FAQs

What are varicose veins?
Veins are the blood vessels that carry blood back to the heart. In the legs, this means an uphill climb against gravity. The mechanism relies on our leg muscles squeezing the vein (which is why walking is so good for us) and one-way valves within the veins, which stop the blood falling back down the vein.

Varicose veins are abnormally enlarged and tortuous veins that you can see just below the surface of the skin. These veins contain more blood at higher pressure than normal which causes fluid to leak into the surrounding tissue. As a result, our legs often swell and feel heavy.

Thread veins or "spider veins" (telangiectasia) are smaller veins in the skin itself. Being so close to the surface they are easily visible. Although not dangerous they are a real source of concern. Many people are embarrassed to show their legs in public because of their cosmetic appearance.

What causes varicose veins?
Varicose veins are due to a failure of the one-way valves inside the veins. If the valves become incompetent (or leak) then blood can flow back down the leg when we are standing. The increased pressure within the veins cause them to swell and become varicose (swollen and lumpy).

How common are varicose veins?
Approximately 50% of people will have some form of vein disease by the time they reach 60. Varicose veins are seen in up to one-third of all adults with men and women probably affected equally.

Risk factors include
• occupation requiring one to stand for great lengths of time
• family history of varicose veins
• pregnancy
• weight gain

What are the symptoms?
Cosmetic appearance is by far the commonest problem. Many patients with varicose veins will not wear skirts or shorts. We have seen mothers who have never taken their children swimming or feel unable to get undressed in front of their husbands.

The raised pressure inside damaged veins commonly causes:
• Unsightly varicose veins
• Painful “aching” legs – especially after long periods of standing
• Swollen ankles and legs
• A feeling of heavy legs and fatigue
• Occasionally phlebitis (inflammation) 
• Bleeding if traumatised
• Skin changes i.e. eczema, brown discolouration and skin ulcers.
Many of these symptoms are worse at the end of the day, especially in those people who are on their feet the whole time.

What can be done about my varicose veins?
Varicose veins are more than just unsightly and uncomfortable. They can slowly progress lead to more serious and unpleasant conditions such as phlebitis, skin damage and leg ulcers. Early treatment minimises skin damage and can restore the leg to normal.

There are several different treatments available for varicose veins including the new virtually painless techniques (see VNUS). Everyone’s legs and varicose veins are different so whilst one technique may be right for one patient, a different method of treatment may be better for someone else. Although varicose veins may seem to affect only one leg, detailed investigation often shows early problems in the other leg.

Can varicose veins come back again after treatment?
Unfortunately – yes. Some people have a tendency to form new varicose veins. Conventional surgery, although regarded as the gold standard, has a recurrence rate of over 20% after five to ten years. However one of the commonest reasons for recurrence is inadequate initial treatment and not using a duplex ultrasound vein scan. The newer techniques with duplex scanning have a 10% risk of recurrence. Recurrent varicose veins are often less troublesome and frequently respond well to non surgical treatment.

What are venous leg ulcers?
Leg ulcers are areas of the lower leg where the skin has died exposing the flesh underneath. They occur in 1% of elderly people but can affect any adult. They can be of any size and are painful, often odorous open wounds which leak fluid. Leg ulcers can last for months or even years and can often be socially isolating.
The commonest cause of leg ulcers is vein disease – including varicose veins – left untreated. Most ulcers can be healed once the cause has been expertly diagnosed. Using duplex ultrasound for accurate diagnosis, appropriate treatment by vascular surgeons and the application of four-layer bandaging by skilled staff has increased healing rates to nearly 90%.

What can I do to prevent varicose veins?
• Avoid standing still for long periods
• Do plenty of walking
• Watch your diet and weight
• Wear support stockings
• Consider a mid-day siesta
• Get your feet up in the evenings
Note: No creams or drugs work in the prevention or treatment of varicose veins.
The earlier varicose veins and thread veins are treated the better the long term and cosmetic outcome.

How are Varicose Veins Investigated?

Clinical examination
Your first outpatient appointment is vital to assess your varicose veins, what trouble they are giving you and how best we can treat them. After listening to your detailed medical history, you will be examined to assess your leg veins and the condition of the skin. This determines whether you have either thread veins or varicose veins and their extent. Thread veins can be treated straight away. Varicose veins will require a painless scan using duplex ultrasound.

Duplex ultrasound scan
This is totally painless and similar to the scan performed during pregnancy to assess the developing baby. Duplex ultrasound provides an accurate 3-dimensional map of the failing valves in the legs and is the gold standard for investigating vein disease. It will demonstrate leaky valves and blood flowing the wrong way down any varicose veins.
Pre-Operative marking

Duplex Ultrasound imaging is also used to map the veins before an operation. This ensures the greatest accuracy, enables the veins to be removed through the smallest possible incisions and the lowest risk of recurrence.

Should I have laser or microwave to treat my veins?

At The Midlands Vein Clinic we can offer both VNUS closure and EVLT. During your consultation we will give you as much information as possible to decide which is the best treatment option for you. Recent research shows that 5 years after treatment, 85% to 94% of the treated veins remain closed.

Be proud of your legs