves failing and eventually a varicose vein becomes prominent.
Without treatment, chronic venous insufficiency (CVI) can raise the pressure in your legs so much that tiny blood vessels, called capillaries, burst. This causes the skin to become reddish-brown and more susceptible to damage if bumped or scratched. A common complication of varicose veins and CVI are leg ulcers – open sores on the surface of the skin – which can quickly become infected.
Risk factors
Whilst there is no one definitive cause of varicose veins or venous insufficiency, a number of risk factors have been identified:
- Older age – aging causes wear and tear to the valves in the veins that help control blood flow. Veins also lose some of their elasticity as you get older
- Having female anatomy – hormonal changes from puberty, pregnancy, and menopause can lead to varicose veins, and taking birth control pills or hormone replacement therapy can increase your risk
- Being born with defective valves or weak walls in your veins – which means you are far more likely to develop varicose veins as a result of venous insufficiency
- Obesity – being overweight puts added pressure on the veins which means they have to work harder to send blood back to your heart
- Pregnancy – during pregnancy, the blood volume in the body increases. This change supports the growing baby but can also enlarge the veins in the legs
- History of blood clots in your legs – if you have had a blood clot or DVT in the past, this may have caused damage to the valves and/or walls of your veins, leading to increased pressure
- Standing or sitting for long periods of time – movement helps blood flow so sitting for long periods can hinder circulation, whereas with standing, the problem is that it becomes harder for blood to circulate upwards (it simply goes against gravity!)
- Family history of varicose veins – evidence suggests that there is a genetic component to varicose veins, so if other members of your family have them, particularly your parents, then you are more likely to develop them too.
Prevention
Unfortunately, there is no way to prevent the valve problems that cause varicose veins. They can appear at any stage of life from age 18 to 80 years old and are often determined by family history. However, the inheritance pattern is not simple, and some family members can have large varicose veins even at a young age, whilst other family members have none in their lifetimes.
The best way of preventing varicose veins from appearing, if you have venous insufficiency, is to have the underlying problem treated with one of the modern minimally invasive techniques, such as EVLA.
Although varicose vein treatment is the only way to fix the problem and prevent the veins from getting worse, the following may help to ease symptoms:
- Wearing compression stockings to improve drainage from the legs when standing up
- Regular exercise, which helps your calf muscles to pump blood back toward your heart, stopping it pooling within the veins
- Elevating your legs when sat or lay down
- Avoiding standing up for long periods of time
- Controlling your weight and/or stopping smoking, which puts less pressure on the veins
The timing to come forward for varicose vein therapy is an individual one and will be based on whether appearances and/or symptoms are the main concern. Patients also need to balance the benefits and risks of any procedure(s) required. Many patients manage with varicose veins for many years and even large bulgy veins can be surprisingly symptom free.
Symptoms
Whilst not everyone with varicose veins or venous insufficiency will be symptomatic, the symptoms of varicose veins can include:
- Visible bulging, twisted and swollen blue or purple veins
- Aching, discomfort and a tired or ‘heavy’ feeling in the legs
- Burning, throbbing, muscle cramping and swelling in the lower legs and feet
- ‘Restless leg’ symptoms
- Worsened pain after sitting or standing for a long time
- Itching around one or more of the veins
- Changes in skin color e.g. redness from inflammation or reddish-brown patches, indicative of burst capillaries in the legs
- Varicose eczema – dry, itchy and thin skin over the affected vein
- Skin damage, including bleeding, sores and ulcers
Many of the patients who come to us will experience at least a few of the symptoms listed above. However, some patients live with symptoms for so long that they only realise that their veins have caused the problems following treatment. Patients will often say their legs feel far less tired and that “it is like having a new pair of legs!” within only a few weeks of their treatment.
Diagnosis
The only way to accurately diagnose venous insufficiency and determine the underlying cause of varicose veins or thread veins is by having a colour duplex ultrasound scan performed on your legs, from your feet up to your groin.
Our varicose vein therapy always includes a colour duplex ultrasound scan as part of the consultation process, alongside a discussion with one of our expert consultants, in order to accurately diagnose the cause of your varicose veins.
