Varicose Veins

Some varicose veins are mainly a cosmetic concern; others cause aching, heaviness, swelling, itching, inflammation or skin damage that benefits from treatment.

Healthy leg veins rely on one-way valves and the pumping action of the calf muscles to push blood back to the heart. When valves become incompetent, blood pools and the vein wall stretches and becomes tortuous. Reflux most often affects the great or small saphenous vein and their branches, and ultrasound is needed to show which vein is the true source.

Several factors can contribute:

• Family history of varicose veins
• Pregnancy
• Increasing age
• Prolonged standing, often work related
• Previous deep vein thrombosis
• Increased body weight

Visible bulging veins are the most obvious sign, but symptoms matter as much as appearance. Many people notice:

• Aching, throbbing or heaviness in the legs
• Tiredness or burning after prolonged standing
• Itching over the veins
• Night cramps or restless legs
• Ankle swelling towards the end of the day

Symptoms often improve with walking or elevating the legs. Importantly, the size of visible veins does not always match the severity of the underlying reflux, which is why imaging guides treatment rather than appearance alone. Advanced venous disease may cause skin pigmentation, eczema, inflammation, bleeding or ulceration.

Assessment combines clinical examination with duplex ultrasound, which maps the superficial and deep veins, measures reflux and checks for obstruction or previous thrombosis. Mapping before treatment is essential because the veins you can see are often fed by a deeper source of reflux that cannot be identified by looking at the leg.

The surgeon also reviews your general health, medications, previous vein procedures and any history of clotting, because these influence which treatments are safe and durable. For referrers, duplex reporting of truncal reflux (great and small saphenous systems), perforator incompetence and deep venous patency underpins procedure selection, and further cross-sectional imaging is reserved for suspected pelvic or deep venous contribution.

Conservative management

Regular walking, weight management, leg elevation, skin care and properly fitted compression stockings can reduce symptoms. Compression should be fitted correctly, and arterial circulation should be checked first if there is any concern about peripheral arterial disease.

Procedural treatment

When intervention is appropriate, options include:

• Radiofrequency ablation (heat sealing of the refluxing vein)
• Endovenous laser treatment
• Medical adhesive (vein glue)
• Ultrasound-guided foam sclerotherapy
• Phlebectomy (removal of surface veins through tiny incisions)
• Open surgery in selected cases

Treatment is matched to the pattern of reflux, vein size and depth, symptoms, previous thrombosis and your preferences. The least invasive choice is not automatically the right one for every leg; durability and the anatomy of the refluxing vein also count.

What to expect after treatment

Most minimally invasive vein treatments are day procedures. Walking is encouraged straight away, while heavy exertion and long periods of immobility are limited for a short time. Some bruising, tightness or tenderness along the treated vein is common, and a follow-up ultrasound may be arranged depending on the procedure.

Skin changes and complications

Longstanding venous pressure can damage the skin of the lower leg. Possible complications include venous eczema, brown pigmentation, hardening of the tissues (lipodermatosclerosis), superficial thrombophlebitis, bleeding from a fragile vein and venous ulceration near the ankle. Sudden one-sided leg swelling or pain is different from typical varicose vein discomfort and needs prompt assessment to exclude deep vein thrombosis. Heavy bleeding from a burst vein, spreading redness or severe unremitting pain should be assessed urgently, through Triple Zero (000) or an emergency department if severe.

Untreated varicose veins may stay stable for years or gradually progress to skin change or ulceration; treatment timing is guided by symptoms and the scan findings, not by appearance alone. Procedural risks include bruising, tenderness, pigmentation, phlebitis-like inflammation, nerve irritation, deep vein thrombosis (uncommon), recurrence over time and the need for staged or repeat treatment. New varicose veins can develop in other veins later, so review and occasionally repeat ultrasound are part of long-term care.

Useful points to clarify at a varicose vein consultation include which veins are refluxing, whether the visible veins explain your symptoms, and whether there is any involvement of the deep venous system. Duplex ultrasound provides this information and helps distinguish a local surface-vein problem from more extensive venous disease.

The recommended treatment should reflect the source of reflux, the size and position of the veins, the presence of swelling or skin change, and your priorities regarding recovery and durability. It is reasonable to ask why a particular method is preferred, whether treatment will be completed in one session or staged, and what level of improvement is realistic.

Recurrence does not necessarily mean that the original procedure has failed. New reflux can develop in untreated veins over time, particularly where there is a strong inherited tendency. Your surgeon can explain the expected recovery, whether compression is needed, when you may return to driving or work, and what follow-up imaging is appropriate. Bring any previous vein scans and details of earlier treatment to the appointment.

Yarra Vascular Surgeons assesses and treats varicose veins with the full range of options, from compression and lifestyle advice through endovenous ablation, adhesive closure and sclerotherapy to phlebectomy and surgery. Duplex mapping before any procedure means treatment targets the true source of reflux.

Varicose veins may reflect underlying venous reflux that contributes to aching, swelling, inflammation, skin change or ulceration. Yarra Vascular Surgeons provides specialist clinical assessment and duplex ultrasound mapping before recommending treatment. Access to endovenous ablation, medical adhesive, sclerotherapy, phlebectomy and surgery allows management to be tailored to the source of reflux, your symptoms and your individual anatomy.