Varicose Veins Q&A

Ask the Consultant

Three of our leading vascular specialists answer frequently asked questions on varicose veins including the symptoms, risks and treatments available.

Mr Tahir Ali

Some of our veins lie immediately beneath the skin and others are hidden from view within the deeper muscle layers of the body. We need our veins to be able to drain blood back to heart, often against gravity, as part of our normal circulation.

Our veins cleverly use a series of delicate in-built valves to achieve this together with the pumping effect of muscles when we are active. We can see that our veins often become prominent when they are required to carry more blood, say during exercise or pregnancy or when we need to cool down during hot weather or at bath time!

However, when the integrity of our delicate valves fails or is overwhelmed, the veins are not only visible but with time become elongated, unraveled and often unsightly. It is this appearance which we describe as 'varicose veins'


Mr Bruce Braithwaite

They are abnormally enlarged veins near the surface of the skin on the legs. They can be in various sizes from fine blue or red veins (spider veins) to large 'worm-like' lumps that can be over 1cm in diameter.


Mr Martin Claridge

Varicose veins are lumpy tortuous veins that are often unsightly. As well as the visible veins there are usually more veins hidden below the surface which can cause aching, pain and swelling in the affected leg.

Mr Tahir Ali

The component parts of our blood vessels are packaged together whilst we are still growing in the womb. This includes the veins and their valves. How strong or resilient they will be during our lifetime is to a certain extent determined by our genes but is also influenced by the stresses they are required to cope with as we age.

When a vein wall becomes repeatedly overstretched or if the valve apparatus itself fails, the vein accommodates any non-returning blood by becoming tortuous and knotted. Eventually these changes in the vein wall spread to neighbouring segments and branches of the affected vein. These changes are likely to be visible to the naked eye particularly when these veins are in a prominent location such the lower calf where they can be felt as clusters or bulges.

These clusters and bulges are called 'varicosities' and are most commonly seen in the legs particularly when standing up.

We are still unsure of the trigger which causes our veins to become varicosed and it may well be that with time we will find that a specific weakness or defect in the vein or the valve itself it's the underlying factor rather than disturbances caused by high pressure within the vein.


Mr Bruce Braithwaite

Varicose veins are probably an inherited condition but can sometimes occur after a deep vein thrombosis. The veins and symptoms they cause can be made worse if your job involves standing or after pregnancy.


Mr Martin Claridge

Basal cell carcinoma can bleed then scab, then bleed then scab. Often the lesion looks like it will heal, only for the scab to come off in the shower, on the towel or on the pillow and bleed.

They form if the veins in the superficial venous system become big and dilated, together with failure of the valves in them. Veins are present to return blood back to the heart and if the veins in the superficial venous system in the leg stop working properly, then blood will pool in them (called reflux). This can put pressure on the skin and veins causing the symptoms that patients seek attention for.

Mr Tahir Ali

It is a common misconception to think that varicose veins only affects older adults or only women. Almost anyone male or female can develop varicose veins, and the likelihood is that you or someone you know has the condition. It is estimated that as many as forty percent of people may have the condition. The onset of the process can even be seen in teenagers but becomes much more common during our adult years.

Certain prolonged or repetitive strain on our veins such as pregnancy, standing still for long periods, or being a little overweight is known to make our veins more liable to become overwhelmed and varicosed, but these changes commonly occur in people who have no such risk factors.


Mr Bruce Braithwaite

Varicose veins are very common and about one third of the adult population have some form of varicose veins. Look and see how many people are wearing trousers or long skirts on a hot summer's day. Varicose veins can occur in men and women in about the same proportion but women tend to request treatment more than men.


Mr Martin Claridge

Up to half of the adult population may have varicose veins, with the problem being slightly more common in women than men. We know that it runs in some families, and that there is an increased likelihood for them to develop with pregnancy. Being overweight and leading a sedentary lifestyle may also contribute together with standing still for long periods.

Mr Tahir Ali

The majority of varicose veins are annoying rather than being harmful. The symptoms associated with the veins vary in severity for different people and may simply be the annoyance of the visual impact they cause or pain developing in the bulges seen.

Often they cause us to find that our legs tire or ache. Others may find that their legs and ankles are puffy particularly at the end of the day. The affected skin may become itchy or burn. Some people will suffer from restlessness or cramps in the legs which can disturb their sleep.

We have found that one in ten people will have varicose veins which are severe enough to cause concerns to them or their GP or consultant.

In some instances, the condition is associated with the development of changes to the appearance of the overlying skin, or the development of irritation within the veins themselves.

These may require lifestyle or work changes, or medical intervention such as prescription of steroid creams, painkillers or tight stockings to wear during the day to help prevent over-distension of the veins and encourage the better drainage of blood from the leg.

Your GP can advise you if you feel that your veins are becoming troublesome. Often we just want someone experienced to look at our veins and advise that nothing harmful will happen if left alone.


Mr Bruce Braithwaite

Many people do not like the look of the veins but they often cause heaviness and aching in the leg, pain, a feeling of heat or 'something running down the leg'. More severe varicose veins cause swelling of the ankle, itching, exczema and changes to the skin around the ankle.


Mr Martin Claridge

Patients may wish for treatment for a number of reasons. They may seek attention for cosmetic issues, due to dissatisfaction with the appearance of their legs. Pain, aching and leg swelling can all be caused by symptomatic varicose veins. If the veins have been present for a significant period of time they may cause skin changes around the ankle or even ulceration.

