varicose veins
Varicose veins are swollen/ enlarged veins that are located on the legs and feet with lumpy, dilated and irregular patterns caused by the veins. It can cause pain, burning and the feeling of heaviness but there is no known cause to the condition. It is suspected that a history of poor venous supply to certain areas of the body or problems with the blood clotting excessively contribute to the presence of the condition.
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In the UK, it was found that less than 50% of the population who have minor problems with diseases affecting the veins (venous) experience visible varicose veins. With women being 20-25% and men being 10-15% [1]
Prevalence increases with age and they develop often in pregnancy [2]
Prevalence is higher in developed countries and more industrialised countries too [3]
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Increased blood pressure in the veins that can run in the family
Pregnancy- hormonal changes and uterus increases pressure in veins
Ageing
Standing for long periods of time
Obesity
Leg injury [5]
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Medical students
The specific cause of varicose veins is still being debated.
The general agreement is the failure of venous valve closure resulting in the superficial veins becoming dilated, elongated and tortuous.
The main factor contributing to the development of varicose veins is sustained venous hypertension.
This increases the diameter of the superficial veins resulting in further valve incompetence.
Patients
The specific cause of varicose veins is still being debated.
The general agreement is the failure of venous valve (structure that take blood back to the heart against the force of gravity) to close
Resulting in the superficial (close to the surface) veins becoming dilated, elongated and tortuous (twisted).
The main factor contributing to the development of varicose veins is sustained venous hypertension.
This increases the diameter of the superficial veins resulting in further valve incompetence. [4]
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Older age
Standing or sitting for long periods of time
Sedentary lifestyle (inactive)
History of varicose veins or deep vein thrombosis (formation of blood clots causing obstruction) [6]
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Tense and palpable (able to be touched)
May progress to enlarged, more obvious signs
Can cause tiredness, fatigue, pressure, pain and hypersensitivity in the legs
Can impact the inner ankle (medial malleolus) region when discolouration occurs
Ulcer formation after small injuries
Thin bleeding sacs may form with pain and rupture after small levels of trauma [7]
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Clinical examination of the appearance of the legs
Ask for a history of varicose veins, pregnancy, deep vein thrombosis history, body mass index and history of leg injury
Referral to a specialist may be needed if the varicose veins cause pain and discolouration of the legs
A test called a duplex ultrasound scan will be needed.
This uses high-frequency sound waves in a device to create an image of the veins investigated, helping the veins affected to be focused on in management [8]
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Telangiectasia- red, small thread- shaped veins
Venulectasia- blue, networks of vessels [9]
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Medical Students
Treatment Goals
Relieve symptoms
Improve cosmetic appearance
Prevent complications (e.g., thrombosis, skin changes)
Conservative Management
Compression stockings
Local wound care (for ulceration or skin breakdown)
Minimally Invasive Interventions
Sclerotherapy: induces a thrombophlebitic reaction to occlude veins
Recannulation is common
Thermal ablation: laser or radiofrequency to destroy vein tissue
Surgical Management
Ligation and stripping of veins
Offers short-term relief
Long-term efficacy is limited due to recurrence
Treatments often need to be repeated
New varicose veins may form over time despite prior therapy
Patients
What Treatment Aims to Do
Ease symptoms (like aching or swelling)
Improve the look of your legs
Prevent problems like blood clots or skin damage
Basic Treatments
Wearing compression stockings to help blood flow
Wound care if you have skin sores
Other Treatment Options
Sclerotherapy (injection to close off the vein)
May need repeating as veins can reopen
Thermal ablation (laser or heat treatment inside the vein)
Surgery: Tying off or removing problem veins. Helps in the short term but veins may come back
Even after treatment, new varicose veins can appear
You might need repeat treatments over time
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Blood clots- obstructions of the blood vessels
Inflammation or swelling of the veins (phlebitis)
Bleeding due to injury or trauma [8,10]
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Varicose veins only have visible symptoms (cosmetic symptoms)
The condition only affects elderly people
Only women experience the symptoms of varicose veins
If you cross your legs, it increases your chances of varicose veins
Varicose veins will come back after treatment [11,12]
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What causes varicose veins?
How can I get support for my varicose veins if I feel insecure about them?
How do I decide which treatment to use to treat my varicose veins?
What happens if my varicose veins return?
How long will treatment take to show improvement in the appearance of varicose veins?
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Vascular Society
John Hopkins Medicine
NHS Inform
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[1] https://pubmed.ncbi.nlm.nih.gov/8156326/
[2] https://cks.nice.org.uk/topics/varicose-veins/background-information/prevalence/
[3] http://www.bestpractice.bjm.com
[5] https://www.circulationfoundation.org.uk/help-advice/veins
[9] https://dermnetnz.org/topics/varicose-veins
[10] https://www.hopkinsmedicine.org/health/conditions-and-diseases/varicose-veins
[11] https://www.azuravascularcare.com/infoveins/varicose-veins-top-10-myths/
[12] https://www.veinclinics.com/blog/7-varicose-veins-myths/
Source: Hammed A Ninalowo
Varicose veins
Varicose veins seen on the leg (protruding structures)
Source: DermNetNZ.org
Varicose veins
Protruding and twisting veins
