Symptoms
- Bulging, rope-like blue or purple veins.
- Aching, heaviness or tiredness of the legs, worse after standing.
- Ankle swelling, night cramps and itching.
- Skin darkening, eczema or hardening around the ankle.
- In advanced cases, a non-healing venous ulcer or bleeding from a vein.
Risk factors
Family history, prolonged standing (teachers, traffic police, salespeople, surgeons), pregnancy, obesity, increasing age and previous deep vein thrombosis (DVT) all increase the risk.
Diagnosis: venous duplex ultrasound
A colour Doppler (duplex) scan maps the veins and shows which valves are leaking – most commonly at the junction of the great saphenous vein in the groin or the small saphenous vein behind the knee. It also rules out DVT. Treatment is planned on this map.
Treatment options
Conservative care
Graduated compression stockings, leg elevation, regular walking, weight control and avoiding long periods of standing relieve symptoms but do not remove the veins.
Endovenous laser ablation (EVLA)
Under ultrasound guidance a thin laser fibre is passed into the faulty vein through a needle puncture. Heat seals the vein shut, and blood naturally reroutes through healthy veins. It is done under local (tumescent) anaesthesia; most people walk out the same day.
Radiofrequency ablation (RFA)
Similar to laser, but uses radiofrequency energy. Both EVLA and RFA have success rates above 90% and are recommended as first-line treatment by NICE.
Foam sclerotherapy
A medicated foam is injected to close smaller or residual veins and spider veins. It can also be used for recurrent veins.
Cyanoacrylate glue (VenaSeal)
A medical adhesive closes the vein without heat, avoiding the need for multiple anaesthetic injections.
Phlebectomy and surgery
Small bulging branches are removed through tiny nicks (ambulatory phlebectomy). Traditional ligation and stripping is now reserved for selected cases.
After treatment
- Walk for 10–15 minutes immediately and several times a day.
- Wear compression stockings for 1–2 weeks as advised.
- Return to normal activities in 1–2 days; avoid strenuous exercise and long flights for 2 weeks.
- A follow-up scan confirms the vein is closed.
Frequently asked questions
Are varicose veins only cosmetic?
No. Left untreated they can cause chronic swelling, skin damage, bleeding and venous ulcers. Symptomatic veins deserve treatment.
Can varicose veins come back?
New veins can develop over time because the tendency is lifelong. Recurrence rates after laser or RFA are lower than after traditional surgery.
Is laser treatment painful?
Most patients feel only the local anaesthetic injections and mild tightness or bruising along the treated vein for a week or two.
Last reviewed: October 2026. This page is general information and does not replace advice from your own doctor.