FAQs - Vein Care

Frequently Asked Questions about Vein Care

1. Do I need to do anything about my veins?
2. Why did I get varicose veins?
3. What could happen if I don't do anything about the veins?
4. What can I do, or not do, after vein treatments?
5. Will they come back after treatment?
6. Should I fix the veins before or after I start a family?
7. Are varicose veins dangerous?
8. What about long distance travel with varicose veins?
9. I'm pregnant and the varicose veins are getting very bad, what can I do?
10. How will the blood get out of my legs if the veins are removed?
11. How do I know if I have a DVT?

1. Do I NEED to do anything about my veins?

• NOT IF YOUR veins are not bothersome. Doing nothing is always an option. However if they bother you in any way, look or feel, then there are several treatments which may suit you.
• The veins will worsen over time in appearance and symptoms, and it is easier to treat a small problem than a large one.


• Men in particular tend to leave their varicose veins until a late stage, when sometimes the damage that the veins have caused is irreversible.


• BUT, you will certainly benefit from treatment if you have:
• heavy, tired legs
• aches, pain, cramps in the legs
• swelling at the end of the day
• small dark veins that bleed easily
• venous eczema (rash) especially over the inner, lower calf
• YES, YOU SHOULD seek medical advice, if the skin (especially over the lower leg) has become pigmented, itchy and "woody" or if the varicose veins have ever become very tender, inflammed or developed clots (thrombophlebitis). The skin changes could mean you may develop a venous ulcer (which are very difficult to heal), and the thrombophlebitis is potentially dangerous.

2. Why did I get varicose veins?

• Usually varicose veins are hereditary, with a parent or close relative also having them. If this is the case, nothing you do, or do not do, would prevent you from developing them if you going to. Often patients will complain that they the only one to get them, while their brothers & sisters haven't!


• However, what you do, once you already have varicose veins, can make them more or less bothersome. Pregnancy is often the time when women first notice them and they worsen with sucessive pregnancies. Prolonged standing can make varicose veins a lot worse, increasing swelling and discomfort.


• Sometimes varicose veins are as a result of a leg injury or a previous deep vein clot.


• Hormonal changes often seem to trigger the development of veins - adolescence (especially males), pregnancy and menopause, but often there is no apparent reason.

3. What could happen if I don't do anything about the veins?

• The veins will not disappear without treatment. Usually over time (years) they will worsen in symptoms and appearance, with more developing as well. At the best, they may not ever become problematic, and at the worst you could develop venous ulcers or thromboses (clots).


• The extra weight of the blood in the enlarged veins exerts pressure on the surrounding tissues and over time, this pressure damages those tissues. If left untreated the changes may become irreversible. However it is best to consult with a doctor to assess the extent of your problem, and be guided as to which treatment ( if any) would be best for you.

4. What can I do, or not do, after vein treatments?

• 1. No long distance travel (more than 4 hours) for 1 month before or after treatment.
• 2. No high impact exercise (jogging, aerobics, tennis) or heavy lifting while in stocking.
• 3. Walking is encouraged - 45 minutes a day, while in stockings.

5. Will they come back after treatment?

• Once a particular vein has been removed or damaged beyond repair (which is what the non-surgical treatments try to achieve), then that vein cannot come back. Using ultrasound, the problem veins are easily identified and targeted with the non-surgical techniques, and by marking veins not visible from the surface, surgery now is very accurate.


• A true recurrence happens when a treated vein heals itself, re-opens, and becomes incompetent again. This can and does happen in a small percentage of people. With regular follow up, this is recognised and treated. Occasionally, the treatment itself causes small spider veins to develop. Usually they will be evident within a few months and are easily treated if desired.


• Over years though new spider or varicose veins may develop. These are the "next set" and can be treated in the same ways.

6. Should I fix the veins before or after I start a family?

• These days we recommend that you do treat the varicose veins before pregnancy as they can make the pregnancy very uncomfortable. You still might develop new veins during the next pregnancy, but we also recommend the wearing of compression stockings which minimize the effect the veins will have on you. The stockings should be worn throughout the entire pregnancy.


