One is the most minor grade and 6 the most severe. Grade 1 veins are essentially tiny thread veins most commonly seen on ladies with fair skin. They are mainly a cosmetic matter. Grade 2 veins are 'isolated varicose veins' - in other words a little bit swollen but quite small - also essentially cosmetic. You won't be surprised to hear that the NHS won't treat grade 1 or 2 veins and that is reasonable - one wouldn't expect the Health service to be providing cosmetic treatment for patients.
Grade 3 veins are larger bulgy veins that are being filled from a leaky vein deeper inside the leg that can't be seen with the naked eye. This is the commonest category of vein patient that goes to see a doctor because usually the veins are causing pain and discomfort. The symptoms patients complain of are typically aching, throbbing, leg swelling and soreness on standing for long periods.
In the past, the NHS would treat grade 3 veins but the goalposts have been moved and these patients are now not eligible for treatment. They are required to use compression stockings instead of having surgical operations. Grade 4 veins cause complications including phlebitis where the vein gets inflamed, hard and lumpy or venous eczema where the skin at the ankle becomes dry and itchy. Grade 5 veins have severe skin damage to the skin at the ankle which becomes discoloured with a brown pigment.
Grade 6 veins are a venous ulcer - and that is very bad news indeed - very painful and hard to heal. You may experience some bruising or bleeding afterwards. Varicose veins can cause complications because they stop your blood flowing properly. Most people who have varicose veins will not develop complications. If they do, it's usually several years after varicose veins first appear.
Varicose veins near the surface of your skin can sometimes bleed if you cut or bump your leg. The bleeding may be difficult to stop. You should lie down, raise your leg and apply direct pressure to the wound.
Seek immediate medical advice if this does not stop the bleeding. If blood clots form in veins located just under the surface of your skin superficial veins , it could lead to conditions such as:. Skip to Main Content. Search the site. Varicose veins.
On this page. Other symptoms include: aching, heavy and uncomfortable legs swollen feet and ankles burning or throbbing in your legs muscle cramp in your legs, particularly at night dry, itchy and thin skin over the affected vein The symptoms are usually worse during warm weather or if you've been standing up for long periods of time. When to see your GP If you have varicose veins and they don't cause you any discomfort, you may not need to visit your GP.
Varicose veins are rarely a serious condition and do not usually require treatment. But speak to a GP if: your varicose veins are causing you pain or discomfort the skin over your veins is sore and irritated the aching in your legs is causing irritation at night and disturbing your sleep The GP can diagnose varicose veins based on these symptoms, although further tests may be carried out.
Causes of varicose veins Varicose veins develop when the small valves inside the veins stop working properly. Certain things can increase your chances of developing varicose veins, such as: being female having a close family member with varicose veins being older being overweight having a job that involves long periods of standing being pregnant other conditions Treating varicose veins If treatment is necessary, your doctor may first recommend up to 6 months of using compression stockings, taking regular exercise and elevating the affected area when resting.
The most common treatment options include: endothermal ablation — where heat is used to seal affected veins sclerotherapy — this uses special foam to close the veins ligation and stripping — the affected veins are surgically removed It's unlikely you'll receive treatment on the NHS for cosmetic reasons — you'll have to pay for cosmetic treatment privately.
Preventing varicose veins There's little evidence to suggest you can stop varicose veins getting worse or completely prevent new ones developing. But there are ways to ease symptoms of existing varicose veins, such as: avoiding standing or sitting still for long periods and trying to move around every 30 minutes taking regular breaks throughout the day, raising the legs on pillows while resting to ease discomfort exercising regularly — this can improve circulation and help maintain a healthy weight Types of varicose veins There are several types of varicose veins, such as: trunk varicose veins — these are near to the surface of the skin and are thick and knobbly; they're often long and can look unpleasant reticular varicose veins — these are red and sometimes grouped close together in a network telangiectasia varicose veins — also known as thread veins or spider veins, these are small clusters of blue or red veins that sometimes appear on your face or legs; they're harmless and, unlike trunk varicose veins, don't bulge underneath the surface of the skin.
