The problem is pressure, deeper than the vein you can see. Leg veins push blood uphill using one-way valves. When a valve fails, blood slides back down on standing, the vein swells, and the next valve down gets stretched open. By the time a vein looks ropy, the pressure has been building for years — and it leaks fluid into the ankle, stains the skin with iron pigment, and eventually breaks it down 1.
Closing the broken vein works; stockings don't cure anything. Endovenous ablation seals the refluxing vein with heat or medical glue in one visit, holds for years, and even heals stubborn ulcers faster 2 3. Stockings don't shrink the veins or fix the valves; they ease symptoms only while worn, and NICE advises against them as treatment when a procedure is possible 4. Nor is it a women's problem: trunk varices turn up in 40% of men and 32% of women 5.
Symptoms are the trigger to act. Legs that only look veiny and feel fine can wait; once they start talking to you, get a duplex scan.
What the scan leads to. First-line is thermal ablation — laser or radiofrequency, 30 to 60 minutes under local anaesthetic, back to work in one to three days 2. Medical glue (VenaSeal) is a heat-free option, non-inferior at three years 6. Foam injections are cheap and good for surface veins but least durable on the trunk, reopening in about a third by five years 7. Compression is only for the wait, after an ulcer, or during pregnancy.
What treatment buys back. Within a week the legs feel lighter and the end-of-day ache you'd stopped noticing is gone. A tender cord and bruising along the vein last two to four weeks. By month three the ropy veins have flattened, and quality of life improves and holds to five years 2. By a year the ankles aren't puffy by evening, and the night cramps and restless legs are usually quieter 8. Long-standing brown staining fades slowly and may not fully clear.
The fine print — when to skip it, and what people get wrong
"Recurrence means it failed." Roughly one in four returns within five years because the disease recruits a new vein, not because the procedure broke 7. A second ablation a decade on is normal.
When to defer. Pregnancy (most veins regress after delivery; wait three months postpartum), an active deep-vein clot, or severe arterial disease that firm compression would starve 3. Ablation itself carries a small clot risk, well below untreated veins.
The common trap. Injecting visible spider veins without scanning for a deeper feeder vein first — they come straight back, and it looks like the treatment failed when it never reached the source.
- 1Caggiati et al. (2008). The Nature of Skin Pigmentations in Chronic Venous Insufficiency: A Preliminary Report. European Journal of Vascular and Endovascular Surgery. link
- 2Brittenden et al. (2019). Five-Year Outcomes of a Randomized Trial of Treatments for Varicose Veins. New England Journal of Medicine. link
- 3Gohel et al. (2018). A Randomized Trial of Early Endovenous Ablation in Venous Ulceration. New England Journal of Medicine. link
- 4NICE (2013). Varicose veins: diagnosis and management (CG168). link
- 5Evans et al. (1999). Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. Journal of Epidemiology and Community Health. link
- 6Morrison et al. (2015). Randomized trial comparing cyanoacrylate embolization and radiofrequency ablation for incompetent great saphenous veins (VeClose). Journal of Vascular Surgery. link
- 7Lawaetz et al. (2017). Comparison of Endovenous Ablation Techniques, Foam Sclerotherapy and Surgical Stripping for Great Saphenous Varicose Veins. Extended 5-Year Follow-up of a RCT. European Journal of Vascular and Endovascular Surgery. link
- 8Pyne et al. (2022). Lateral Subdermic Venous Plexus Insufficiency: The Association of Varicose Veins with Restless Legs Syndrome and Nocturnal Leg Cramps. Journal of Vascular and Interventional Radiology. link
დაკავშირებული სახელმძღვანელოში (4)
- — Your calf muscles are the pump that pushes blood back up your legs — a daily walk eases the aching and swelling of varicose veins.
- — Hours of sitting still let blood pool in your leg veins, worsening the aching and swelling — get up and move every half hour.
- — Jobs that keep you standing still for hours raise the odds of ropy leg veins; sitting-standing rotation beats either extreme.
- — A varicocele is essentially varicose veins of the testicle; the underlying valve problem is identical.