Health condition · Clinically reviewed
Varicose veins, when cosmetic becomes medical.
Enlarged, twisted veins caused by venous reflux. Symptoms range from cosmetic concern to leg ulceration. Duplex ultrasound guides the modern NICE-aligned treatment pathway.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
- 02
Sourced, not summarised
Every claim is checked against NICE, the Vascular Society or a peer-reviewed source you can see at the end.
- 03
Updated for 2026
Reflects current UK guidance on duplex ultrasound and endovenous treatment.
Key facts
Varicose veins at a glance.
The essentials, in plain English — what they are, how common they are, why the scan is essential, and how they are treated in the UK today.
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What they are
Dilated, tortuous superficial veins caused by valve failure and venous reflux.
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How common
Affects around 30% of UK adults — more common with age, pregnancy and family history.
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The real cause
Reflux through failing valves, not simply weak vein walls — which is why the scan matters.
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How they are diagnosed
Duplex ultrasound is essential before any treatment — it maps the reflux and guides the plan.
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First-line treatment
NICE recommends endovenous techniques (EVLA or RFA) over traditional open surgery.
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Not the same as
Spider veins (telangiectasia) are a separate, cosmetic problem — not truncal reflux.
Why this guide matters
When cosmetic quietly becomes medical.
Varicose veins are often dismissed as an appearance issue — until skin changes, pain or ulceration appear. The three points below shape everything else on this page.
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Reflux is the real problem
The bulges you see are downstream of failing valves. Treating the appearance without the reflux invites recurrence.
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A scan is not optional
Duplex ultrasound is required before any treatment — it identifies where the reflux starts and where it ends.
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Modern treatment is day-case
EVLA and RFA have replaced stripping for most patients — walk in, walk out, back to normal quickly.
How the diagnosis is made
From first bulge to a clear plan.
The steps a UK vascular pathway will normally follow, in order — so you know what to expect and why.
Phase 1 · Recognising
History and standing examination
Phase 2 · Confirming
Duplex ultrasound, CEAP and specialist review
Phase 3 · Managing
Shared treatment decision
- 01
Recognising
Symptom and cosmetic history
How long the veins have been visible, what they feel like, and what bothers you most.
- 02
Recognising
Standing examination
Veins are only fully assessed with you standing — they collapse when you lie down.
- 03
Recognising
Duplex ultrasound (mandatory)
The essential test — it maps the veins and identifies where reflux is happening.
- 04
Confirming
CEAP classification
A standard clinical grading (C0-C6) that decides urgency and shapes the treatment plan.
- 05
Confirming
Vascular surgery consultation
A specialist review to match anatomy and symptoms to the right procedure.
- 06
Managing
Consideration of comorbidity
A history of DVT, clotting disorders or pregnancy alters which treatments are suitable.
- 07
Managing
Treatment plan chosen with patient
Endovenous ablation, sclerotherapy or conservative care — decided together after the scan.
Typical timeline: 2-6 weeks from first consultation to a settled plan.
Symptoms
What varicose veins actually feel like.
They range from purely cosmetic to genuinely disabling — here is what to look for, and when to seek urgent care.
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Visible bulging veins
Rope-like, blue or greenish veins that stand up when you stand and settle when you lie down.
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Aching and cramping
A dull ache after long periods of standing, often worse by the end of the day.
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Heaviness
A tired, heavy feeling in the legs that eases with elevation or compression.
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Restless legs at night
An urge to move the legs in bed, sometimes with crawling or twitching sensations.
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Ankle swelling
Mild oedema around the ankle, worse in the evening — a sign of chronic venous congestion.
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Skin pigmentation
Brownish staining around the ankle (haemosiderin) — a marker of longer-standing reflux.
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Venous ulceration
A break in the skin, usually just above the inner ankle, that is slow to heal.
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Red flag: DVT
Sudden red, hot, painful, swollen leg — call 999. This is a possible deep vein thrombosis.
Treatment
How varicose veins are treated in the UK.
Compression first for milder cases, endovenous techniques for reflux — what each option does and when it is used.
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Compression stockings
The mainstay of early management — they reduce symptoms and support the venous return.
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Endovenous laser ablation (EVLA)
A NICE-recommended day-case procedure that seals the refluxing vein with laser energy.
