Varicose Veins


Varicose veins are knobbly, enlarged veins. Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That’s because standing and walking upright increases the pressure in the veins of your lower body.

What causes Varicose Veins?

To date, no specific cause for the development of varicose veins has been identified. However, various genetic and environmental risk factors have been ascribed to their formation. Primary varicose veins have been shown to affect up to one third of the Western adult population and are a major cause of morbidity. Estimates of prevalence range from 2% to 56% in men and 1% to 60% in women.

It has also been reported that there is a significant correlation between CVD onset and sex with females showing first symptoms at a mean age of 30.8 years and males at 36.8 years.

Varicose veins increases with age. The Edinburgh Vein Study reported the prevalence of varicose veins increases from 11.5% in 18 to 24 year olds age to 55.7% in 55 to 64 year olds.

There are several established risk factors associated with varicose veins, including age, sex, pregnancy, raised body mass index in women, obesity, and family history of varicose veins.

Signs and symptoms

Common chronic symptoms of varicose veins that should be elicited include the following:

  • Leg heaviness/aches/ pains
  • Exercise intolerance
  • Pain or tenderness along the course of a vein
  • Pruritus
  • Itching
  • Burning sensations
  • Restless legs
  • Night cramps
  • Leg/ankle oedema
  • Skin changes e.g. colour changes, eczema etc
  • Paresthesias
  • Bleeding from the veins
  • Leg ulcer

Common symptoms of telangiectasia include the following:

  • Burning
  • Swelling
  • Throbbing
  • Cramping
  • Leg fatigue

For many people, varicose veins and spider veins – a common, mild variation of varicose veins – are simply a cosmetic concern. For other people, varicose veins can cause aching pain and discomfort. Sometimes varicose veins lead to more-serious problems.

Varicose veins may also signal a higher risk of other circulatory problems. Treatment may involve self-care measures or procedures by your doctor to close or remove veins.

How would you know you have varicose veins?

Varicose veins usually don’t cause any pain. Signs you may have varicose veins include:

  • Veins that are dark purple or blue in color
  • Veins that appear twisted and bulging; often like cords on your legs
  • When painful signs and symptoms occur, they may include:
  • An achy or heavy feeling in your legs
  • Burning, throbbing, muscle cramping and swelling in your lower legs
  • Worsened pain after sitting or standing for a long time
  • Itching around one or more of your veins
  • Skin ulcers near your ankle, which can mean you have a serious form of vascular disease that requires medical attention

Spider veins are similar to varicose veins, but they’re smaller. Spider veins are found closer to the skin’s surface and are often red or blue. They occur on the legs, but can also be found on the face. Spider veins vary in size and often look like a spider’s web


To diagnose varicose veins, your doctor will do a physical exam, including looking at your legs while you’re standing to check for swelling. Inspection may reveal the following findings:

  • Ulceration
  • Telangiectasias
  • Eczematous lesions
  • Microulcers
  • Stasis dermatitis
  • Flat angiomata
  • Prominent varicose veins
  • Scars from a prior surgical operation
  • Evidence of previous sclerosant injections
  • Thrombosed superficial veins

You will also need an ultrasound test (Venous Duplex Scan) to see if the valves in your veins are functioning normally or if there’s any evidence of a blood clot both in the superficial and deep veins.

Management (Non-Surgical and Surgical)

The following are the modern techniques used to ablate varicosities:

  • Sclerotherapy – The most widely used medical procedure for varicose veins and spider veins
  • Laser and intense-pulsed-light therapy
  • Radiofrequency (RF) or laser ablation

Common surgical approaches to large-vein varicose disease include the following:

  • Ligation of the saphenofemoral junction with vein stripping
  • Phlebectomy performed through microincisions
  • The principal surgical approach to small-vein disease is by microincisional phlebectomy followed by sclerotherapy.