Varicose Veins

What are Varicose Veins?

Varicose veins are swollen, gnarled veins occurring most frequently in the superficial veins of the legs, which are under high pressure when standing. They occur as a result of a condition called Venous Insufficiency in which the blood circulating around the lower limbs is not able to return to the heart effectively because the one-way valves in the leg veins are damaged. The blood therefore pools in the superficial veins distending them and leading to pain, ankle swelling, skin discolouration and if longstanding and severe, ulcer formation around the ankle.

Not only are varicose veins an unsightly cosmetic concern, they can also cause the patient pain especially when walking or standing. They can often feel itchy and the legs can ache as the day progresses. Swollen ankles or calves are also possible. However, serious complications are rare.

Varicose veins never go away without treatment and frequently progress and worsen over time. Varicose veins can occur in people of any age and gender, however, women are much more prone, along with those who have a family history of varicose veins or people who spend a great deal of time standing.

Investigation of Varicose Veins

A full and thorough clinical history which includes details about pregnancies, medications, exercise and diet habits will enable your surgeon to determine possible underlying causes for your varicose veins and thus to determine possible treatment options. In particular you will be asked about any history of deep vein thrombosis (DVT) as this can sometimes be a contraindication for varicose vein treatment.

Clinical examination within the surgeon’s office enables a preliminary analysis of your varicose veins to be made, however if surgical or endovenous treatment is being considered, it is essential to accurately assess the full anatomy of the venous system of the leg and in particular, identify where the damaged venous valves are located. By doing this, corrective treatment can be tailor-made to each individual’s requirements.

 To fully assess the venous anatomy of your legs, a Duplex Venous Doppler scan may be required.

Treatment for Varicose Veins

There are several options available for the treatment of varicose veins.

Conservative Treatment

In many cases, conservative treatment is the most appropriate. Patients with symptoms from varicose veins such as aching and ankle swelling can be helped by using compression / support hosiery. In hot climates these can be uncomfortable so many patients prefer a more permanent solution.Lifestyle changes including weight loss and exercise can also help reduce the symptoms of varicose veins.

Surgical / Interventional Treatment

The most suitable surgical / interventional option varies from patient to patient and depends on the root cause and severity of the venous insufficiency and subsequent varicose veins. With great advances in medical technology, pre-conceived ideas of varicose vein treatment being severe with a lengthy recovery are fading. Today treatment is simple, easy and relatively pain-free with modern walk-in, walk-out endovenous surgical procedures. Broadly speaking varicose vein treatment is divided into three areas:

  1. Treatment of the large major long and short saphenous venous trunks in the thigh and calf;
  2. Treatment to smaller low pressure veins in the lower leg and;
  3. Treatment to varicose capillaries, venous flares and spider veins.

Treatment of large veins in the inner thigh / calf and behind the knee.

Varicosities of the large long saphenous or short saphenous venous systems results from damage to major valves in the groin or behind the knee. If these become damaged or incompetent, they allow blood to backfill the large veins in the skin if the thigh and calf, which over time become swollen or varicose. As it's impossible to repair the damaged valves, surgical treatment has traditionally focussed on removing (stripping) the swollen vein.

Vein Stripping

As the traditional surgical approach to varicose veins, this procedure requires general or spinal anesthesia. Incisions are made in the groin and near the knee through which the diseased primary vein is disconnected at the top and bottom and is literally pulled / stripped from the body using a surgical device. Whilst it's effective, vein stripping generally produces significant post-operative pain and bruising, and usually requires a lengthy and uncomfortable recovery period.

Many surgeons still perform this operation, however it is slowly becoming obsolete as a result of the advances in new minimally invasive catheter technology. Using these techniques even serious varicose veins can be treated in a doctors' office under local anesthetic in just a few minutes.

VNUS® ClosureFAST™ Catheter

This is the latest technology in varicose vein treatment and along with Endovenous Laser Treatment (EVLT), is quickly making vein stripping in the USA and UK virtually obsolete.

Surgeons using the VNUS® ClosureFAST™ catheter – the only radiofrequency device available for the treatment of venous reflux – report that most patients return to normal activity almost immediately following the procedure, with little or no post operative pain.

Under local anesthetic and ultrasound guidance, a catheter device is inserted into the diseased vein, where it delivers radiofrequency (RF) to heat the vein to approximately 120oC and thus seal the vessel. The technique is extremely successful and far less painful and traumatic to the patient than vein stripping. Radiofrequency devices operate at far lower temperatures than lasers to heat and shrink the vein walls thus limiting the impact on surrounding tissues and, according to clinical studies cause significantly less pain and bruising than laser.

Currently none of the available treatment options for varicose veins guarantee long term success. Recurrence of varicose veins occurs in about 30% of patients undergoing conventional vein stripping compared to only 5-7% of patients undergoing VNUS® ClosureFAST™

The British Surgical clinic is proud to be the only clinic in Southern Spain to offer this technique to our patients from both our Gibraltar and Marbella clinics. Click here for more information about the VNUS closure system

Endo-venous Laser Treatment (EVLT)

Endo-venous Laser Treatment (EVLT) devices utilize an optical fibre to deliver extremely high laser heat (over 700 degrees centigrade) that boils the blood in the vein to create a clotting effectwhich seals the vein as the device is withdrawn. Research evidence suggests that whilst the long term results of this technique is similar to VNUS® ClosureFAST™, patients can suffer from more pain and bruising and there is also a significant chance of some staining appearing on the treated leg along the track of the vein, which is difficult to eliminate.

Treatment of small below knee varicose veins


Some patients have small varicose veins which occur predominantly below the knee. If clinical examination and Doppler scanning fails to identify major valve damage, it is possible to remove the small varicose veins (phlebectomy) under local anaesthetic via minute incisions which allow the surgeon to tease out the veins and remove them almost painlessly. The incisions are so small that stitches are usually not necessary afterwards.

Sclerotherapy / Foam (Injection Therapy)

This treatment is used mainly for the elimination of small varicose veins or spider veins / capillary flares however can also be used in conjunction with phlebectomy to eliminate small low pressure varicose veins below the knee.

Sclerotherapy is performed by injecting an irritant solution or foam directly into the veins themselves. The irritant damages the vein walls, causing them to swell, adhere and seal shut. The vein then slowly turns into scar tissue and gradually disappears over a period of weeks. Sclerotherapy and foam therapyis generally performed in the surgeon’s office in less than 30 minutes and is considered highly effective when properly done, although the same vein may require multiple injections and repeat treatments over time. The treatment can be painful, with a burning or stinging sensation common, but the discomfort usually passes in a few minutes. Side affects are generally mild and temporary, and can include skin sores, superficial phlebitis, bruises and discoloration around the treatment site.

At The British Surgical Clinic, our team is fully trained in all the above techniques. Our approach to varicose vein treatments, which is unique on the Costa del Sol, enables us to provide a multi-disciplinary team approach to your problem. Each patient receives a thorough and complete clinical assessment and a bespoke treatment plan.

Varicose Veins Video

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