Mr Tahir Ali

The most commonly seen complication of varicose veins is the damage it causes to the skin.

Irritant components of the blood leak out of the vein wall when over distended. This is due to high pressure of the blood carried within the vein. The leakage from the veins contains proteins capable of irritation and skin injury.

This leakage may only result in a progressively more swollen leg, but as the condition becomes more established, permanent staining of the skin may develop in up to one in ten people. Untreated this damage ultimately leads to a compromise to the nourishment of the skin. With further damage, localised breakdown of the skin and an ulcer may develop in one to two percent of people.

Other complications include the development of thrombosis (clot) in the vein itself and repeated episodes of inflammation of the vein wall which in itself can lead to either infection or thrombosis (phlebitis and thrombophlebitis).


Mr Bruce Braithwaite

For many people there are no risks. For a few, the varicose veins can cause severe inflammation which can result in ulceration ( a sore), severe pain and sometimes bleeding.


Mr Martin Claridge

For many people there are no risks. For a few, the varicose veins can cause severe inflammation which can result in ulceration ( a sore), severe pain and sometimes bleeding.

Mr Tahir Ali

Treatment options will vary depending on the severity of the varicose veins. If skin changes are a concern already or other symptoms are impacting upon your health, surgical treatment is recommended.

The majority of surgeons will provide tailor-made treatments based on the nature of your valve or vein failure having examined you. Many treatments are performed without need of a general anaesthetic.

Common Treatments include:

  • Endovenous surgery -where the faulty vein or veins are closed by treating the vein with radiofrequency ablation or laser ablation.
  • Ligation the faulty junctions where blood wrongly enters veins lying beneath the skin. This typically requires an incision at the top of the leg or behind the knee.
  • Removal of veins in long or short segments (stripping, avulsions and microphlebectomies)
  • Injection of chemical irritants into veins to destroy the vein and close its channel (sclerotherapy). This may be performed in clinic when treating less extensive areas or small-sized varicose veins. This can also be combined with the other treatments mentioned above.
  • Novel treatments which are currently being evaluated but which have not yet been widely used include injection of polymer glues into the veins.

Mr Bruce Braithwaite

There are now several modern ways to treat veins so that a person can return to normal activity within a few hours of treatment. Traditional stripping is no longer recommended as keyhole methods using Laser, radiofrequency, and foam sclerotherapy have been shown to be much better. Many people can have treatment under local anaesthetic as a walk-in, walk-out procedure.


Mr Martin Claridge

There are a number of minimally invasive (keyhole) treatments available to treat varicose veins. Broadly these can be divided into techniques that use heat (e.g. Laser or RFA) or a chemical (e.g. foam or sealant) to get the treated vein to stick together and thus be removed from the circulation. Surgery (stripping) is still a useful technique, particularly in patients who have a lot of big varicose veins in both legs. Before treatment is carried out, an ultrasound scan should be performed to help decide what options are available.

Mr Tahir Ali

There is little evidence to convincingly say that we can prevent people from getting varicose veins if they are prone to their occurrence. Delaying their onset may be achieved by reducing the work demanded of your veins in everyday life. This may be achieved by avoiding standing still for long periods and using your calf muscle pump mechanism by performing regular toe lift exercises to help circulate the blood from the legs into the pelvis and back to your heart. Losing weight will reduce the stress on your veins and reduce the pressure on the skin around the lower leg. Stopping smoking has been found to improve the nourishment of the skin as will a compression stocking worn during the day. Pregnancy often makes previously normal veins fail and repeated pregnancies will accelerate the development of varicose veins.


Mr Bruce Braithwaite

It is difficult to reduce the chance of getting varicose veins as it is probably an inherited condition. Wearing compression stockings and walking can reduce some of the symptoms but will not get rid of the varicose veins


Mr Martin Claridge

You can reduce the chance of getting varicose veins by keeping active, avoiding standing still for prolonged periods and losing weight if you weigh more than you should.

Mr Tahir Ali

I wanted to be like the man whom I most respected when I began my training. I don't want to embarrass him by naming him. I remember his unwavering commitment to his patients and his loyalty to his team. He was a brilliant surgeon who had helped thousands of people. They entrusted him with their lives. I have a job where I make people better with what I do with my hands which is a huge privilege and honour and I get to work and play alongside a brilliant team of surgeons, doctors and nurses.


Mr Bruce Braithwaite

I trained in Cambridge, London and Oxford and realised then that I wanted to help people with their symptoms in a practical way. That is why I became a consultant surgeon.


Mr Martin Claridge

I chose to become a Consultant Vascular and Endovascular Surgeon as the field of Vascular Surgery is moving forward at a rapid pace. Effective treatment of patients with vascular disease requires expertise in medical management as well as keyhole endovascular techniques together with more invasive open surgery. Often to achieve the best outcome for a patient, a tailored approach involving all three is required.

Mr Tahir Ali

Being awarded a Vascular Society Endovascular Fellowship after my Registrar training enabled me to return to St Thomas' Hospital. This was a very special time for me and I was able to use this unique experience to develop as a sub-specialist in which I practice today.


Mr Bruce Braithwaite

Publishing my research on varicose veins treatments that have helped to show other surgeons across the world that the new keyhole techniques are better for patients than the old fashioned stripping method.


Mr Martin Claridge

Being invited to come and work in Vascular Surgery in Birmingham. We have one of the leading vascular units in the country based in our city that pioneers keyhole treatment for vascular conditions such as varicose veins.

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