Following your scan, you’ll be provided with a full consultation report and treatment quotation, which is valid for 6 months, so you can consider your options.
Our clinic team is also always on hand to answer any questions you might have.
Treatment
Living with varicose veins is possible, although symptoms and appearance do worsen over time. Taking regular exercise, eating a good diet and giving up smoking might help manage your condition, but these lifestyle changes alone will not fix the underlying cause.
There are three main reasons to seek varicose vein therapy and to get the underlying problem of venous insufficiency, which is causing the increased pressure in your veins, treated:
- Varicose and thread veins are unattractive. They can lead to self-consciousness, where people will feel uncomfortable showing their legs even to their partner. This also has an adverse effect on sport participation, enjoyment of holidays and other leisure activities. For some people, it can affect their career, for example actors and models (both sexes) who ‘need’ their legs to look better. Following treatment at UKVC, most patients are delighted with the appearance of their legs.
- They hurt. The increased pressure in varicose veins can cause pain and discomfort. Common symptoms are tired legs, itchiness, throbbing, restless legs and aching. These symptoms usually resolve very quickly after treatment.
- They can lead to serious skin damage and ulcers. Although most patients with varicose veins don’t get ulceration, most leg ulcers are associated with venous insufficiency and more common in those with varicose veins. Treating the varicose veins properly removes this cause and dramatically reduces the risk of leg ulcers.
Although varicose vein therapy is not always necessary it is generally advisable. This is because increased pressure in your veins over time can cause deterioration in the quality of the skin and, if left untreated, may result in a painful varicose ulcer (an open sore on your leg which can easily become infected).
At UKVC, we have a well-established treatment pathway, with proven results, based on over seventeen years of experience at the award-winning Veincentre Ltd clinics in the UK.
We manage your vein problems by first treating their underlying root cause. We identify and destroy any veins containing faulty valves in them before treating the visible varicosities (the unsightly blue or purple thread or bulging veins). By destroying the root cause, we relieve the symptoms and prevent the treated veins from returning.
We prioritise minimally invasive treatment options over traditional vein stripping surgery. With our varicose vein therapy there is no need for general anaesthetic. All the treatments we offer are minimally invasive (walk in, walk out) and guided by accurate medical imaging such as colour duplex ultrasound.
The specific type of treatment we’ll recommend to you will differ depending on the results of your colour duplex ultrasound scan (to determine if there is an underlying cause for your vein problems). From that scan we can recommend the procedure that best suits your condition. If you have definite varicose veins, we would recommend EVLA to fix the underlying cause, and foam sclerotherapy or avulsions to treat the visible veins.
In some instances, we would recommend foam sclerotherapy as the primary treatment for varicose veins, but it is ordinarily used as a secondary treatment following EVLA, in most cases it would only be used as the primary treatment for smaller residual thread veins (also known as spider veins).
In brief: Endovenous Laser Ablation (EVLA)
EVLA is a minimally invasive procedure which can usually be completed in around 1 hour, depending on the extent of your varicose veins. It involves using an ultrasound scan to guide a thin laser fibre into the affected vein, under local anaesthetic. This laser fibre is then slowly pulled along the faulty valves, delivering heat to seal the vein. This is repeated on all of the veins that have been identified as causing your varicose veins.
Once the affected veins have been heated up and destroyed, your body will naturally absorb the dead tissue left behind. Blood is then simply diverted to your healthy veins which are functioning normally.
The treatment is usually described by our patients as ‘uncomfortable’ rather than painful. Although you won’t be able to drive immediately after the surgery, you’ll be able to drive the very next day, and most patients are able to resume their normal activities straight away.
EVLA is the gold-standard treatment for varicose veins, as recommended by NICE in the UK.
In brief: Foam Sclerotherapy
Foam sclerotherapy involves a procedure whereby a diluted drug is injected directly into your varicose veins. The drug is mixed with foam and air, which displaces the blood in the veins and the drug destroys the cells in the vein lining. After the procedure, the treated veins shrivel up and your body breaks down and absorbs the dead tissue naturally.
