Varicose veins Patient information from the BMJ Group

Patient information from the BMJ Group
Varicose veins
Many people have varicose veins. Varicose veins don't usually cause serious
problems, but you may find them uncomfortable. Some people don't like the way
they look.
What are varicose veins?
Varicose veins are veins that have swollen up, because blood isn't flowing through them
Your heart pumps blood all around your body, carrying oxygen to your cells. When the
cells have taken out the oxygen, the blood returns to your heart through your veins. Blood
returning from your feet and legs has to flow upwards, so veins have valves in them to
stop the blood flowing backwards.
You get varicose veins when the valves in some of the veins near the surface of your
legs leak. Blood collects in the veins in your legs, instead of flowing back to your heart.
Varicose veins often appear on the backs of calves, or on the insides of legs.
Varicose veins don't stop your blood getting back to your heart. There are lots of veins
in your legs, and if one doesn't work properly, others can bring the blood back.
You may be more likely to get varicose veins if you're pregnant, or if you are overweight.
What are the symptoms?
Varicose veins look like twisted cords running along your leg. They may bulge and stick
out from the surface of the skin. They often look and feel lumpy.
You may not have any problems with your varicose veins, apart from the fact you can
see them. But some people say their legs feel uncomfortable. Your legs may ache or
throb, or feel heavy or itchy. Hot weather and standing for long periods of time can make
your veins look and feel worse.
If you are concerned about your veins, you may want to see your doctor.They will examine
you and ask you some questions.You might need some tests to check that your varicose
veins are not a sign of a more serious problem with your blood vessels. But this isn't
likely for most people.
What treatments work?
Varicose veins don't usually go away on their own. If they are causing problems,
treatments can help your legs look and feel much better. Treatments have side effects,
so you need to weigh up the pros and cons when deciding what's best for you.
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Varicose veins
Having surgery can get rid of your varicose veins. It is likely to improve the way your legs
look and also help symptoms like aching or heavy and tired legs. Surgery is the most
common treatment for varicose veins.
You may have either a general anaesthetic or a local anaesthetic when you have surgery.
If you have a general anaesthetic, you'll be asleep during surgery. With local anaesthetic,
the doctor just numbs the part of your body that will be operated on, so you'll be awake
but you won't feel any pain.
The surgeon will tie off and strip out the main surface vein. It's often done through two
cuts in your leg: one at your groin and the other at the inside of your knee, or your ankle.
The surgeon first ties the vein near your groin, then removes it through the cut further
down. Sometimes surgeons tie off the vein, but do not remove it. But if it's left in, your
varicose veins may be more likely to come back. Sometimes only the top cut is made,
and the vein is stripped out that way.
If you need lots of varicose veins removed, the surgeon will also make many tiny cuts
along your leg where the veins are. They then will use a hook to pull out bits of your veins
through your skin. Doctors call this avulsion. Sometimes surgeons use an electric suction
device instead. This is called powered phlebectomy. But this isn't done very often.
You'll probably be able to go home the same day as your surgery, but you will need time
off from your normal activities to recover. Recovering from surgery can be painful. Your
legs may feel sore for several weeks. Surgery seems to work for longer than a treatment
that involves having injections into your veins (see below). One study found that 2 in 3
people who had surgery were still free of varicose veins five years later, compared with
less than half the people who had injections.
Like any operation, surgery for varicose veins has some risks. It's hard to say exactly
how often problems happen, because the research isn't very good.
Problems can include having an allergic reaction to the anaesthetic, bleeding heavily
during or soon after the operation, bruising and having numb patches on your legs.
Serious problems are possible, but rare. A blood clot can develop in the deep veins of
your leg. Doctors call this deep vein thrombosis (DVT). This is dangerous. If you have a
high risk of getting blood clots, you may be given small doses of blood-thinning drugs.
