Treating varicose veins

Varicose veins do not always need treatment. If your varicose veins are not causing you discomfort, you may not need to have treatment.

Treatment of varicose veins is usually necessary:

• to ease symptoms, if your varicose veins are causing you pain or discomfort
• to treat complications, such as leg ulcers, swelling or skin discolouration
• for cosmetic reasons, however this kind of treatment is rarely available on the NHS so you will usually have to pay for it to be done privately

If your varicose veins need to be treated, the type of treatment will depend on your general health and the size, position and severity of your veins.

Your GP or vascular specialist (a doctor who specialises in veins) will be able to advise you about the most suitable form of treatment for you.

Self-help

In many cases, varicose veins can be treated at home. Simple methods for easing the symptoms include:

• exercising
• avoiding standing up for long periods
• elevating your legs

Compression stockings

Compression stockings are specially designed to steadily squeeze your legs to improve circulation. They are often tightest at the ankle and get gradually looser as they go further up your leg. This encourages blood to flow upwards towards your heart.

Compression stockings may help relieve the pain, discomfort and swelling in your legs caused by your varicose veins. However, it is not known whether the stockings help prevent your varicose veins getting worse, or prevent new varicose veins appearing.

One review of different studies looking into compression stockings found mixed results for their effectiveness. One reason for this may be that people are reluctant to wear the stockings. You should make sure you are happy with the style and fit of the stockings and wear them as directed by your GP or pharmacist. 

Compression stockings are available in a variety of different sizes and pressures. Most people with varicose veins will be prescribed a class 1 (light compression) or class 2 (medium compression) stocking. They are also available in:

• different colours
• different lengths: some come up to your knee and some also cover your thigh
• different foot styles: some cover your whole foot and some stop before your toes

Compression tights are also available, but not on the NHS. They can be bought from pharmacies or directly from the manufacturers.

You may need to wear compression stockings for the rest of your life if you have deep venous incompetence. Deep venous incompetence is where you have problems with the valves, or blockages, in the deep veins in your legs. In these circumstances, you will need to wear compression stockings even if you have had surgery to treat some varicose veins.

Wearing compression stockings

You will usually need to put your compression stockings on as soon as you get up in the morning and take them off when you go to bed. They can be uncomfortable, particularly during hot weather, but it is important to wear your stockings correctly for you to get the most benefit from them.

Pull them all the way up so the correct level of compression is applied to each part of your leg. Don’t let the stocking roll down or it may dig into your skin in a tight band around your leg. Speak to your GP if the stockings are uncomfortable or do not seem to fit. It may be possible to get custom-made stockings that will fit you exactly.

If custom-made compression stockings are recommended, your legs will need to be measured in several places to ensure that your stockings are the correct size. If your legs are often swollen, they should be measured in the morning, when any swelling is likely to be minimal.

If compression stockings are causing the skin on your legs to become dry, try applying a moisturising cream (emollient) before you go to bed to keep your skin moist.

You should also keep an eye out for sore marks on your legs, as well as blisters and discolouration.

Caring for compression stockings

Compression stockings usually have to be replaced every three to six months. If your stockings become damaged, speak to your GP because they may no longer be effective. 
 
You should be prescribed two stockings, (or two sets of stockings if you are wearing one on each leg) so that one stocking can be worn while the other is being washed and dried. Compression stockings should be hand-washed in warm water and dried away from direct heat.

Surgery

Large varicose veins may sometimes need to be surgically removed, during a procedure known as a phlebectomy. Varicose vein surgery is usually carried out under general anaesthetic, which means you will be unconscious during the procedure. You will usually be able to go home the same day. However, in some cases an overnight stay in hospital may be necessary, particularly if you are having surgery on both legs.

Ligation and stripping

Most surgeons use a technique called ligation and stripping, which involves tying off the vein in the affected leg and then removing it.

Two small incisions are made, approximately 5cm (2in) in diameter. The first cut is made near your groin, at the top of the varicose vein. The second cut is made further down your leg, usually around your knee or ankle. The top of the vein (near your groin) is tied up and sealed.

A thin flexible wire is passed through the bottom of the vein and then carefully pulled out and removed through the lower cut in your leg. 

