Varicose Veins

Varicose veins of the lower limbs are extremely common. Because they so seldom threaten life or limb, they are often regarded as a quality-of-life or cosmetic concern rather than a true disease.

Varicose Veins

Varicose veins are swollen, twisted veins you can see under the skin, usually blue and bulging. They form in the superficial veins just beneath the skin.

Normally, tiny one-way valves keep blood in your leg veins flowing upward to your heart, helped by your calf muscles (the "calf pump"). If these valves weaken, blood pools in the vein, the pressure rises, and the vein stretches and bulges. Standing or sitting for long periods, a family history, pregnancy and being overweight all make this more likely.

Most varicose veins are harmless, although large ones can ache or, over time, cause skin changes. Spider veins are a milder, mainly cosmetic version.

Symptoms

Varicose veins can make your legs feel heavy, tired, achy, restless or burning, especially after long standing or sitting, and you may get night cramps. The skin may change colour or, in more advanced cases, become irritated or form sores.

People with varicose veins have a higher risk of a deep vein thrombosis (DVT) – a clot in a deep vein that causes sudden, painful leg swelling. This needs urgent medical attention.

Varicose veins can also become inflamed and clotted (superficial thrombophlebitis – a tender, red, hard cord under the skin), which should be checked by a doctor. Occasionally a varicose vein bleeds, sometimes heavily, if the thin skin over it is knocked: lie down, raise the leg above the level of your heart and press firmly on the spot for at least 10 minutes, then seek medical help.

Causes

Varicose veins are caused by raised pressure in the superficial leg veins. Things that raise your risk: a family history, being overweight, too little exercise, smoking, long periods of standing or sitting, and previous DVT. They are more common in women, usually appear between the ages of 30 and 70, and often develop in pregnancy (frequently settling within a year of childbirth).

Tests

I examine the veins and check how they fill. The main test is a duplex ultrasound – a painless scan (about 20 minutes per leg) that shows how blood flows through your leg veins, confirms the diagnosis, and shows whether anything else is contributing.

Treatment Options

Conservative

Many people manage their varicose veins well without a procedure. The cornerstone of non-invasive care is graduated compression stockings, supported by simple lifestyle steps:

Wear graduated compression stockings every day – they are tightest at the ankle and looser higher up, which supports the veins, reduces swelling and helps your calf muscles push blood back towards your heart. Put them on first thing in the morning, before the legs swell.
Walk and exercise regularly to work your calf pump.
Raise your legs when resting.
Keep to a healthy weight and stop smoking.
Avoid standing or sitting still for long stretches – keep your feet and ankles moving.

Used consistently, compression eases the aching and heaviness and helps protect the skin. It is the most effective non-invasive treatment – and the one only you can apply. It does not make varicose veins disappear.

Endovenous

Varicose veins can also be treated with procedures that close off the leaking vein from the inside: thermal ablation (radiofrequency or laser, both of which seal the vein with heat), non-thermal ablation (medical glue or mechanochemical ablation, MOCA) and sclerotherapy (an injection of liquid or foam). The European guideline (ESVS 2022) recommends endovenous ablation as the first-line treatment for symptomatic varicose veins caused by a leaking main superficial vein; compression is mainly for people who do not want, or are not suitable for, a procedure. These procedures are offered by doctors who specialise in vein work.

My practice focuses on arterial surgery and does not perform these venous procedures. I offer conservative management with compression, and if you would like a procedure, I can refer you to a vein specialist.

Surgery

Older surgical options, such as vein stripping (removing the main superficial vein), are still used in selected cases by venous surgeons. Again, this practice does not perform venous surgery.

Varicose Vein Stripping

Notice

My practice focuses on arterial surgery and does not offer any venous surgery or procedures for varicose veins.

If you choose conservative management, the most effective non-invasive treatment is one only you can apply: wearing your compression stockings every day. If you would like a procedure, ask for a referral to a vein specialist.

Reference
European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg, 2022.

Compression in Wound Care

Our Services

Conservative Management

The majority of patients with varicose veins can be treated effectively with

Elevation of limbs at rest
Weight control
Exercise
Smoking cessation
Compression bandages
Compression hosiery

Endovenous Procedures

We prefer the least invasive intervention, which is no intervention.

Venous Procedures

Standard open venous surgical procedures remove distended veins.

We prefer the least invasive intervention, which is no intervention.

This practice does not offer elective open or endovenous procedures for varicose veins or chronic venous insufficiency.

If you have any problems with any of these conditions, please contact your General Practitioner, or your Vascular Surgeon. If you live in Pretoria and have not seen a Vascular Surgeon before, you are more than welcome to contact our rooms for a formal consultation.