Varicose veins are enlarged, twisted surface veins, mostly in the legs, that develop when the one-way valves inside them fail. Blood then falls backwards and pools, a process called venous reflux, which raises pressure in the veins below. Fine red or blue spider veins are a related but purely cosmetic finding. Up to a third of adults have varicose veins.
For many people they are mainly a cosmetic concern, and treatment is a choice. In others, years of raised venous pressure lead to swelling, skin darkening, eczema and eventually ulcers near the ankle, and treatment is medically worthwhile. Modern treatment closes the faulty vein from the inside under local anaesthetic, and has largely replaced surgical stripping.
Symptoms
- Visible bulging, rope-like blue or purple veins
- Aching, heaviness or throbbing, worse after standing and at the end of the day
- Ankle swelling by evening
- Itching or burning over the veins
- Night cramps and restless legs
- Brown staining, dry red eczema or hardening of the skin above the ankle
- A tender, red, firm cord where a vein has clotted (superficial thrombophlebitis)
- An ulcer near the inner ankle that is slow to heal
- Bleeding from a vein after a minor knock
Causes and risk factors
The underlying fault is weak vein walls and valves, strongly inherited: risk is high if both parents are affected. Female sex and pregnancy contribute through hormones, increased blood volume and pressure from the womb, with each pregnancy adding to the risk. Age, jobs involving long standing, obesity and a previous deep vein thrombosis that damaged the deep valves are further factors. Rarely, pelvic vein reflux or compression of a pelvic vein feeds leg varicosities. Crossing your legs does not cause them.
How it is diagnosed
- Standing examination: Shows the distribution of veins and any skin changes, recorded with the CEAP classification from C1 spider veins to C6 active ulcer.
- Duplex ultrasound: Essential before any treatment. Done standing, it maps reflux in the great and short saphenous veins and perforators, and confirms the deep veins are open.
- Ankle-brachial index: Checks arterial supply before compression therapy in people with ulcers or weak pulses.
- Pelvic vein imaging: CT or MR venography when veins are in unusual positions such as the vulva or back of the thigh, or recur quickly.
Treatment options
- Conservative measures: Walking, weight control, leg elevation and avoiding long periods standing. Compression stockings relieve symptoms while worn but do not fix reflux.
- Endovenous thermal ablation: Laser or radiofrequency closes the refluxing trunk vein from within under local anaesthetic in about 30 to 60 minutes. First-line treatment in most guidelines, with closure rates above 90 percent.
- Non-thermal ablation: Cyanoacrylate glue or mechanochemical ablation, needing fewer anaesthetic injections and often no stockings.
- Foam sclerotherapy: Ultrasound-guided injection of foamed sclerosant for tributaries, recurrent or tortuous veins. Repeat sessions are often required.
- Ambulatory phlebectomy: Removal of surface bulges through 2 to 3 mm punctures, frequently combined with ablation.
- Microsclerotherapy and skin laser: For spider veins, cosmetic only, generally over several sessions.
- Surgical ligation and stripping: Still used where anatomy is unsuitable for a catheter.
- Ulcer care: Compression bandaging plus early ablation of the refluxing vein, which speeds healing and lowers recurrence.
When it is urgent
Seek emergency care locally for a swollen, painful, warm calf or whole leg, which may be deep vein thrombosis, and call emergency services for sudden breathlessness or chest pain. If a varicose vein bleeds, lie down, raise the leg above heart level and press firmly for 10 minutes, then get medical attention. Spreading redness with fever around an ulcer also needs prompt treatment.
Travelling to Türkiye for treatment
Vein treatment fits a short trip well: duplex scan and consultation on the first day, ablation with phlebectomy the next, walking the same day, and a check scan before you leave, in about 3 to 5 days. The key issue is the flight home. Wait at least several days after treatment, wear compression, walk regularly and drink water; people with added clot risk may be given a short course of blood thinner. Follow-up sclerotherapy for remaining veins, often wanted after 6 to 12 weeks, will need a second visit or a local provider.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
Frequently Asked Questions
Will they come back?
The treated vein rarely reopens, but new varicose veins develop in roughly 2 to 3 in 10 people over 5 to 10 years because the tendency remains.
Don't I need those veins?
No. The diseased surface vein is working against the circulation. The deep veins carry about 90 percent of the blood and cope better once it is closed.
Should I wait until after I have had children?
Usually. Veins often improve within 3 to 6 months after delivery, and further pregnancies may produce new ones. Severe symptoms can be managed with compression in the meantime.
Laser or radiofrequency?
Results are equivalent. Anatomy and the operator's experience matter more than the device.