Who can get it Varicose veins are usually caused by weak vein walls and valves. Increased risk A number of things can increase your likelihood of developing varicose veins, including: being female having a close family member with varicose veins older age being overweight having a job that involves long periods of standing being pregnant other conditions Gender Women are more likely to be affected by varicose veins than men.
Genetics Your risk of developing varicose veins is increased if a close family member has the condition. Age As you get older, your veins start to lose their elasticity and the valves inside them stop working as well.
Being overweight Being overweight puts extra pressure on your veins, which means they have to work harder to send the blood back to your heart.
This can put increased pressure on the valves, making them more prone to leaking. Occupation Some research suggests jobs that require long periods of standing may increase your risk of getting varicose veins. Pregnancy During pregnancy, the amount of blood increases to help support the developing baby. Other conditions In rare cases, varicose veins are caused by other conditions. These include: a previous blood clot a swelling or tumour in the pelvis abnormal blood vessels.
Diagnosis If you have varicose veins and they don't cause you any discomfort, you may not need to visit your GP. Varicose veins are rarely a serious condition and they don't usually require treatment. But speak to your GP if: your varicose veins are causing you pain or discomfort the skin over your veins is sore and irritated the aching in your legs is causing irritation at night and disturbing your sleep Seeing your GP Varicose veins are diagnosed by their appearance.
For example, some women find their menstrual cycle period affects their varicose veins. Treatment Varicose veins don't always need treatment. Treatment of varicose veins is usually necessary: to ease symptoms — if your varicose veins are causing you pain or discomfort to treat complications — such as leg ulcers, swelling or skin discolouration for cosmetic reasons — but this kind of treatment is rarely available on the NHS, so you'll usually have to pay for it to be done privately If treatment is necessary, your doctor may first recommend up to 6 months of self care at home.
This may involve: using compression stockings your blood circulation will first be checked to see if these are suitable for you exercising regularly avoiding standing up for long periods elevating the affected area when resting The various treatments for varicose veins are outlined below. Compression stockings Compression stockings aren't suitable for everyone.
They are also available in: different colours different lengths — some come up to your knee, while others also cover your thigh different foot styles — some cover your whole foot, and some stop before your toes Compression tights are also available, but not on the NHS.
Wearing compression stockings You usually need to put your compression stockings on as soon as you get up in the morning and take them off when you go to bed. Caring for compression stockings Compression stockings usually have to be replaced every 3 to 6 months.
Compression stockings should be hand washed in warm water and dried away from direct heat. Further treatment If your varicose veins need further treatment or they're causing complications, the type of treatment will depend on your general health and the size, position and severity of your veins. Endothermal ablation One of the first treatments offered will usually be endothermal ablation. These treatments are described in more detail below. Radiofrequency ablation Radiofrequency ablation involves heating the wall of your varicose vein using radiofrequency energy.
The vein is accessed through a small cut made just above or below the knee. The procedure may cause some short-term side effects, such as pins and needles paraesthesia.
Endovenous laser treatment As with radiofrequency ablation, endovenous laser treatment involves having a catheter inserted into your vein and using an ultrasound scan to guide it into the correct position. A tiny laser is passed through the catheter and positioned at the top of your varicose vein. Endovenous laser treatment is carried out under either local or general anaesthetic.
Ultrasound-guided foam sclerotherapy If endothermal ablation treatment is unsuitable for you, you'll usually be offered a treatment called sclerotherapy instead. This type of treatment may not be suitable if you've previously had deep vein thrombosis.
But in one study, the varicose veins returned in more than half of those treated. Sclerotherapy can also cause side effects, including: blood clots in other leg veins headaches lower back pain changes to skin colour — for example, brown patches over the treated areas fainting temporary vision problems You should be able to walk and return to work immediately after having sclerotherapy.
