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THE TREATMENT REGISTRY
Patient journey

Varicose veins

By The Treatment Registry editors

Enlarged, twisted superficial veins (most commonly in the legs) caused by valve dysfunction in the venous system. Symptoms range from cosmetic concerns to aching, heaviness, swelling, skin discolouration, and in severe cases venous ulceration. Modern treatment is largely outpatient, minimally invasive, with surgical stripping now rarely performed in favour of endovenous ablation or sclerotherapy.

Clinical overview

Signs and symptoms

Varicose veins present as enlarged, twisted superficial veins, typically in the legs just beneath the skin, and are often only a cosmetic concern. When symptomatic, they cause aching, heavy legs, ankle swelling and night-time leg cramps, together with itching, a burning or throbbing sensation, and fatigue. Skin changes may develop near the affected veins, including a brownish-yellow discolouration, and dryness, redness and itchiness known as stasis dermatitis or venous eczema, as well as lipodermatosclerosis. Severe varicosities can lead to complications from poor circulation, notably venous ulcers near the ankle, superficial thrombophlebitis (clotting within the affected veins, which can extend into deep veins), and severe bleeding from minor trauma, of particular concern in the elderly. Restless legs syndrome commonly overlaps.

Causes and risk factors

Varicose veins have no single specific cause; the underlying problem is weak or damaged valves in the veins, with venous reflux a significant contributor. They are more common in women than in men and are strongly linked to heredity and family history. Related factors include pregnancy, obesity, menopause, ageing, prolonged standing, leg injury and abdominal straining; occasionally they result from chronic venous insufficiency. Pelvic vein reflux, including ovarian and internal iliac vein reflux, is recognised in their development and in recurrence, and affects around 14% of women with varicose veins. Incompetent perforator veins also contribute. Crossing the legs or ankles is unlikely to be a cause.

How it is diagnosed

Varicose veins are typically diagnosed by examination, including observation with ultrasound. Clinical tests such as the Trendelenburg test may be used to locate the site of venous reflux and assess the saphenofemoral junction. Current practice is to investigate patients with lower-limb venous ultrasonography rather than reserving imaging for suspected deep venous insufficiency, recurrence, or saphenopopliteal involvement; a randomised controlled trial showed lower recurrence and reoperation rates with routine ultrasound at two and seven years. Severity is graded using the CEAP (Clinical, Etiological, Anatomical and Pathophysiological) classification, which ranges from telangiectasia and reticular veins through varicose veins, oedema and skin changes to healed and active venous ulcers.

Who it affects

Varicose veins are very common, affecting about 30% of people at some point in their lives. They become more common with age and are most common after age 50. They are more prevalent in women, who develop them about twice as often as men. A hereditary role is recognised, and the condition has also been associated with smoking, chronic constipation, and occupations requiring long periods of standing.

Clinical overview sourced from encyclopaedic medical reference; see sources below. General information only — not a substitute for individual clinical assessment.

Treatment ladder

Conservative options are first-line where appropriate; surgical options are typically reserved for cases where lower-tier options are unsuitable or have failed. Decisions are individual and depend on clinical assessment.

Conservative

  • Graduated compression stockings

    Class 2 (23-32 mmHg) stockings reduce symptoms and slow progression. First-line for symptomatic patients without severe disease.

  • Lifestyle modification (weight, exercise, leg elevation)

    Reduces venous pressure and may slow symptom progression. Not disease-modifying for established varicose veins.

Procedural

  • Endovenous laser ablation (EVLA)

    Catheter-delivered laser energy ablates the main faulty vein from the inside. Outpatient under local anaesthesia with tumescent infiltration. Now first-line for symptomatic varicose veins per modern guidelines.

  • Radiofrequency ablation (RFA)

    Similar to EVLA but using radiofrequency energy. Comparable outcomes; choice depends on operator preference and equipment availability.

  • Foam sclerotherapy

    Injection of a sclerosing foam into the vein causing it to collapse and be reabsorbed. Outpatient procedure; can treat smaller tributary veins as well as main trunks.

  • VenaSeal (cyanoacrylate glue closure)

    Catheter-delivered medical adhesive closes the faulty vein; no tumescent anaesthesia required. Increasingly used for selected cases.

Surgical

  • Vein stripping with high ligation (historic)

    Open surgical removal of the saphenous vein. Largely superseded by endovenous techniques in modern practice; reserved for selected anatomies or where endovenous techniques have failed.

Sources

  1. [1]WHO Surgical Safety Checklist — who.int(accessed 2026-05-09)
  2. [2]Wikipedia — Varicose veins — en.wikipedia.org(accessed 2026-07-24)

Sources marked “on file” are held by The Treatment Registry but are not publicly accessible.