All About Varicose Veins & Dermal Venules
A complete patient guide covering the causes, symptoms, complications and modern treatments for varicose veins and starburst (spider) veins of the lower limbs — including the next-generation 1940nm laser ablation now available at Laser Vein Co.
Book a consultation with Mr Peter Milne
30+ years Specialist vascular experience. Duplex ultrasound at your first visit, so you leave with a personalised plan — not a generic recommendation.
What exactly are varicose veins?
Varicose veins is the medical term used to describe dilated and tortuous veins. Most are visible on the surface of the body — the most common site being the lower limb. They tend to run in families and are aggravated by pregnancy and other environmental factors. They are not particularly dangerous, although they can be painful, unsightly and cause damage to surrounding tissues.
Varicose veins can be primary (the inherited variety) or secondary to a previous episode of deep vein thrombosis. They appear as large bulges under the skin, ropey and tortuous in appearance. When the limb is elevated they generally collapse, refilling on standing.
Dermal venules, spider veins & starburst capillaries
Varicose veins are not to be confused with small superficial blood vessels called starburst veins, burst capillaries, venules or flares — a fine tracery of vessels that look like bruises or wavy blue lines. They are a separate entity, although they often coexist with and are made worse by varicose veins. Sclerotherapy is successful for treating venules and spider veins; if large varicose veins are present, treating venules alone is not useful as they quickly reappear.
Symptoms of varicose veins
These day-to-day signs develop progressively over years as venous pressure damages the skin and underlying tissue.
Unsightly appearance
Lumps and distended veins with discolouration; pressure causes more superficial blue venules to appear.
Aching
Pressure and fluid accumulation in the limbs. Worse at day’s end; vanishes overnight with leg elevation.
Surface vein formation
Spider veins and dermal venules — harmless in themselves, but blebs around the ankles can bleed and need pressure applied.
Dermatitis & itch
High pressure upsets the normal nutrition of the skin, causing scales and redness.
Swelling
Fluid accumulation, generally around the ankles, with more frequent leg cramps and skin irritation.
Discolouration & bruising
Brown staining from iron deposition (hemosiderin) lasts for life — treating veins early avoids this permanent change. Easy bruising after minor knocks is also common.
Complications of varicose veins
When the underlying disease isn’t treated, varicose veins can progress to serious medical events. Early intervention prevents most of these from developing.
Liposclerosis (“champagne bottle legs”)
Hard tissue replaces the soft protective fat under the skin, making the limb unsightly and prone to damage from minor trauma. Once damaged the change is permanent, but further damage can be prevented by treating the underlying varicose veins.
Superficial thrombosis
Surface clot formation causing lumps and inflammation under the skin is common but usually harmless. Thigh clots need review promptly. Thrombosis within 10cm of the groin can result in serious complications and needs prompt management with ligation or anticoagulation. An ultrasound check is required.
Bleeding
Bleeding from surface veins can occur in the lower third of the leg or foot. It can be life-threatening unless treated. First aid: apply pressure on the bleeding point, then a bandage and leg elevation. Emergency treatment is ultrasound-guided injection of sclerosant.
Inflammation (sterile cellulitis)
High pressure starves fat cells under the skin of oxygen; dying cells release liquid fat causing a hot swollen leg. This is not an infection but a reaction to damaged tissue, and leads to liposclerosis.
Ulcer formation
Especially around the ankles. Treatment is compression dressings, not antibiotics. Treating the underlying varicose veins results in rapid healing and prevention of further problems.
Deep Vein Thrombosis (DVT)
Varicose veins can be associated with DVT but rarely cause it, although very large varices can predispose to DVT under certain circumstances.
Serious events
Bleeding from veins can be life-threatening if neglected — bleeding during sleep can be lethal. Thrombosis close to the groin can result in clots travelling to the lungs (pulmonary embolism). Any clotting in varicose veins should be reviewed by your doctor with an ultrasound check.
How do varicose veins form?