If the big nerve that runs down the back of your thigh is damaged, it can make your foot
floppy and weak. Doctors call this foot drop. In a study of 600 people, one person got
foot drop.
Very rarely, surgery goes wrong and damages deeper veins. This may make your
problems with blood flow worse. You may need more surgery.
Radiofrequency ablation
Radiofrequency ablation uses heat to close up varicose veins. A special heating device
is put into the catheter. This heats the vein and closes it off.
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Varicose veins
There's not much good research to show how well this method works in the long term.
It seems to be roughly as good as surgery. The National Institute for Health and Care
Excellence (NICE), which advises the government on health care, says that this treatment
is safe enough and works well enough for use in the NHS. Talk to your doctor about the
risks and benefits.
Laser treatment
In laser treatment, a very thin tube (called a catheter) is threaded through a small hole
in your skin into the vein. A laser is then placed in the tube. The intense light from the
laser heats your vein and makes it close up.
There's not much good research to show how well this method works in the long term.
It seems to be roughly as good as surgery. The National Institute for Health and Care
Excellence (NICE), which advises the government on health care, says that this treatment
is safe enough and works well enough for use in the NHS. Talk to your doctor about the
risks and benefits.
Having injections of chemicals into your varicose veins may get rid of them. The injections
make the blood vessels collapse so blood can't get through them. Doctors call these
injections sclerotherapy. They are often used to clear up remaining varicose veins after
Your veins will probably look better after injections. But there's not much good research
to say whether injections can help with other symptoms like aching.
Injections can have side effects. Your skin may look discoloured afterwards. This can
take awhile to go away. Injections may not work as well as having surgery to remove a
vein. Varicose veins are more likely to come back after injections than after surgery.
Some people say the injections hurt. About 1 in 3 people get an itchy rash with swollen
circles at the spot where the needle went in. But this is temporary. Some people also get
bruising, inflammation, and red skin patches after injections. Injections are likely to be
less painful than surgery though.
Things you can do for yourself
There are things you can do yourself that may help your symptoms, or stop them getting
worse. But there's not much research to show whether these things can help or not.
Wearing support stockings, which are tight around your lower legs, may reduce
swelling and aching in your legs. These stockings are designed to help the veins
squeeze the blood back up your legs. It's important to be sure you have the right
type of stockings and that they fit well. Talk to your pharmacist or doctor about getting
the right type.
Keeping a healthy weight may help reduce the pressure on your veins. Exercise
like running or walking may help your veins pump the blood around your legs better.
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Varicose veins
If your legs are achy, try resting with your legs higher than your heart – for
example, lying down with your legs up on cushions. Avoid standing or sitting for long
Stop smoking. Smoking damages blood vessels, so might be linked to varicose
What will happen to me?
Without treatment, varicose veins tend to get worse over the years.This normally happens
very slowly. You may also get more varicose veins in your legs over time.
Varicose veins do not usually disappear on their own. But if you get varicose veins while
you are pregnant, they may disappear after you have your baby.
Sometimes, older people find they get other problems from their varicose veins. These
include thin, dry, itchy skin over the veins. Bumping a vein can be painful and lead to
bleeding. And occasionally people get small blood clots in the blood that builds up in
varicose veins. This can be sore and make the vein swell. You should see your doctor
if this happens. Less often, the skin near varicose veins gets broken. This is called an
ulcer and needs treatment.
Many people worry they will get deep vein thrombosis (DVT) because of their varicose
veins.This is when a big blood clot develops in your deep veins, which can be dangerous.
But there is no good evidence that having varicose veins leads to DVT.
This information is aimed at a UK patient audience. This information however does not replace medical advice.
If you have a medical problem please see your doctor. Please see our full Conditions of Use for this content.
For more information about this condition and sources of the information contained in this leaflet please visit the Best
Health website, . These leaflets are reviewed annually.
© BMJ Publishing Group Limited 2014. All rights reserved.
Last published: Sep 05, 2014
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