varicose veins X ray explained

Overview

Varicose veins are swollen, twisted veins that you can see just under the skin. They usually happen in the legs. An X-ray of the veins, called a venogram, uses a special dye to make the veins show up on the X-ray picture. This test is not common anymore because doctors mostly use ultrasound instead. But sometimes a venogram is done if ultrasound cannot give enough information or before certain treatments.

Yes, varicose veins affect up to 1 in 3 adults at some point in their lives. They become more common with age.

Varicose veins can affect anyone, but they are more common in women, people over 40, people who are pregnant, and those who stand or sit for long periods.

Symptoms

Common symptoms

• Bulging, twisted veins that look blue or dark purple under the skin
• A heavy or aching feeling in your legs
• Swelling in your ankles and feet
• Itching or burning around the vein
• Cramping in your legs, especially at night

Symptoms in children

• Varicose veins are rare in children. When they do occur, it may be due to a problem with the veins from birth or an underlying condition. Symptoms are similar to adults but less common.

Symptoms in older adults

• In older adults, varicose veins often cause more discomfort, swelling, and skin changes. The skin over the vein may become thin and itchy. Older adults are also at higher risk of complications like ulcers or bleeding.

Causes

Main causes

• Weak vein walls and faulty valves inside the veins. Valves normally keep blood flowing upward toward the heart. When they stop working well, blood can pool and the vein stretches and twists.

Risk factors

• Age (veins get weaker over time)
• Family history (varicose veins often run in families)
• Being female (hormonal changes during pregnancy, menstruation, or menopause weaken vein walls)
• Pregnancy (increased blood volume and pressure on leg veins)
• Being overweight or obese (extra weight puts pressure on veins)
• Standing or sitting for long periods without moving
• Lack of exercise

When to see a doctor

See a doctor urgently if:

• If a varicose vein breaks and bleeds, or if you have signs of a blood clot (sudden leg swelling, pain, redness, warmth)
• If the skin over the vein breaks open and forms an ulcer (sore)
• If you have severe pain or the leg becomes very swollen

Book a routine appointment if:

• If you are bothered by the appearance of your veins and want advice on treatments
• If your legs ache, feel heavy, or swell after standing or sitting
• If you have itching or skin changes around the veins

Diagnosis

Your doctor will first ask about your symptoms and look at your legs. The main test for varicose veins is an ultrasound scan, which uses sound waves to see blood flow and check the valves. A venogram (X-ray with dye) is only used in special situations, such as when ultrasound results are unclear or when planning a complex treatment. During a venogram, a dye is injected into a vein in your foot or groin, and then X-rays are taken as the dye moves through your veins.

Tests that may be done

• Physical exam (looking at and feeling your veins while you stand)
• Ultrasound scan (duplex ultrasound) – the standard test
• Venogram (X-ray with contrast dye) – rarely needed

What to expect at your appointment

If your doctor recommends a venogram, it is usually done in a hospital X-ray department. You will lie on an X-ray table. A small needle is used to inject the dye into a vein, and you may feel a warm sensation. The X-ray machine takes several pictures. The whole process takes about 30 to 60 minutes. You can go home the same day. Let your doctor know if you have any allergies (especially to iodine or contrast dye) or if you are pregnant.

Treatment

Treatment for varicose veins depends on how severe your symptoms are and whether you have any complications. Many people do not need treatment. When treatment is needed, the goal is to ease symptoms, prevent complications, and improve how the legs look. Treatments range from self-care to medical procedures that close or remove the affected veins. Your doctor will discuss what is best for you.

Self-care at home

• Wear compression stockings (graduated compression) to help blood flow and reduce swelling
• Elevate your legs when resting – try to keep them above the level of your heart
• Exercise regularly, such as walking or swimming, to improve circulation
• Avoid standing or sitting for long periods – take breaks to move around
• Maintain a healthy weight to reduce pressure on your veins

Medical treatments

There are several treatments that do not require surgery. These include sclerotherapy (injecting a solution into the vein to make it scar and close), laser or radiofrequency ablation (using heat to seal the vein from inside), and foam sclerotherapy. These procedures are done by a specialist and usually take less than an hour. They are less invasive than traditional surgery and have a shorter recovery time. Your doctor will explain which option may suit you based on your vein size and location.

When is surgery considered?

Surgery (called ligation and stripping) is rarely needed now because the less invasive treatments work well for most people. However, it may be considered if the varicose veins are very large, or if other treatments have not helped. Surgery is done under anaesthetic and involves tying off and removing the damaged vein through small cuts. Recovery takes a few weeks.

Living with this condition

Living with varicose veins is usually manageable. Wearing compression stockings can help with discomfort, and simple changes like taking regular walks and putting your feet up can make a big difference. If you have had treatment, follow your doctor's advice on wearing stockings and avoiding strenuous activities for a short time.

Lifestyle tips

• Keep moving – avoid sitting or standing still for hours
• Wear comfortable shoes and avoid high heels for long periods
• Raise the bottom of your bed a few inches to help blood flow at night
• Stay hydrated – drinking enough water helps your circulation

Diet and exercise

Eating a balanced diet rich in fibre (whole grains, fruits, vegetables) can help prevent constipation, which can worsen varicose veins. Maintaining a healthy weight is important. Exercise like walking, swimming, cycling, and yoga can improve blood flow and tone your leg muscles, which helps pump blood back to your heart.

Mental health and emotional wellbeing

Varicose veins can affect how you feel about your appearance. Some people feel self-conscious or embarrassed, especially in summer or when wearing shorts. It is normal to have these feelings. Talking to your doctor about treatment options can help. If your mood is affected a lot, speaking with a counsellor or support group may be helpful.

Prevention

You cannot always prevent varicose veins, especially if they run in your family. But you can lower your risk or stop them from getting worse by staying active, keeping a healthy weight, avoiding long periods of standing or sitting, and wearing compression stockings if recommended.

Vaccines

There is no vaccine for varicose veins.

Complications

If left untreated

• Skin changes: the skin around the vein may become dry, itchy, or discoloured
• Venous ulcers: open sores that are hard to heal, usually near the ankle
• Bleeding: a varicose vein near the skin surface may break and bleed, sometimes heavily
• Superficial thrombophlebitis: a blood clot in the surface vein, causing redness and pain
• Deep vein thrombosis (DVT): a blood clot in a deeper vein – this is rare but serious and needs urgent medical attention

Long-term outlook

For most people, varicose veins are not dangerous. With self-care and available treatments, symptoms can be well controlled. Even if you have complications like ulcers or clots, these can usually be treated successfully. The outlook for varicose veins is generally very good – they rarely lead to serious health problems. Treatment has improved a lot in recent years, so help is available.

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