Varicose vein treatment options

A new treatment for varicose veins looks promising but there’s a danger unqualified operators could benefit at the expense of patients.
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01.Vein pain

Varicose veins

In brief

  • Varicose veins can be painful, uncomfortable and lead to serious health consequences if left untreated.
  • Endovenous laser therapy offers a good success rate, provided it’s done by accredited practitioners.
  • If you have a tendency to varicose veins, you’re likely again no matter what treatment you have.

Varicose veins aren't merely a cosmetic problem. They can cause pain and discomfort on a daily basis, with some of the more persistent symptoms including swelling, throbbing and cramping of the legs. Serious complications can develop over time, such as phlebitis (vein inflammation), blood clots, dermatitis and painful vein ulcers that in extreme cases can lead to amputation.

While many treatments exist, the one currently attracting most attention is endovenous laser therapy – a less invasive alternative to surgery with good success rates reported in the hands of experienced and skilled practitioners. Its popularity is likely to increase if a proposed Medicare rebate for the treatment is approved.

CHOICE discovers what varicose veins are and who gets them, what treatment options are available, and management strategies to help reduce discomfort.

Please note: this information was current as of May 2009 but is still a useful guide today.

What are varicose veins?

There are two venous systems in our legs, deep veins and superficial veins, which are joined by perforator veins. Most varicosities are due to problems with the main superficial, or saphenous, veins, that collect blood from other surface veins.

One-way valves in veins direct the flow of blood back to the heart. In the legs – the most common location of varicose veins – these valves are particularly important because the blood is flowing against gravity. When one or more valves fail, blood can pool in the section, causing the bulgy, tortuous appearance of varicose veins. Weak vein walls exacerbate the problem.

When the blood flows backwards because of weak valves, it is known as reflux. Deeper veins, which lie within and between muscles, are not affected in the same way, because muscular contraction (when walking and so on) compresses the veins, creating a pumping action that returns blood to the heart and provides support. The veins near the surface, however, have little support.

Not all varicosities are caused by valve problems in the saphenous or perforating veins; any superficial leg vein can become varicose, although these veins are usually quite small and cause few symptoms. However, the severity of the symptoms isn’t always related to the appearance of the veins, and even large, obvious ones may cause little or no discomfort.

Varicose veins serve no useful purpose: alternative pathways have already been formed to bypass the abnormal varicose veins and return blood to the heart. Compressing, closing off or eliminating varicose veins improves circulation and relieves many of the symptoms.

Who gets varicose veins and why?

In Western nations it’s estimated about 40% of people suffer from varicose veins, and it appears to be hereditary. Susceptibility varies among cultures, although it’s not clear if this is genetic or lifestyle-related (poor diet and lack of physical activity may be partly responsible).

Women seem to get varicose veins more than men, most likely due to the hormone oestrogen. Taking oestrogen-based contraceptive pills or hormone replacement therapy also appears to increase risk. Women who have had children are more likely to get varicose veins in the future, as hormones in pregnancy relax vein walls, and the weight of the uterus puts more pressure on leg veins. Varicose veins that occur during pregnancy often go away within a few months of giving birth.

Poor diet, obesity, smoking and a sedentary lifestyle increase risk, as does standing still for long periods of time.



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