Risks and benefits of varicose vein surgery

Overview

Varicose veins are swollen, twisted veins that usually appear on the legs. They happen when the small valves inside the veins stop working properly, allowing blood to pool in the veins instead of flowing back to the heart. Vein surgery is a procedure to remove or close off these damaged veins to relieve symptoms and prevent complications.

Yes, varicose veins are very common. Up to 1 in 3 adults may have them at some point. The condition becomes more common with age and affects women more often than men.

Varicose veins can affect anyone, but they are more common in women, people over 50, pregnant women, and those who have a family history of the condition. People who stand or sit for long periods at work are also at higher risk.

Symptoms

Common symptoms

• Visible, bulging, blue or dark purple veins on the legs
• Aching, heavy, or tired legs, especially after standing
• Swelling in the ankles or lower legs
• Itching or burning sensation over the vein
• Cramping in the leg muscles, especially at night

Symptoms in children

• Varicose veins are uncommon in children but can occur. They may appear as small, bluish bulges under the skin and can sometimes cause mild discomfort. Children with varicose veins should be evaluated by a doctor to rule out underlying vein problems.

Symptoms in older adults

• In older adults, varicose veins are more common and often more advanced. Symptoms may include severe leg aching, swelling that does not go away with rest, and skin changes around the ankle (such as color changes or hard, dry skin). Older adults are also at higher risk for leg ulcers and bleeding from varicose veins.

Causes

Main causes

• Weakened or damaged valves in the veins that allow blood to flow backward and pool
• Increased pressure in the veins, often from prolonged standing or sitting, pregnancy, or obesity
• A genetic tendency – varicose veins often run in families

Risk factors

• Age (over 50)
• Being female
• Pregnancy
• Obesity or being overweight
• Family history of varicose veins
• Jobs that involve long periods of standing, such as nursing, teaching, or retail work
• Lack of regular exercise

When to see a doctor

See a doctor urgently if:

• If you have sudden leg swelling, pain, warmth, and redness – seek medical help immediately or call your local emergency number.
• If a varicose vein starts bleeding and you cannot stop the bleeding with firm pressure.

Book a routine appointment if:

• If you have persistent leg pain, aching, or swelling that bothers you
• If you notice skin changes like ulcers, hardening, or color changes around the ankle
• If you want to discuss treatment options, including surgery

Diagnosis

Your doctor will first ask about your symptoms and examine your legs while you are standing. They will look for visible, swollen veins, skin changes, and any swelling or ulcers. To confirm the diagnosis and check the health of your deep veins, they will usually recommend an ultrasound scan.

Tests that may be done

• Physical examination – the doctor looks and feels for varicose veins and checks for swelling or skin changes
• Duplex ultrasound – a painless test that uses sound waves to see the blood flow in your veins and check for valve damage or blood clots

What to expect at your appointment

The ultrasound is done in a clinic or hospital. You will lie on a table, and a gel will be spread on your leg. A small hand-held device (probe) is moved over your skin to create images of your veins. The test takes about 20 to 30 minutes. It does not hurt.

Treatment

Treatment for varicose veins depends on how severe your symptoms are and whether you have complications like skin changes or ulcers. Many people do well with self-care and lifestyle changes. If these are not enough, there are several medical treatments available. Surgery is an option when other treatments have not worked or if your veins are very large or causing problems.

Self-care at home

• Wear compression stockings – these help squeeze your legs and improve blood flow
• Elevate your legs whenever possible, especially after standing for a long time
• Stay active – walking and gentle exercise help pump blood through your veins
• Avoid standing or sitting for long periods without taking a break to move
• Maintain a healthy weight to reduce pressure on your veins

Medical treatments

Medical treatments are done by a specialist. They may include endovenous laser or radiofrequency treatment (using heat to close the vein from inside), sclerotherapy (injecting a solution to close the vein), or phlebectomy (removing small veins through tiny cuts). Your doctor will explain the options that are right for you.

When is surgery considered?

Surgery for varicose veins (often called vein stripping or ligation) is usually recommended only when other treatments have not helped or if you have severe symptoms. The surgeon removes or ties off the affected veins through small cuts. Recovery can take a few weeks, and there is a risk of infection, bruising, nerve damage, or blood clots. However, for many people surgery provides lasting relief of symptoms. Your doctor will discuss the specific benefits and risks based on your situation.

Living with this condition

Living with varicose veins often means managing symptoms with simple daily habits. Wearing compression stockings, taking breaks to elevate your legs, and staying active can make a big difference. If you have had surgery, you will need to rest and follow your doctor’s advice for recovery, which may include wearing stockings and avoiding heavy lifting for a few weeks.

Lifestyle tips

• Walk or do gentle exercises like swimming or cycling to keep your leg muscles active
• Take regular breaks – if you sit at a desk, stand and move every 30 minutes
• Avoid crossing your legs when sitting – this can slow blood flow
• Elevate your legs above heart level for 10–15 minutes several times a day
• Wear compression stockings as recommended by your doctor

Diet and exercise

A healthy diet helps with weight management, which reduces pressure on your veins. Eating plenty of fiber can prevent constipation (which can worsen vein problems). Include fruits, vegetables, whole grains, and lean proteins. Drink plenty of water. Regular exercise like walking, swimming, or cycling for 30 minutes most days can improve blood flow and reduce symptoms.

Mental health and emotional wellbeing

Varicose veins can affect how you feel about your appearance, which may lead to self-consciousness or lower confidence. The pain or discomfort can also affect your mood. If you are feeling anxious or down, talk to your doctor or a mental health professional. If you ever feel overwhelmed, reach out to a crisis helpline or support service in your area.

Prevention

Varicose veins are not always preventable, but you can reduce your risk or slow their progression. Staying active, maintaining a healthy weight, elevating your legs, and avoiding long periods of standing or sitting can help. If you are prone to varicose veins, wearing compression stockings may prevent them from getting worse.

Screening programmes

There is no routine screening for varicose veins. However, during a regular check-up, your doctor may check your legs if you have symptoms or risk factors. If you have a family history, you can mention it to your doctor.

Complications

If left untreated

• Chronic leg pain and swelling that gets worse over time
• Skin changes such as darkening, thickening, or hardening around the ankle
• Leg ulcers – open sores that can be slow to heal and may become infected
• Superficial thrombophlebitis – inflammation and blood clots in a vein near the surface of the skin
• Bleeding from a varicose vein, which can be serious if not stopped quickly

Long-term outlook

With proper care and treatment, the outlook for varicose veins is very good. Most people find relief from symptoms and can prevent complications. Surgery and other treatments are effective for many, though new varicose veins can appear over time. Staying on top of self-care can help keep your veins healthy and reduce the chance of recurrence.

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