Varicose veins? See the treatments options available

What you can get on the NHS and how much it costs to go private

Varicose veins on a leg
As you get older, varicose veins can become more of a problem. Whether your veins are causing you trouble, or you just hate their lumpy, knobbly appearance, there are things you can do. Read on for the treatment options available.

See also: Swollen feet and ankles? What causes it and what you can do

See also: Could you have restless legs syndrome?

Treating varicose veins
Varicose veins may look unattractive, but they generally don't affect the circulation or pose a serious health problem for most people. If you want to get rid of your varicose veins for cosmetic reasons, you're unlikely to receive help on the NHS and will need to pay for treatment privately.

Treatment on the NHS
If your varicose veins are causing you pain or discomfort, your doctor is likely to suggest that you follow some self-care advice for six months before offering you treatment. This generally involves wearing compression stockings, exercising regularly, not spending long periods standing, and keeping the affected area elevated while resting.

If you follow the recommendations for six months but don't see an improvement, or the veins are causing complications – such as leg ulcers, swelling or skin discolouration - your GP may suggest going ahead with treatment.

The three main procedures available are: endothermal ablation (heat is used to seal affected veins), sclerotherapy (a special foam is used to close the veins), and ligation and stripping (the affected veins are surgically removed).

Endothermal ablation
Your GP is likely to suggest endothermal ablation as a first option. The procedure uses either high-frequency radio waves (radiofrequency ablation) or lasers (endovenous laser treatment) to seal the affected veins. This treatment is good for straight, small veins but not suitable for big twisted veins, as it's harder for the laser to pass through. Varicose veins recur in less than 5 per cent of cases.

Radiofrequency ablation is carried out under local anaesthetic. The surgeon will make a small cut just above or below the knee to access the vein and insert a catheter (narrow tube) into the vein using an ultrasound scan to guide it. Once in place, a probe is placed into the catheter that sends out radiofrequency energy.

This heats the walls of the varicose vein, causing them to collapse and close. Once sealed shut, your blood will naturally be redirected to one of your healthy veins.

Endovenous laser treatment follows a similar procedure, but instead of using radiofrequencies, a laser delivers short bursts of energy that heat up the vein and close it.

Side effects and recovery
After the treatment you may experience some tightness in your legs, and the treated areas may feel bruised and painful. Some patients may experience nerve injury (numbness or pins and needles), but this is usually temporary. You will need to wear compression stockings a week or so after having the treatment.

How much does it cost?
Expect to pay £2,000-£3,000 per leg to have the treatment done privately.

Foam sclerotherapy
Your doctor may suggest foam sclerotherapy if the treatments mentioned above are considered unsuitable for you. A needle is inserted into the vein, which is then filled up with a foamy detergent that acts like a chemical burn, dissolving the vein lining. Foam sclerotherapy is particularly effective for small varicose veins — on larger ones it can cause inflammation around the vein.

The procedure is typically carried out under local anaesthetic, and it's possible to treat more than one vein during the same session. Foam sclerotherapy has been shown to be effective in 84 out of 100 cases, but studies suggest a relatively high recurrence rate (30 per cent after two years) compared to laser or radiofrequency. One study found that varicose veins returned in more than 50% of people treated. Sclerotherapy may not be suitable if you have previously had deep vein thrombosis.

Side effects and recovery
Side effects of the treatment can include: blood clots in other leg veins, headaches, lower back pain, changes to skin where the treated veins were, fainting and temporary vision problems. Sclerotherapy has been known to have serious potential complications, such as strokes or transient ischaemic attacks, but this is rare.

Your varicose veins should begin to fade after a few weeks after the treatment, though you may require more than one session. Compression stockings need to be worn for a week or two to press the sides of the burnt vein together to make sure it remains blocked. You should be able to walk around as normal immediately after having the treatment.

How much does it cost?
Expect to pay around £1,000 per leg to have the treatment done privately.

If none of the above treatments are considered suitable, your GP may suggest surgery, where the affected veins are removed in a process called ligation and stripping. This is performed under general anaesthetic, and an overnight stay in hospital may be necessary, especially if you have surgery on both legs.

Ligation and stripping involves tying off the vein in the affected leg and then removing it. The surgeon makes two small cuts around 5cm (2in) in diameter – one near your groin and another around your knee or ankle. The vein is tied to seal off the blood and a hook-like instrument is used to remove the vein. The wounds are then closed with dissolvable stitches and the leg bandaged.

Surgery is considered the most effective way to treat large, lumpy veins because the surface area is too large for the thin light of a laser to tackle all parts of the vein. However, after 10 years, about one-in-three patients report their varicose veins to be as bad as before they had surgery.

Side effects and recovery
The procedure can cause pain, bruising and bleeding. Although serious complications are rare, these can include nerve damage or deep vein thrombosis. About one-in-five patients experience numbness in the leg after surgery due to nerve damage, although this often fades in time.

Most people need up to three weeks to recover before returning to work, although this depends on the state of your general health. For some, the bruising can take as long as six weeks to go down. You will need to wear compression stockings as part of your recovery.

How much does it cost?
Expect to pay around £1,500 per leg to have the treatment done privately.