Foam sclerotherapy is most commonly used as a secondary treatment to EVLA to treat visible veins and improve the cosmetic appearance of the legs. For patients with smaller varicose veins or thread veins (also known as spider veins), foam sclerotherapy may be the only treatment required.
This treatment is carried out on an outpatient basis, and usually takes no more than 30-45 minutes, depending on how many veins need treating. There’s little to no recovery time required after the procedure, so you’ll usually be able to drive and resume normal activities straight away.
Read more about our sclerotherapy treatment for varicose and thread veins.
In brief: Avulsions
Avulsions, also known as phlebectomies, are used to physically remove visible varicose veins. They are an alternative treatment to foam sclerotherapy either alongside or following EVLA.
An avulsion involves inserting a small medical tool, similar to a crochet hook, through a tiny incision in the skin. This is used to grasp the surface veins and physically remove them. The procedure is performed under local anaesthetic. The nicks in the skin require no stitches but are sealed with steristrips.
Although avulsions and foam sclerotherapy each have their own pros and cons, most of our patients are treated with foam sclerotherapy, because it is simpler and quicker, with less likelihood of post-procedure discomfort.
The main advantage of avulsions is the speed of resolution of the varicose veins. It is particularly useful, therefore, if there is a forthcoming event like a wedding that you wish to be ready for in a short timeframe.
Treatment costs
We have a clear pricing structure, whether you are using health insurance, or self-funding your varicose vein therapy with us. We outline the total costs involved in the diagnosis and treatment of varicose veins, if the primary treatment required is EVLA or foam sclerotherapy.
Our prices are upfront and fixed. We charge per leg, not per vein. There are no “from” prices and no hidden fees. Consultant fees and clinic fees are included in all of our prices. Our quoted prices remain fixed for 6 months from the date of your initial consultation, so you can be sure our fees won’t increase during this time.
If you have health insurance, please disregard our self-funding prices.
Treatment risks
As with all medical procedures, it’s important that you weigh up the benefits of having varicose vein therapy, versus the risks of side effects. You can find a full list of risks for all our vein treatments on our treatment FAQs page.
Aftercare
Following any vein treatment, you will need to wear a surgical support stocking for a week on the affected leg(s). Your nurse will explain how to wear these and bathe in them. The stockings should not restrict your movement, although we do discourage you from swimming whilst wearing them.
Although all our varicose vein therapy is minimally invasive, your body is still in a period of recovery and is busy absorbing all the veins we’ve treated. We strongly encourage you to continue with your normal activities following treatment (unless your normal is sitting down all day or running a marathon). You are advised to walk for at least 20 minutes each day during your recovery – this helps to improve blood circulation and speed up the healing process, as well as preventing blood clots.
Exercise should be guided by how your legs feel – don’t push your body too far. The only exercises we universally restrict are horse riding and heavy weightlifting for 1 week post-treatment. Swimming is also discouraged due to the need to wear compression stockings post-surgery. Your consultant will advise if there is anything else, lifestyle-wise, that you may be best avoiding for a while.
You are not able to drive on the day of treatment if you have EVLA or avulsions, but you are fine to drive the next day. Long-haul flights (more than 4 hours) are restricted for 4 weeks post-treatment due to the risk of blood clots.
The vast majority of our patients describe the procedures themselves and the recovery period as uncomfortable or only mildly painful. Any pain is usually managed effectively with over-the-counter painkillers. You may experience some mild bruising.
There is a small minority of patients who suffer from worse pain than most. If patients do experience pain, this is most commonly reported around 5 -7 days post treatment, when the treated veins start to be absorbed by the body. Patients will often describe this as a ‘tightening’ sensation in the legs. Some patients have also reported that they needed to take a day or two off work to recover following their procedure.
Frequently asked questions
Can varicose veins cause leg pain?
Is physical activity beneficial for varicose veins?
You can find the answers to these questions and many more in the varicose veins section of our Conditions FAQs page.
If you have any other questions, please do not hesitate to contact us, and a member of our clinic team will be pleased to help.
