Varicose Veins

What are varicose veins ? Lumpy, swollen veins under the skin that usually occur on the inner thigh or on the calf.
Why have I got them ? The valves in the vein that usually guide blood back to the heart have failed. Although blood still flows up the vein when you are walking, when you rest it flows back (reflux) down the vein under gravity. Because the pressure is slightly higher, the veins get larger and more obvious over time. The main reason for the valves failing is genetic, and there is a family tendency in many patients. Pregnancy or being overweight are secondary causes that may contribute.
Are they dangerous ? No
Do they cause ulcers or clots ? No
What should I do about them ? If they are not causing any symptoms, then no treatment is needed. If they cause aching, itching or swelling then elastic socks or stockings are usually very effective, although they have to be the right size, worn regularly and replaced periodically. Surgery is usually possible but not often recommended.
Who is surgery recommended for ? This depends who you ask. The NICE guidelines indicate that surgery is appropriate for patients with skin changes such as ulceration or eczema. Fortunately these are rare. Surgery may also be recommended for recurrent thrombophlebitis or 'intolerable symptoms'. Cosmesis is not an NHS indication as it is not a health risk.
Why doesn't everyone with varicose veins get offered surgery ? There is a risk:benefit balance to be considered. The risk of the veins causing a serious problem is very small, and there is an unavoidable small risk of serious complications with any operation including vein surgery. Not all patients having vein surgery will see their symptoms improve, because there are other causes of aching or swollen legs. As a result, in this era of cost saving, varicose vein surgery has been seen as a way of reducing expenditure, without compromising patient safety. It has become a low priority for the NHS providers.

From a non-medical point of view, vein surgery is not cost effective either., because patient expectations are so high, there is quite a lot of dissatisfaction with the end result particularly if a routine complication such as a groin wound infection or skin nerve injury occurs. This leads to significant numbers of complaints and claims for compensation which all takes money from the NHS budget, even if few are successful. Because vein surgery is subject to the same waiting time rules as cancer or life-saving surgery, there are financial penalties for not meeting these targets and vein surgery ends up costing Trusts as much as it brings in, there is no incentive to offer it.

Is surgery a cure ? No. Effective surgery will remove the visible veins but since the tendency to get varicose veins is in the genes, quite a lot of people go on to develop more veins as other valves fail later.
Can I have surgery privately ? Many people do so, but caveat emptor (buyer beware!). It is no safer or more effective in the private sector but here the choice about the risk:benefit balance is made by the patient and is often outweighed by cosmetic issues. It remains the commonest source of patient complaints, partly due to expectations and partly because it is such a common problem, but the private sector is much less likely to pay out for compensation claims unless something catastrophic has occurred. However it is not cheap, you can expect to pay significantly more than the NHS tariff would reimburse a hospital.