Your questions, answered

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 valves which shut to prevent backwards flow. If the valves are defective, faulty or weak, blood flows backwards down the vein, placing extra strain on other valves, which may then also fail.

The common area of initial leakage is in the groin (saphenofemoral junction), where the large surface vein joins the vein inside the leg. The valve behind the knee is the second most common site of failure, followed by smaller perforating veins in the thigh or calf. This is why veins tend to become progressively worse with time. Pregnancy or obesity adds strain; as the veins stretch they dilate, lengthen and become tortuous.

Pressure inside the veins can become so great that blood leaks into the tissues, causing brown staining and dermatitis. Fluid leakage causes ankle swelling, and eventually tissue damage can lead to ulcer formation. Compression stockings can manage these complications initially, but do not stop the progression of varicose veins.

An inherited predisposition to valve or vein weakness is the most common cause. Pregnancy and/or obesity accelerates their formation. Other causes are malformations in the blood vessels of the limb (usually a birth defect) and previous deep vein thrombosis in the leg.

Initial management can be intermittent leg elevation, which reduces pressure, swelling and discomfort. Elastic stockings provide external compression and can help symptoms, but do not prevent varicose veins.

Injection treatment suits minor superficial varicose veins and discoloured areas; under ultrasound guidance it is also useful for larger or recurrent veins. Laser, coiling, ultrasound-guided sclerosis and surgery remain the major means of controlling large varicose veins — removing refluxing veins while leaving normal veins untouched. Treatment decisions are made after anatomical mapping with duplex ultrasound.

The operation ligates points of venous valve failure and extracts the varicose veins through multiple small incisions (“ligation, puncture and extraction”). Removal of the surface thigh or calf vein is performed by invaginating rather than “stripping” the vein, reducing trauma and speeding recovery. This technique achieves a 95% rate of cure for high-pressure varicose veins over 5 years.

With laser treatment only needle punctures occur and normal mobility resumes in 2–3 hours. Bruising is common but transient. With surgery, expect a 1–3cm incision over leaking valves (generally at each groin, less frequently behind the knee), with most extraction sites being punctures under 1mm. Hospital time for surgery is 1–2 days; for coiling or laser, 1–2 hours.

All treatments are 99.9% safe. The risk of loss of life or limb from complications of surgery is extremely small.

Rarely. The only dangerous complications are clot (surface thrombosis) ascending up the thigh towards the groin, and bleeding from bubble-like varicose veins around the foot and ankle. Thrombosis is rare and easy to detect from pain and a firm lump in the thigh — it requires urgent attention. For bleeding, first aid is leg elevation and immediate compression with the thumb followed by a firm bandage. You will be advised if either complication is likely at your consultation.

No. The only reliable means of preventing varicose veins is to remove gravity from the equation. Crossing the legs whilst sitting does not cause varicose veins.

Large varicose veins are usually curable with surgery for a 10-year period; with ultrasound mapping, surgery cures large varicose veins in 95% of patients for at least 5 years. Veins tend to recur with pregnancy, obesity, other illnesses and time — recurrences are often manageable by sclerotherapy. Smaller spider veins recur throughout life and are managed by repeated injection treatment, a little like regular “haircuts” but less frequent.

The indication for treatment is patient request, except for dangerous circumstances like thigh thrombosis or bleeding. It is essentially 100% safe to keep your varicose veins unless those occur. Age is not a contraindication — it is never too late to request treatment. Recurring ulceration, pain or bleeding often drives people to seek treatment, but most treatment is elective.

Yes. The deep veins inside the leg are the main system for blood transport back to the heart and are not involved in varicose vein surgery. Removing abnormal surface veins actually lessens the load on the deep system.

You may. Leg vein remains the best material for bypass surgery to save legs from gangrene secondary to blocked arteries — most relevant for smokers and diabetics. For diabetic patients, valve repair may be preferable. Cessation of smoking is always advised.

Your initial consultation with your vascular surgeon is the time to ask. For very large, complicated varicose veins, surgery is still the quickest and most comfortable method. For modest, less complex problems, sclerotherapy, coil occlusion or laser ablation are more attractive options without significant hospital time. All therapies are of equal safety but side effects vary — after surgery, bruising and lumps resolve by 6 weeks; after sclerotherapy, laser and coil treatment, lumps and tenderness may take 3–6 months and discolouration can last over 12 months.