The blood flow in your legs will not be affected by the surgery. This is because the veins that are situated deep within your legs will take over the role of the damaged veins.

Ligation and stripping can cause:

• pain
• bruising
• bleeding

More serious complications are rare, but could include nerve damage or deep vein thrombosis, which is where a blood clot forms in one of the deep veins of the body.

Following the procedure, you may need between one and three weeks to recover before returning to work, although this will depend on your general health and the type of work you do. You may need to wear compression stockings for up to two weeks after surgery.

Sclerotherapy

Sclerotherapy is usually suitable for people who have small to medium-sized varicose veins. The treatment involves injecting a chemical into your veins. The chemical scars the veins, which seals them closed.

Larger veins may require foam sclerotherapy. Instead of the liquid chemical, a special type of foam is injected into the affected vein. This type of treatment may not be suitable if you have previously had deep vein thrombosis.

The injection is guided to the vein using an ultrasound scan. It is possible to treat more than one vein in the same session.  Both standard sclerotherapy and foam sclerotherapy are usually carried out under local anaesthetic, where a painkilling medication will be used to numb the area being treated.

Following sclerotherapy, your varicose veins should begin to fade after a few weeks as stronger veins take over the role of the damaged vein, which is no longer filled with blood. You may require treatment more than once before the vein fades and there is a chance that the vein may reappear.

Although sclerotherapy has proven to be effective, it is not yet known how effective foam sclerotherapy is in the long terphlebectomym. The National Institute for Health and Clinical Excellence (NICE) found that, on average, the treatment was effective in 84 out of 100 cases. However, in one study, the varicose veins returned in over half of those treated.

Sclerotherapy can also cause side effects, including:

• blood clots in other leg veins
• headaches
• lower back pain
• changes to skin colour, for example, brown patches over where the treated veins were
• fainting
• temporary vision problems

Following sclerotherapy you should be able to walk and return to work immediately afterwards. You will need to wear compression stockings or bandages for up to two weeks. 

In rare cases, sclerotherapy has been known to have serious potential complications, such as strokes or transient ichaemic attacks (TIAs).

Other treatments

There are a number of new treatments for treating varicose veins. However, their availability on the NHS may be limited. They are:

• radiofrequency ablation
• endovenous laser treatment
• transilluminated powered phlebectomy

These treatments are less invasive than traditional surgery because they require fewer or smaller incisions. However, less is known about their long-term effectiveness and some, particularly transilluminated powered phlebectomy, are not used very often. 

Radiofrequency ablation

Radiofrequency ablation involves heating the wall of your varicose vein using radiofrequency energy. The vein is accessed through a small cut made just above or below the knee.

A narrow tube, called a catheter, is guided into the vein using an ultrasound scan. A probe is inserted into the catheter that sends out radiofrequency energy. This heats the vein until its walls collapse, closing it and sealing it shut. Once the vein has been sealed shut, your blood will naturally be redirected to one of your healthy veins.

Radiofrequency ablation is carried out under local anaesthetic. The procedure may cause some short-term side effects, such as pins and needles (paraesthesia).

You may need to wear compression stockings for up to two weeks after having radiofrequency ablation.       

Endovenous laser treatment

As with radiofrequency ablation, endovenous laser treatment involves having a catheter inserted into your vein and using an ultrasound scan to guide it into the correct position. A tiny laser is passed through the catheter and positioned at the top of your varicose vein.

The laser delivers short bursts of energy that heat up the vein and seal it closed. The laser is slowly pulled along the vein using the ultrasound scan to guide it and allowing the entire length of the vein to be closed.

Endovenous laser treatment is carried out under local anaesthetic. After the procedure you may feel some tightness in your legs and the affected areas may be bruised and painful. Nerve injury is also possible, but usually only temporary.

Transilluminated powered phlebectomy

During transilluminated powered phlebectomy, one or two small incisions are made in your leg. Your surgeon will place a special light, called an endoscopic transilluminator, underneath your skin so they are able to see which veins need to be removed. The affected veins are cut before being removed through the incisions using a suction device.

Transilluminated powered phlebectomy can either be carried out under general anaesthetic or local anaesthetic. As with endovenous laser treatment, you may experience some bruising or bleeding afterwards.

As this treatment in relatively new, there is little information about its long term effects.