• Do not start treatment if you are trying to become pregnant.


• Once you are pregnant, NO treatment can be done apart from the wearing of stockings.


• Many women develop vulval or vaginal varices during the pregnancy. These can be very uncomfortable, but your midwife or doctor may be able to give advice. Usually these varices disappear or at least reduce in size once the pregnancy is over. These veins originate in the pelvis, and often contribute to the varicose veins in the legs. If you seek treatment for leg veins following a pregnancy, tell the vein physician or ultrasonographer that you had vulval varices (they should ask you). Our vein physician Dr Elisabeth is very experienced with this problem.

7. Are varicose veins dangerous?

• Varicose veins are generally NOT dangerous, but there are exceptions:


• Thrombophlebitis: (Seek medical advice)
  This is inflammation and clotting within a surface (superficial) vein. A superficial clot, which extends into a deep vein and continues to develop, is potentially dangerous.


• If you develop a thrombophlebitis you should seek medical attention. A doctor needs to assess the extent and may request a scan. The doctor will advise on treatment. Wearing a compression stocking gives a lot of comfort.


• The path of the vein will be visibly red, hot, hard and very painful. This pain usually persists for about a week, but the hardness (the clot) will last for weeks or months until the body reabsorbs it, just as it would any "bruise" or collection.


• Often a scan of the deep veins is done to exclude a similar problem there. (DVT)


• Injury and Bleeding: (Seek medical advice)


• If varicose veins are very prominent they may be prone to injury (bad bruising or even bleeding). Even small veins can bleed spontaneously, which is frightening, The blood will squirt in a steady stream (not pulse) because of the pressure behind it. Elevate the leg and apply pressure.

8. What about long distance travel with varicose veins?

• The main concern with long haul travel is the risk of Deep Vein Thrombosis (DVT)


• Anyone with two or more risk factors for DVT should wear compression stockings for the travel.
• DVT Risk 1.
  Air, train or bus travel of over 4 hours is considered "long haul".
• DVT Risk 2.
  Varicose veins. This is because the surface veins could clot under these circumstances, which in turn can lead to a deep vein clot (DVT).
• Consult with your doctor or vein specialist if you have a history of superficial or deep thrombosis prior to travel in case other precautions are necessary.


• The stockings should be worn on both legs (even if the varices are only on one leg), and should cover the visible varicose veins i.e. Do not wear knee-high stockings if the varicose vein is visible in the thigh or around the knee above the stocking, get a pair of thigh-high compression stockings or pantyhose from a specialist shop or vein clinic.

9. I'm pregnant and the varicose veins are getting very bad, what can I do?

• Consult with your doctor, midwife, obstetrician or vein specialist.


• Unfortunately, no treatment can be performed on varicose veins while you are pregnant, apart from wearing compression stockings. The stockings may need to be fitted. Nothing can be done for vulval varices during a pregnancy.


• Try to avoid prolonged standing.


• If your legs begin to swell, check with your maternity care-giver, as there can be several reasons for this during pregnancy.


• The veins will usually improve after the pregnancy, but advice about treatment and future pregnancies is recommended.

10. How will the blood get out of my legs if the veins are removed?

• The veins on the surface of the legs only drain the blood from the skin and fatty layers (about 10% of the total volume of blood in the leg). There are so many veins in this level that the blood can be returned towards the heart via many different pathways (liken it to driving through a city via the back streets).


• In fact, removing or stopping flow in the faulty veins actually improves the efficiency of the remaining veins.

11. How do I know if I have a DVT?

• Seek immediate medical attention if your leg becomes swollen and painful, and if you have any of the known risk factors, which include:
• Recent surgery
• Recent illness or injury
• Recent long distance travel by air, bus or train
• Personal or family history of DVT
• Known contributing blood factors
• Being pregnant
• Taking Hormones or The Pill
• Diagnosis is made with an ultrasound scan.

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