Surgery If endothermal ablation treatments and sclerotherapy are unsuitable for you, you'll usually be offered a surgical procedure called ligation and stripping to remove the affected veins. If you're referred for surgery, you may want to ask your surgeon some questions, such as: who will do my operation? Ligation and stripping Most surgeons use a technique called ligation and stripping, which involves tying off the vein in the affected leg and then removing it.
You may need to wear compression stockings for up to a week after surgery. Transilluminated powered phlebectomy Transilluminated powered phlebectomy is a relatively new treatment, and there's some uncertainty about its effectiveness and safety.
During transilluminated powered phlebectomy, 1 or 2 small incisions are made in your leg. Complications Varicose veins can cause complications because they stop your blood flowing properly. Some possible complications of varicose veins are explained below. A technique called ligation and stripping involves tying off the vein in the affected leg and then removing it.
The first is made near your groin at the top of the varicose vein and is approximately 5cm in diameter. The second, smaller cut is made further down your leg, usually around your knee.
The top of the vein near your groin is tied up and sealed. A thin, flexible wire is passed through the bottom of the vein and then 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 deep within your legs will take over the role of the damaged veins. Ligation and stripping can cause pain, bruising and bleeding. More serious complications are rare, but could include nerve damage or deep vein thrombosis , where a blood clot forms in one of the deep veins of the body.
After the procedure, you may need up to 3 weeks to recover before returning to work, although this depends on your general health and the type of work you do. Transilluminated powered phlebectomy is a relatively new treatment, and there's some uncertainty about its effectiveness and safety.
NICE does not recommend it as part of the normal treatment plan for varicose veins. But it says the treatment may be offered if a doctor thinks it'll help and the benefits and risks are explained. The surgeon will place a light called an endoscopic transilluminator underneath your skin so they're able to see which veins need to be removed. The affected veins are cut before being removed through the incisions using a suction device.
Transilluminated powered phlebectomy can either be carried out under general anaesthetic or local anaesthetic. You may experience some bruising or bleeding afterwards. Another new procedure is called cyanoacrylate glue occlusion. This involves injecting a special type of glue into affected veins.
The glue seals the veins shut, stopping them filling with blood and improving symptoms. Evidence suggests that this procedure is both safe and effective. But there are currently not many doctors trained to carry it out, so access to it on the NHS is limited in most areas.
Page last reviewed: 07 May Next review due: 07 May Treatment of varicose veins is usually only necessary to: ease symptoms — if your varicose veins are causing you pain or discomfort treat complications — such as leg ulcers , swelling or skin discolouration Some people also get treatment for cosmetic reasons — but this kind of treatment is rarely available on the NHS, so you'll usually have to pay for it to be done privately If treatment is necessary, your doctor may first recommend self care at home.
This may involve: using compression stockings your blood circulation will first be checked to see if these are suitable for you exercising regularly avoiding standing up for long periods elevating the affected area when resting Compression stockings Compression stockings are not suitable for everyone.
They are also available in: different colours different lengths — some come up to your knee, while others also cover your thigh different foot styles — some cover your whole foot, and some stop before your toes Compression tights are also available, but not on the NHS.
Wearing compression stockings You usually need to put your compression stockings on as soon as you get up in the morning and take them off when you go to bed. Caring for compression stockings Compression stockings usually have to be replaced every 3 to 6 months. Compression stockings should be hand washed in warm water and dried away from direct heat. Further treatment If your varicose veins need further treatment or they're causing complications, the type of treatment will depend on your general health and the size, position and severity of your veins.
Endothermal ablation One of the first treatments offered will usually be endothermal ablation. Radiofrequency ablation Radiofrequency ablation involves heating the wall of your varicose vein using radiofrequency energy. The vein is accessed through a small cut made just above or below the knee.
Endovenous laser treatment As with radiofrequency ablation, endovenous laser treatment involves having a catheter inserted into your vein and using an ultrasound scan to guide it into the correct position. A tiny laser is passed through the catheter and positioned at the top of your varicose vein. Endovenous laser treatment is carried out under either local or general anaesthetic.
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