# VARICOSE VEINS

Varicose veins of the lower limbs are extremely common. Because they so seldom threaten life or limb, they are often regarded as a quality-of-life or cosmetic concern rather than a true disease.

## Varicose Veins

Varicose veins are swollen, twisted veins you can see under the skin, usually blue and bulging. They form in the superficial veins just beneath the skin.
Normally, tiny one-way valves keep blood in your leg veins flowing upward to your heart, helped by your calf muscles (the "calf pump"). If these valves weaken, blood pools in the vein, the pressure rises, and the vein stretches and bulges. Standing or sitting for long periods, a family history, pregnancy and being overweight all make this more likely.
Most varicose veins are harmless, although large ones can ache or, over time, cause skin changes. Spider veins are a milder, mainly cosmetic version.

### Symptoms

Varicose veins can make your legs feel heavy, tired, achy, restless or burning, especially after long standing or sitting, and you may get night cramps. The skin may change colour or, in more advanced cases, become irritated or form sores.
Rarely, severe varicose veins slightly raise the risk of a deep vein thrombosis (DVT) – a clot in a deep vein that causes sudden, painful leg swelling. This needs urgent medical attention.

### Causes

Varicose veins are caused by raised pressure in the superficial leg veins. Things that raise your risk: a family history, being overweight, too little exercise, smoking, long periods of standing or sitting, and previous DVT. They are more common in women, usually appear between the ages of 30 and 70, and often develop in pregnancy (frequently settling within a year of childbirth).

### Tests

I examine the veins and check how they fill. The main test is a duplex ultrasound – a painless scan (about 20 minutes per leg) that shows how blood flows through your leg veins, confirms the diagnosis, and shows whether anything else is contributing.

## Treatment Options

### Conservative

For most people, varicose veins are best managed without surgery. The cornerstone is graduated compression stockings, supported by simple lifestyle steps:
Wear graduated compression stockings every day – they are tightest at the ankle and looser higher up, which helps your calf muscles push blood back to your heart. Put them on first thing in the morning, before the legs swell.
Walk and exercise regularly to work your calf pump.
Raise your legs when resting.
Keep to a healthy weight and stop smoking.
Avoid standing or sitting still for long stretches – keep your feet and ankles moving.
Used consistently, compression eases the aching and heaviness and helps protect the skin. It is the single most effective treatment – and the one only you can apply.

### Endovenous

Some varicose veins can be treated with procedures that close off the affected vein – such as sclerotherapy (an injection), ablation (heat) or laser. These are offered by doctors who specialise in vein work.
My practice focuses on arterial surgery and does not perform these venous procedures. For varicose veins, I recommend and support conservative management with compression.

### Surgery

Older surgical options, such as vein stripping (removing the main superficial vein), are still used in selected cases by venous surgeons. Again, this practice does not perform venous surgery.

### Varicose Vein Stripping

### NOTICE

My practice focuses on arterial surgery and does not offer any venous surgery or procedures for varicose veins.
For most people, varicose veins are best managed conservatively – and the single most effective treatment is one only you can apply: wearing your compression stockings every day.

Reference
European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg, 2022.

Videos about Varicose Veins

## Our Services

### Conservative
Management

The majority of patients with varicose veins can be treated effectively with
Elevation of limbs at rest
Weight control
Exercise
Smoking cessation
Compression bandages
Compression hosiery

### Endovenous
Procedures

We prefer the least invasive intervention, which is
NO INTERVENTION

### Venous
Procedures

Standard open venous surgical procedures remove distended veins.
We prefer the least invasive intervention, which is
NO INTERVENTION

THIS PRACTICE DOES NOT OFFER ANY OPEN OR ENDOVENOUS PROCEDURES FOR VARICOSE VEINS OR CHRONIC VENOUS INSUFFICIENCY

If you have any problems with any of these conditions, please contact your General Practitioner, or your Vascular Surgeon. If you live in Pretoria and have not seen a Vascular Surgeon before, you are more than welcome to contact my rooms for a formal consultation.

Contact us

## Gregory Weir Vascular Surgery

The purpose of this web site is to offer Dr Weir’s patients and their families access to information regarding vascular disease in general as well as specific information on certain disease processes. The information on this site does not necessarily apply to all patients with the same diagnosis. If you are not a patient of Dr Weir, please do not regard the information on this website as a substitute for a thorough assessment by a qualified Vascular Surgeon. If in doubt, consult your doctor.
If you are experiencing a medical emergency, phone us. If you are not able to get through or if we are not available, please visit your nearest casualty department.

## Consultation Rooms

Vascular & Hyperbaric Unit, Life Eugene Marais Hospital, Pretoria

Medically reviewed by Dr Gregory Weir, vascular surgeon. Last updated June 2026.