The essential defect is a weakness in the valves or walls of the veins that allows blood to flow in the wrong direction. Veins carry blood from the limb back towards the heart — upwards, against gravity — using one-way valves. If valves are defective, blood flows backwards, placing extra strain on valves further down, which may then also fail. This is why veins become progressively worse with time.
The most common area of initial leakage is in the groin, where the large surface vein joins the main deep vein. The valve behind the knee is the second most common site. Pregnancy and obesity aggravate the condition by adding strain on the valves.
The inherited predisposition to valve weakness is the most common cause, affecting up to 30% of us. Other causes include previous deep vein thrombosis or a malformation in the blood vessels of the limb (secondary varicose veins).
Next Generation Laser — now available
Laser Vein Co has invested in the latest generation laser delivery system with Infinite-ring delivery and a 1940nm wavelength — a notable advance over previous 1470nm systems.
Only 2-hour downtime
Compared with previous laser generations
Less surrounding tissue thermal damage than 1470nm
Faster return to normal life
For hospital treatment
Available for comfort
How are varicose veins treated?
Elevation
Reduces pressure in the veins, allowing reduction in swelling and discomfort. The horizontal position in bed at night provides relief from symptoms.
Injection treatment (Sclerotherapy)
For minor superficial varicose veins; under ultrasound guidance also useful for bigger or recurrent veins. No hospitalisation or time off work; bandages worn for only 24 hours.
Elastic stockings
Assist with symptoms via external compression, but do not prevent varicose veins. More often used to treat complications like ulcers, swelling and itch.
Surgery, laser & ultrasound-guided sclerotherapy
The major means of controlling large varicose veins — removing refluxing veins while leaving normal veins untouched. Decisions are made after anatomical mapping with duplex ultrasound.
| Hospital time | Procedure time | Anaesthetic | Discomfort | |
|---|---|---|---|---|
| Surgery | 1–2 days | 1–2 hours | General | 2–6 weeks |
| Laser | 2–3 hours | 20–40 minutes | Local / General | 1–2 weeks |
Permanence: surgery is normally 95% effective in removing large veins for up to 10 years. Laser treatment is more reliable at 10 years with fewer recurrences. Small surface veins recur with time after either treatment and can be managed with sclerotherapy in the office.
Safety: all treatments are 99.9% safe. There is a less than 1:8000 chance of further hospital admission for thrombosis or infection. The risk of loss of life or limb from complications of surgery is extremely small (<1:200,000).
Patient questions
Are varicose veins dangerous?
Rarely. The only dangerous complications are clot (surface thrombosis) ascending up the thigh towards the groin — called ascending phlebitis, needing emergency intervention — and bleeding from bubble-like varicose veins around the foot and ankle. First aid for bleeding: leg elevation and immediate compression with the thumb, followed by a firm bandage.
Are varicose veins curable?
Large varicose veins are usually curable with appropriate treatment for a 10–15 year interval. With ultrasound mapping, surgery can cure large varicose veins in 95% of patients for at least 5 years. Smaller spider veins recur throughout life and are managed with repeated injection treatment.
Should I have my veins fixed?
The indication is normally patient request, except for dangerous circumstances like thigh thrombosis or bleeding. It is essentially 100% safe to keep one’s varicose veins unless thrombosis or bleeding occurs (both very uncommon) — however, ulcers can cause pain, infection and scarring that damage the limb for life.
Which treatment is best for me?
Duplex ultrasound is the essential diagnostic tool, usually offered at your initial consultation. For very large and complicated veins, surgery is usually quickest and most effective. For most people, laser ablation and other interventions are more attractive options with little or no hospital time. All therapies are of equal safety (99.9%), but side effects differ.
Remember: most varicose vein treatments are elective. The exceptions are bleeding or clotting — these require prompt review.
Book a consultation with Mr Peter Milne
30+ years Specialist vascular experience. Duplex ultrasound at your first visit, so you leave with a personalised plan — not a generic recommendation.