They affect one in three but are often not treated on the NHS. Here’s what you need to know
Healthy veins take blood from our feet and legs – where it has taken vital oxygen and nutrients – to the heart. But because it’s working against gravity, the blood will try to flow the wrong way.
This is prevented by one-way valves that open and close to let blood through.
“Varicose veins occur when the small valves in our leg veins fail,” says Professor Mark Whiteley, a consultant venous surgeon. “This allows blood to fall back to the ankles and feet, and collect in veins.”
Veins can become varicose if their wall is stretched and the valve is weakened. They become more common with age, and women are at risk because their hormones relax walls, making valves more prone to leaking. The biggest influence is genetics, says Professor Whiteley. ‘The more relatives you have with it, the more likely you are to have them.’
It’s a myth: Crossing your legs won’t cause varicose veins. But anything that puts pressure on your legs or abdomen might – such as obesity, pregnancy or regularly standing for long periods.
How can you treat varicose veins?
Left untreated, varicose veins can lead to further health problems, such as aching legs, swollen ankles, blood clots, skin damage and venous leg ulcers – painful sores around the ankle.
“Research suggests that one in 20 people with “simple” varicose veins will go on to have leg ulceration sometime in their life, if varicose veins aren’t treated,” says Professor Whiteley.
Getting treatment on the NHS may be tricky, though, since guidelines changed so that cosmetic reasons are not covered. Your GP may prescribe support stockings but can only refer you to a vascular specialist for NHS treatment if you meet NICE (National Institute for Health and Care Excellence) guidelines. These include severe discomfort, pain, swelling, pigmentation, eczema, or an ulcer that has lasted more than two weeks.
“Superficial thrombophlebitis can be treated with non-steroidal anti-inflammatory drugs such as ibuprofen tablets or gel,” says Dr Melanie Wynne-Jones. “Cellulitis requires antibiotics, while eczema can be treated by your GP with steroid creams.”
Treatments are continuing to advance. The latest cutting-edge procedure, available privately, is the 100% non-invasive Echotherapy. Sonovein uses high-intensity focused ultrasound (HIFU)to treat veins from the outside.
Is it possible to stop varicose veins from appearing?
There’s not much you can do to stop varicose veins developing or getting worse, but there are ways to ease symptoms and reduce the risk of complications.
- Walking activates the pump that feeds blood back from your legs to your heart. Professor Whiteley says, ‘As you put weight onto your foot, blood pumps into your calf, which contracts and shoots it to your thigh, into your pelvis and back to your heart.’
- Don’t smoke. It damages blood vessels and arteries, and raises your risk of blood clots, particularly if you’re on HRT or the pill.
- Put your feet up when watching TV. Avoid blood pooling in your ankles by raising your legs on a stool in front of you or sofa beside you.
- Get support. Going on a long-haul flight or immobile for long periods? Wear compression stockings to encourage blood flow up your legs.
What it’s like to get a scan for varicose veins
Varicose veins can be diagnosed with an ultrasound (Doppler) duplex scan, available privately or on the NHS. Health Editor Tanya Pearey describes the experience.
“I’m standing bare legged up a couple of steps, while a woman runs a lubricated probe along the length of my legs – occasionally giving my thigh or calf a squeeze.
“It’s just like the ultrasound for pregnancy but instead of lying down exposing my tummy, I’m standing up baring my legs. And in place of an embryo, on the screen are my veins. Standing still for long periods can cause dizziness (look at those guards and soldiers who sometimes faint on duty) so I get to sit down twice during the 30-minute procedure.
“The scan helps spot veins which have deteriorated, lost their valves and/or become varicose. I have several in my right leg. My left is unaffected. One superficial vein has become varicose, which I’m aware of because it’s visable. But the scan also reveals the source of the problem – a deep vein, also suffering valve problems and which will need treating to stop recurrence.”
“A thorough scan is crucial to understanding exactly what’s going on,” says consultant Dr Whiteley (the Whiteley Clinic offers private scans and treatment. Call 0330 058 1850 or visit whitleyclinic.co.uk).
“Then you can get the right treatment and reduce the risk of varicose veins returning.” He recommends microwaving (endothermal ablation) for me – a treatment he has given to presenter Chris Evans. Unfortunately I won’t qualify for NHS treatment because my veins aren’t causing pain so if I want to do anything about them I’ll have to go privately.
Other varicose veins treatments available
- Endovenous laser treatment uses ultrasound to guide a laser wire into the vein to heat it and seal it off. Endothermal ablation uses a radiofrequency catheter in the same way.
- Stripping and ligation involves surgery to remove and tie off affected veins, and is only recommended in a few cases.
- Sclerotherapy is when a special chemical foam is injected into veins to close them. It’s best for small thread veins; when used for larger veins, they can return.