Varicose veins

Varicose veins are dilated, elongated and twisted superficial veins visible through the skin, almost always on the legs. They are very common: they affect a large part of the adult population, more often women, and become more frequent with age. Besides being an aesthetic concern, they can cause heaviness, tiredness and swelling of the legs.

What varicose veins are

Varicose veins appear when the valves in the veins, which keep blood flowing up from the legs towards the heart, stop working properly. If the valves do not close well, blood pools, pressure rises and the vein dilates. This failure of the veins is called chronic venous insufficiency.

Varicose veins and spider veins

Not every visible vein is a varicose vein:

• Spider veins or telangiectasias: very fine vessels (under 1 mm), red or purple, in a web or spider pattern. They are mainly an aesthetic concern.
• Reticular veins: bluish veins of 1–3 mm that often feed spider veins.
• Varicose veins: veins over 3 mm, bulging and tortuous, which usually indicate venous insufficiency.

Why varicose veins appear

Factors that favour varicose veins include family history, female sex and hormones, pregnancy, age, long hours standing or sitting, excess weight and a sedentary lifestyle.

Symptoms of varicose veins

Varicose veins can cause heavy, tired legs, swelling at the end of the day, night cramps, itching and, in advanced cases, skin discolouration around the ankle and ulcers. If a varicose vein becomes red, hot and painful, or a leg suddenly swells, seek urgent medical care.

Treatment of varicose veins

Treatment of varicose veins depends on their size and on whether there is venous insufficiency. Before treating large varicose veins, a Doppler ultrasound shows which veins are failing.

• Sclerotherapy: a solution injected into the vein closes it; foam (microfoam) is used for medium veins. It is the usual treatment for spider and reticular veins.
• Vascular laser: for very fine spider veins.
• Endovenous radiofrequency or laser ablation: closes the main diseased vein (saphenous vein) from inside; it has largely replaced classic surgery.
• Surgery: removal of the vein (stripping) or of individual varicose veins (phlebectomy).
• Compression stockings, exercise and weight control: relieve symptoms, although they do not make varicose veins disappear.

Spider veins are usually treated in aesthetic medicine. Varicose veins with venous insufficiency should be assessed by a vascular surgery specialist.