Venous disease
Varicose Veins
Bulging, aching leg veins caused by faulty valves. Modern treatment is walk-in, walk-out — usually without surgery in the traditional sense.
Last reviewed 24 Jul 2026
Reviewed by Dr Tay Jia Sheng · Vascular, Endovascular & General Surgeon
What are varicose veins?
Varicose veins are enlarged, twisted veins — most often in the legs — that develop when the one-way valves inside the veins stop closing properly. Blood that should be travelling back to the heart pools in the leg instead, stretching the vein wall. Over time this causes visible bulging veins, aching, heaviness, night cramps, itching, ankle swelling and, in more advanced disease, skin darkening and ulcers around the ankle. They are common: population studies suggest roughly one in five adults has varicose veins to some degree.
Why treat them?
Varicose veins are a progressive condition. Not every varicose vein needs a procedure, but symptoms that affect daily life, skin changes, bleeding from a vein, or a history of superficial clots are reasons to have the veins properly assessed rather than watched indefinitely.
How severe are my veins? The CEAP scale
Vein specialists grade chronic venous disease on the CEAP clinical scale. It is worth knowing where you sit, because the stages are a one-way street — and the earlier rungs are far simpler to treat:
| Stage | What it looks like |
|---|---|
| C0 | No visible veins, though legs may ache or feel heavy |
| C1 | Spider veins or fine thread veins |
| C2 | Varicose veins — bulging, rope-like veins |
| C3 | Ankle or leg swelling on top of visible veins |
| C4 | Skin changes — darkening, eczema, hardening around the ankle |
| C5 | A healed venous ulcer |
| C6 | An active venous ulcer |
From C4 onwards the skin damage is a warning that the pressure in the veins is injuring the tissues. Treating the underlying leak at that stage is about preventing an ulcer, not about appearance — more on this under chronic venous insufficiency.
How I assess them
Diagnosis rests on a duplex ultrasound scan, which maps which valves are leaking and plans treatment around your anatomy. In my clinic the scan is done during your consultation and I read it with you, so assessment and treatment planning happen in one visit.
Treatment options
Treatment is matched to your anatomy, symptoms and preferences. Options include:
- Conservative care — compression stockings, leg elevation and lifestyle measures for mild disease
- Endovenous ablation — heat-based closure of the faulty vein through a needle puncture, under local anaesthesia
- Medical adhesive closure (VenaSeal) — sealing the vein with a medical adhesive, without heat and usually without compression stockings afterwards
- Sclerotherapy and microsclerotherapy — injections for smaller varicose and spider veins
- Microphlebectomy — removal of surface clusters through tiny incisions
Most of these are performed in the clinic under local anaesthesia. Patients walk in and walk out on the same day, and most return to normal activities quickly. How the options compare — including the non-thermal and non-invasive techniques — is set out in choosing a varicose vein treatment.
What international guidelines say
The European Society for Vascular Surgery's 2022 guidelines on chronic venous disease recommend duplex ultrasound as the first-line investigation for suspected varicose veins, and recommend endovenous ablation ahead of open surgery when a truncal vein is the source. That is the sequence this practice follows: scan first, then match the technique to the anatomy.
When to see a doctor promptly
Sudden painful swelling of one leg, a hard tender cord along a vein, bleeding from a varicose vein, or a non-healing wound near the ankle warrant early review.
Reference: European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. European Journal of Vascular and Endovascular Surgery 2022;63(2):184–267.
Frequently asked questions
- Do varicose veins always need treatment?
- No. Mild veins that cause no symptoms can reasonably be observed, with compression stockings and lifestyle measures if needed. Treatment is worth considering when veins ache, swell or interfere with daily life — and becomes important once the skin starts to change, because darkening, itching or hardening around the ankle signals pressure that can progress towards an ulcer.
- Is varicose vein treatment painful?
- Modern treatments are done through needle punctures under local anaesthesia, and most patients describe discomfort rather than pain. The techniques differ — heat-based ablation involves a series of anaesthetic injections along the vein, while adhesive closure typically needs a single puncture — and that comparison is part of choosing between them at consultation.
- Will varicose veins come back after treatment?
- Treated veins stay closed in the large majority of cases, but vein disease is a lifelong tendency and new leaks can develop over the years. Periodic review and early treatment of new veins keep any recurrence small. A practice being honest with you will not promise that veins can never return.
- Can varicose veins cause serious problems?
- They can. Advanced disease can lead to skin damage and venous ulcers, clots in the surface veins (superficial thrombophlebitis), and occasionally bleeding from a burst vein. These complications are what treatment aims to prevent — and why bleeding, sudden painful swelling or a non-healing ankle wound deserve prompt review.
- What happens at the first consultation?
- Your veins are scanned with duplex ultrasound during the consultation itself. I read every scan and go through the findings with you, so you leave with a diagnosis and a plan — including the option of not treating — in a single visit.