woman's legs on beach
woman's legs on beach
(Image credit: Rex Features (Shutterstock))

Usually dark purple or blue in colour and bulging, varicose veins often form on the back of the calf muscle or the side of the leg. They can not only cause discomfort, especially when the sufferer is on their feet for long periods of time, but also knock their confidence.

The past few years have seen great advances in treatments for varicose veins. The old painful surgical stripping technique has been demoted in favour of minimally invasive laser and injection techniques.

What are varicose veins?

Veins become varicose when the valves that push the blood supply back towards the heart become damaged, allowing the blood to pool, causing unsightly bulges.

How do you treat varicose veins?

1. Endovenous ablation (heat treatment)

Keyhole treatment is usually performed under local anasthetic and the veins are destroyed with a laser or high frequency radio waves. Other deeper veins take over the function and the redundant veins are reabsorbed into the body. It takes about 25 days as a day patient.

Mild bruising is usual but the risk of complications is low. Available on the NHS, for people where ultrasound confirms varicose veins and also a condition called truncal reflux. This is when the blood flows back down the great saphenous vein that runs the length of the leg, or the small saphenous vein that runs along the back of the leg, from the foot to just behind the knee.

For you? Yes, provided there is a long and straight enough stretch of vein. Over ten years, 9 out of 10 people stay vein-free, compared to 4 out of 10 with traditional ligation and strapping.

2. Sclerotherapy

A foam or liquid solution is injected foam or liquid solution is injected into the vein, which irritates it causing the walls to stick together. The vein is absorbed into the body and the blood shunted to deeper healthier veins.

For you? For less straightforward or recurrent veins. Foam is best for twisted (tortuous) veins and liquid for isolated, small, lumpy veins. Sclerotherapy can cause discolouration (caused by blood leaking into the skin), which can last for several months. The jury is still out on the effectiveness of foam sclerotherapy in the long run, however - according to some studies veins return in as many as half of cases.

3.Ligation and Stripping

The surgeon makes a cut in the groin and ties off (ligates) the offending vein. A fine flexible rod is passed through the cut and the vein is ‘stripped' out through another cut in the upper calf. It's done under local or general anaesthetic.

For you? Once the gold standard but now demoted in favour of less invasive treatments, it can cause pain, bruising and bleeding and, albeit rarely, nerve damage or deep vein thrombosis. You'll also need two or three weeks off work.

'After years of pain - I've banished my varicose veins'

Angela Evison explains why she chose to treat her veins after years of suffering...

'I had varicose veins for so long I can't remember not having them - and I can't remember the last time I bared my legs. Whatever the weather, whatever the trend, I would cover up or stick faithfully to my thick black opaque tights. They have always been my cross to bear, obliging me to beg for extra leg room on flights (deep vein thrombosis scares echoing in my ears), and causing me anxiety when I stood for hours.

Finally, the wake-up call came when they constantly felt heavy, a bit itchy and every long flight was one trip too many. And I knew that the longer I left it, the worse they would get. The fact is that veins start to lose their elasticity and the valves inside them stop working as well when you get older.

My main reason for seeking treatment was first and foremost medical, but if I could come through with legs that were not an embarrassment on holiday, then that would be an extra bonus. Tales of classically stripped veins being unsuccessful long term caused me to investigate the amazing new developments in perforating vein laser surgery and brought me to the Whiteley Clinic in central London, where Professor Mark Whiteley is the guru of all things related to veins and vascular surgery.

Friendly, knowledgeable staff put me at ease and my first consultation (with the Professor himself) was to assess my legs and discuss the surgery required (TransLuminal Perforator vein surgery) to reduce further deterioration.

The key to discovering the true extent of vein damage is their Duplex Ultrasound scan and it's as thorough as it gets. Sonographer Tim marked in a lurid blue pen all the underlying veins that needed attention, which can only be identified by the scan - the procedure isn't unpleasant, but takes time and is messy (lots of gel), and a graphic map is duly drawn to highlight the areas for treatment. Then the procedure plan is outlined (phlebectomies in medical lingo) for which veins need to be addressed and the cost. This is where taking a deep breath helps! Yes, it is expensive, but you get what you pay for, a result that claims to be permanent and varicose veins that will not reappear (while veins that are stripped invariably do).

With the day of the operation scheduled, practical advice is given beforehand: avoid shaving legs, wear comfy leggings to go home in afterwards and keep legs free of creams.

One leg was treated in the morning and the other after lunch, allowing me the chance to walk around freely without the constraints of feeling hospitalised. It's advised to have both legs done in one go and I certainly would recommend it for ease in aftercare.

After cleansing the legs from groin to ankle, the laser, which emits a faint heat and whirring sound and needle that feels occasionally like tugging, the veins are heated and shrivel away inside the body. Gone for good, it's claimed. Each leg took about an hour of surgery, then was dressed (the tricky bit) with bandages wrapped Egyptian mummy style, and further tightened with compression footless tights.

Though a seemingly simple operation, it is still an operation and should be treated as such. It's important to follow the aftercare procedure. I was allowed to remove the bandages after 24 hours, but told to leave the steristrips in place over the tiny needle puncture holes for another three days. And compression tights must go back on immediately. So it was back to black tights for me for a while longer.

So what did it look like afterwards? Bruised, really black and blue for a good three weeks, and numb in sections above the knee. Not painful, but a bit uncomfortable. I kept my tights on for a month afterwards to play safe. The clinic encourages staying active, but no hot baths for a while, and after six weeks I went back to my weekly swim and the bruises gradually faded.

Six months later? Eureka! No bulbous blue knobbly bits any more. It's amazing to imagine they ever existed. My legs feel in better condition medically than ever (no more heaviness) and I feel confident about flying and ready to ditch the black tights forever!

What next? My treatment was to eliminate my varicose veins and reduce the deterioration due to vein reflux, rather than cosmetic. It's recommended that I follow up with ultrasound guided foam sclerotherapy which further improve the appearance, but this is best done in cooler weather, as heat can irritate and compression tights need to be kept on for two weeks. So come autumn that's top of my agenda!'

COST? All-in treatment starts from £2,742 for one leg WHERE: thewhiteleyclinic.co.uk For further information, visit circulationfoundation.org.uk

FGY TIP Try to fit in a brisk ten-minute walk every day - as the muscles in your calves contract with each step, it will help get blood moving back to your heart