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Radiofrequency ablation (RFA)
The other NICE-recommended endovenous option — heat energy delivered via catheter.
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Foam sclerotherapy
An injected foam that irritates and closes small or residual varicose veins.
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Ultrasound-guided sclerotherapy
The same technique guided by real-time ultrasound to reach deeper feeder veins.
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Phlebectomy
Tiny stab incisions to remove the surface bulges — often combined with EVLA or RFA.
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Traditional stripping
Open surgical removal — now rarely used since endovenous methods proved superior.
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Ulcer care programme
Multi-layer compression bandaging and wound care for established venous ulceration.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
A vascular consultant knows your scan and history and can tell you which parts apply to you. If in doubt, arrange a duplex ultrasound.
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National Institute for Health and Care Excellence (NICE). Varicose veins: diagnosis and management (CG168).
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Vascular Society of Great Britain and Ireland. Standards for venous disease.
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College of Phlebology. Patient information on venous disease and treatment.
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Circulation Foundation. Varicose veins — patient guide.
Red flags
When varicose veins become an emergency.
Most varicose veins are a slow-burn problem. These are the situations where they stop being slow — and you should act today.
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Sudden painful red leg
Hot, swollen, painful — call 999. Possible deep vein thrombosis (DVT).
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Bleeding from a varicose vein
Elevate the leg above heart level and apply firm pressure — then seek urgent care.
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Non-healing venous ulcer
Any leg wound that has not healed within two weeks needs specialist vascular review.
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Rapid skin changes
New pigmentation, hardening (lipodermatosclerosis) or eczema — arrange prompt assessment.
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Post-thrombotic syndrome features
Chronic swelling, pain and skin changes after a previous DVT — needs vascular follow-up.
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Pregnancy with severe symptoms
Marked swelling or vulval varices in pregnancy warrant same-day obstetric review.
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Recurrent varicose veins
Returning veins after prior surgery or ablation — repeat duplex ultrasound is needed.
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Superficial thrombophlebitis
A tender, red, cord-like vein — assess promptly as it can extend into the deep system.
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Unexplained leg swelling
One-sided swelling without an obvious cause needs a duplex scan to exclude DVT.
Living with it
A long-term problem, but a very manageable one.
Four things that make the biggest difference day to day — movement, compression, skin care and review.
A quiet reminder
Consistency beats intensity, every time.
Compression stockings worn most days do more than perfect stockings worn now and then.
- 01 Daily habits
Move and elevate
Walk regularly, avoid long static standing, and elevate the legs when resting to help the venous return.
- 02 Compression
Wear stockings correctly
Class 2 stockings put on first thing in the morning give the greatest symptom benefit.
- 03 Skin care
Look after the gaiter area
Moisturise daily and check the skin above the ankle for early pigmentation or breakdown.
- 04 Reviews
Repeat duplex if symptoms return
Recurrence after treatment is common — a repeat scan quickly shows what is happening.
Frequently asked
Everything we get asked about varicose veins.
Quick answers on causes, duplex ultrasound, endovenous treatment and when to worry.
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What causes varicose veins?
Failing valves in the superficial venous system allow blood to flow backwards (reflux), which stretches and distorts the veins. It is a valve problem, not simply weak vein walls.
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Do I need a scan before treatment?
Yes. Duplex ultrasound is mandatory before any treatment — it maps where reflux is happening and determines which technique is appropriate.
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What is the difference between varicose veins and spider veins?
Spider veins (telangiectasia) are small superficial threads that are almost always cosmetic. Varicose veins are larger, bulging veins caused by truncal reflux and can cause medical complications.
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Is EVLA or RFA better than surgery?
NICE recommends endovenous techniques (EVLA and RFA) over traditional stripping surgery. They are done as day cases, cause less bruising and allow a faster return to normal activities.
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Will they come back after treatment?
Some recurrence is common over time as new incompetent veins can develop. A repeat duplex ultrasound quickly clarifies whether it is true recurrence or new disease.
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When is a varicose vein an emergency?
A sudden red, hot, painful, swollen leg suggests DVT — call 999. Bleeding from a varicose vein needs elevation, firm pressure and urgent medical review.
Related content
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Injection treatment for smaller and residual varicose veins.
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