Patient information
Understanding varicose veins
Varicose veins are one of the most common vascular conditions in the UK. They can cause persistent discomfort, visible changes to your legs, and — if left untreated — more serious complications. This page explains what varicose veins are, how they affect people, and the modern treatment options available.
What are varicose veins?
Varicose veins are swollen, twisted veins that sit just beneath the surface of the skin — most commonly in the legs. They develop when small one-way valves inside the veins stop working properly. These valves normally prevent blood from flowing backwards; when they become weak or damaged, blood pools in the vein, causing it to stretch, bulge, and become visible.
Healthy leg veins carry blood upwards towards the heart against gravity. Tiny valves open to let blood through, then close to stop it falling back. When these valves fail — a condition called venous reflux — the increased pressure in the vein causes it to enlarge and become varicose.
Varicose veins can appear as blue, purple, or dark-coloured cords running along the leg. They may be raised and lumpy, or sit deeper beneath the skin. They are different from spider veins (thread veins), which are smaller, closer to the surface, and usually a cosmetic concern rather than a medical one.
Who is affected?
Varicose veins are extremely common. They affect men and women of all ages, though they become more prevalent with age. Several factors increase the likelihood of developing them:
- Family history — if your parents or siblings have varicose veins, you are more likely to develop them
- Pregnancy — hormonal changes and increased blood volume put extra pressure on leg veins
- Prolonged standing or sitting — jobs that involve long periods on your feet (or at a desk) reduce the natural muscle-pump action that helps blood return to the heart
- Age — vein walls and valves naturally weaken over time
- Being overweight — extra body weight increases pressure on the veins in your legs
- Previous deep vein thrombosis (DVT) or leg injury — damage to the deep veins can affect how blood drains from the leg
How varicose veins affect daily life
Many people assume varicose veins are purely cosmetic. While appearance is a valid concern, the symptoms can be surprisingly disruptive to everyday life:
A dull, persistent ache or heavy feeling in the legs — often worse after prolonged standing or towards the end of the day.
Ankles and lower legs may swell, particularly in warm weather or after long periods of inactivity.
Some people experience throbbing sensations or painful night cramps that disturb sleep.
The skin over and around varicose veins can become dry, itchy, and irritated — a sign of underlying venous pressure.
Over time, chronic venous pressure can cause the skin around the ankle to become discoloured (brown or reddish), thickened, or hardened. This is called lipodermatosclerosis.
Inflamed, flaky, or weeping skin on the lower leg — often misdiagnosed as ordinary eczema.
In advanced cases, the skin can break down and form slow-healing wounds (ulcers), usually near the ankle. These can be painful and difficult to manage without treating the underlying vein problem.
These symptoms often develop gradually. Many patients live with them for years before seeking help — sometimes because they assume nothing can be done, or because they expect treatment to involve a major operation. Modern varicose vein care is very different.
When should you seek help?
It is worth seeing a vascular specialist if you notice any of the following:
- Persistent aching, heaviness, or swelling in your legs
- Visible varicose veins that are getting larger or more uncomfortable
- Skin changes around your ankles — discolouration, thickening, or itching
- A varicose vein that has bled (even a small amount)
- A hard, painful lump in a varicose vein (which may indicate superficial thrombophlebitis)
- A wound or ulcer on your lower leg that is slow to heal
- Symptoms that are affecting your sleep, work, or daily activities
Early assessment is always sensible. A consultation and duplex ultrasound scan can confirm whether your symptoms are caused by venous reflux and help you understand your options — including whether treatment is needed at all.
Treatment options and objectives
The goal of varicose vein treatment is to eliminate the underlying venous reflux, relieve symptoms, prevent complications, and improve the appearance of the leg. Modern treatments are minimally invasive, performed as day cases, and designed to get you back to normal activity quickly.
It starts with the right diagnosis
Before any treatment, a duplex ultrasound scan is essential. This painless, non-invasive scan maps the anatomy of your veins and identifies exactly where the valves are failing. Without it, treatment is guesswork. With it, your surgeon can create a targeted plan that treats the cause — not just the visible veins.
Radiofrequency ablation (RFA)
A thin catheter is inserted into the affected vein under ultrasound guidance. Controlled radiofrequency energy heats the vein wall, causing it to seal shut. Blood is naturally rerouted through healthy veins.
- Performed under local anaesthetic as a day-case procedure
- Walk-in, walk-out — most patients walk immediately afterwards
- Minimal scarring (a single needle puncture)
- Approximately 90% symptom resolution within weeks
Foam sclerotherapy
A specially prepared foam solution is injected directly into the varicose vein. The foam displaces blood and irritates the vein lining, causing it to close and eventually be absorbed by the body.
- Particularly effective for certain vein patterns identified on duplex scan
- Can be used alone or alongside other treatments
- No incisions required — performed with a fine needle
- Compression stockings are usually worn for a short period afterwards
Avulsions (phlebectomies)
Surface varicose veins are removed through tiny incisions (typically 2–3 mm). This is often combined with treatment of the underlying refluxing vein to address the root cause.
- Performed under local anaesthetic
- Incisions are small enough that stitches are rarely needed
- Immediate cosmetic improvement in most cases
- Usually combined with RFA or foam sclerotherapy for a complete result
Treatment objectives
Every treatment plan is tailored to the individual patient, but the broad objectives are consistent:
Reduce aching, heaviness, swelling, and cramping so your legs feel comfortable again.
Stop venous reflux from causing skin damage, ulceration, or worsening symptoms over time.
Remove or reduce visible varicose veins so you feel confident in your legs.
Use the least invasive approach that achieves a good result, with rapid return to daily life.
What recovery looks like
Most patients are back on their feet immediately after treatment. Discomfort is usually mild and settles within one to two weeks. You can typically return to normal daily activities straight away — though your surgeon will advise on any specific precautions based on your procedure.
Compression stockings are usually recommended for a short period after treatment to support healing and optimise results.
Is treatment right for everyone?
Not always — and that is an important part of the assessment. Some varicose veins cause no symptoms and may not need treatment. Others respond well to conservative measures like compression stockings and lifestyle changes. Your consultant will explain whether treatment is appropriate, what it involves, and what results you can realistically expect.
The decision is always yours. A good consultation gives you the information you need to make a confident choice.
Ready to get clear answers about your veins?
A specialist consultation and duplex ultrasound scan can confirm what is causing your symptoms and help you understand your options. Initial consultations are typically available within five days.
If you have urgent symptoms (e.g. sudden leg swelling, significant bleeding from a varicose vein), please seek urgent NHS assessment via 111 or A&E.