Embarrassing Illnesses

Not everyone with varicose veins will require treatment for their condition. If you have no symptoms and your varicose veins do not cause you discomfort, then you do not necessarily need to have treatment. There are some instances when treatment may be necessary:

• To ease symptoms. If your varicose veins are causing you pain or discomfort.
• Complications. You may require treatment if your varicose veins cause you to develop complications, such as leg ulcers, swelling or skin discolouration.
• Cosmetic reasons. Despite having no symptoms, some people want their varicose veins removed for cosmetic reasons. This kind of treatment is rarely available on the NHS, and you will normally have to pay for it to be done privately.

If your varicose veins do require treatment, the type of treatment you will receive will depend on your general health, and the size, position and severity of your varicose veins. Some of the available treatments for varicose veins are outlined below. Your GP will be able to advise you about the most suitable form of treatment for you.

Compression stockings

Compression stockings are specially designed stockings which steadily squeeze your legs to help improve your circulation. They may help to relieve pain, discomfort or swelling in your legs which is being caused by your varicose veins. It is not yet known whether compression stockings can help to prevent your varicose veins from getting worse, or if they prevent new varicose veins from appearing.

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) type of compression stocking. They are available in different colours.

It is important that your compression stockings fit you properly otherwise they may not be effective. Your GP or pharmacist will need to measure your legs in several places to make sure that your stockings will be the right size. If your legs are often swollen, they will usually need to be measured first thing in the morning, when any swelling is likely to be minimal.

Compression stockings usually have to be replaced every three to six months. If your stockings become damaged in any way, speak to your GP because they may no longer be effective.   

You should also be prescribed two stockings (or two sets of stockings if you are wearing a stocking 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.

When should I wear my compression stockings?

You will normally have to put your compression stockings on as soon as you get up in the morning. You can then take them off when you go to bed. Compression stockings are often tightest at the ankle and get gradually looser as they go further up your leg to encourage your blood to flow upwards towards your heart.

Wearing compression stockings can be uncomfortable, particularly during hot weather, but it is important to wear your stockings in the right position for you to get the most benefit from them. 

You may find that wearing compression stockings can cause the skin on your legs to become dry. When you take your stockings off before going to bed, you can apply an emollient (moisturising cream) to help keep your skin supple and moist. Speak to your GP if you find that the skin on your legs is becoming dry after wearing compression stockings.

Sclerotherapy

Sclerotherapy is usually suitable for people who have small to medium-sized varicose veins. This treatment involves a special chemical being injected into your veins. The chemical works by scarring the veins, which then 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. The injection is guided to the vein using an ultrasound scan. Although this treatment has been proven to be effective, it can cause side effects, including:

• blood clots in other leg veins,
• headaches,
• fainting, and
• temporary vision problems.

Your GP will advise you whether foam sclerotherapy is a suitable form of treatment for you.

Following your sclerotherapy treatment, your varicose vein should begin to fade after a few weeks. This is because stronger veins take over the role of the damaged vein, which is no longer filled with blood.

You may require sclerotherapy more than once before the vein fades. However, sclerotherapy is not always permanent, and there is a chance that the vein may reappear. Both standard sclerotherapy and foam sclerotherapy are usually carried out under local anesthetic. 

Surgery

Large varicose veins may sometimes have to be surgically removed. Varicose vein surgery is usually carried out under general anaesthetic, and you will normally be allowed to go home the same day. However, in some cases, you may require an overnight stay in hospital, particularly if you are having surgery on both legs.

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

Two small cuts (incisions) will be made, approximately 5cm 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 your vein (near the groin) is tied up and sealed.

A thin flexible wire is passed through the bottom of the vein, which is 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 which are situated deep within your legs will take over the role of the damaged veins. You may need between one and three weeks to recover before you return to work, although this will depend on your general health and the type of work that you do.

Other treatments

A number of new treatments have recently been developed to treat varicose veins. However, their availability on the NHS may be limited so ask your GP about their availability on the NHS.

Radiofrequency ablation

Radiofrequency ablation involves heating the wall of your varicose vein using radio-frequency energy. The energy is emitted from a small probe that is inserted into your vein. The vein is heated until its wall collapses, closing the vein and sealing it shut.

The vein is accessed through a small cut made just above or below the knee. Once the vein has been sealed shut, your blood will naturally be redirected to one of your healthy veins. This treatment rarely causes any discomfort and is carried out under local anaesthetic.              

Endovenous laser treatment

During endovenous laser treatment, a narrow tube, known as a catheter, is put into your vein, using an ultrasound scan to guide it into the correct position. A tiny laser is then passed through the catheter and positioned at the top of your varicose vein.

The laser emits short bursts of energy, heating the vein up and sealing it closed. The laser is slowly pulled along the vein, using the ultrasound scan as a guide, allowing the entire length of the vein to be closed.

Endovenous laser treatment is carried out under local anaesthetic. Afterwards, you may feel some tightness in your legs, and the affected areas may be bruised and painful.

Transilluminated powered phlebectomy

During a 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 that they are able to see which veins need to be removed. The affected veins are then cut and then removed through the incisions using a suction device.

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