Varicose Veins

Varicose veins are dilated, elongated, and tortuous superficial veins of the legs that result from venous valve incompetence and reflux. They are extremely common, range from a cosmetic concern to a manifestation of chronic venous disease with skin changes and ulceration, and are a frequent reason for vascular surgical referral.

Definition

Varicose veins are abnormally dilated, tortuous superficial veins, typically of the lower limb, arising from incompetence of venous valves that allows blood to reflux and pool, raising venous pressure in the affected segment.

Scope

The entry covers the venous reflux that underlies varicose veins, their place within the broader spectrum of chronic venous disease, and the principal interventional approaches that close or remove the refluxing vein. It is a reference overview of the condition and its surgical context, not individualised clinical guidance.

Key concepts

• Venous valve incompetence
• Venous reflux and ambulatory venous hypertension
• Great and small saphenous systems
• Chronic venous disease spectrum (CEAP)
• Endovenous thermal ablation
• Sclerotherapy
• Surgical stripping and ligation

Mechanisms

Competent one-way valves normally direct venous blood upward against gravity; when valves fail, blood refluxes and pools in superficial veins, raising local venous pressure (ambulatory venous hypertension). The sustained pressure dilates and lengthens the vein wall, producing the visible varicosity, and over time can drive the skin changes and ulceration of advanced chronic venous disease. Treatments abolish the refluxing channel — historically by surgical ligation and stripping, and increasingly by endovenous thermal ablation or sclerotherapy that occlude the vein from within.

Clinical relevance

Varicose veins matter clinically because, although often benign, they can progress to symptomatic chronic venous insufficiency with oedema, skin damage, and venous ulceration, and they are among the most common conditions managed in vascular surgery; understanding venous reflux supports critical appraisal of treatment evidence. This entry is educational and does not provide treatment recommendations for individuals.

Epidemiology

Varicose veins are very common in adult populations, increasing with age and associated with female sex, pregnancy, family history, obesity, and prolonged standing. Many people have asymptomatic or minimally symptomatic disease, while a minority progress to advanced chronic venous insufficiency.

History

Open surgical ligation and stripping of the saphenous vein was the mainstay of treatment through the twentieth century. From the early 2000s, minimally invasive endovenous techniques — radiofrequency and laser thermal ablation, and foam sclerotherapy — progressively displaced open stripping as first-line interventional options, a shift reflected in society practice guidelines.

Debates

Endovenous ablation versus surgical stripping

Endovenous thermal ablation and foam sclerotherapy offer less invasive alternatives to open stripping with comparable closure of the refluxing vein and faster recovery, and guidelines have moved toward endovenous approaches as preferred, though the relative long-term outcomes continue to be studied.

Seminal works

• raju-2009-cvi
• gloviczki-2011-svs

Frequently asked questions

What causes varicose veins?

They develop when the one-way valves in superficial leg veins fail, allowing blood to flow backward and pool; the resulting rise in venous pressure dilates and lengthens the vein into the characteristic bulging, tortuous form.

Are varicose veins always harmful?

Often they are mainly a cosmetic or mildly symptomatic issue, but in some people they are part of a wider chronic venous disease that can progress to swelling, skin changes, and venous ulceration, which is when intervention is more likely to be considered.