Varicose Veins

Dr Suresh Babu
Dr Suresh Babu
Senior Consultant Vascular and Interventional Radiologist

Varicose veins are enlarged, twisted veins that appear close to the surface of the skin. They occur when the valves within veins become weak or damaged, allowing blood to pool rather than flow efficiently back to the heart. This condition typically affects veins in the legs and can range from a cosmetic concern to a source of discomfort that impacts daily activities. While varicose veins can affect anyone, they are more common among older adults, pregnant women, and individuals who stand for long periods.

Symptoms of Varicose Veins

Varicose veins present through various symptoms that can differ in severity from person to person. Common symptoms include:

Visible, enlarged veins

The most recognisable symptom is the appearance of dark purple or blue veins that protrude from the skin surface. These veins often have a twisted, rope-like appearance that is noticeable on the legs.

Aching or heavy legs

Individuals with varicose veins frequently experience a sensation of heaviness or aching in their legs, particularly after standing or sitting for extended periods. This discomfort tends to worsen throughout the day.

Swelling

Fluid retention in the affected areas can lead to swelling of the ankles and feet. This swelling may be more pronounced in the evening and subside overnight while sleeping.

Muscle cramping

Some individuals experience cramping in the calves, particularly at night. These cramps can range from mild to severe and may disrupt sleep patterns.

Itching around veins

The skin surrounding varicose veins may become itchy or irritated. This irritation occurs due to increased pressure and inflammation in the affected vessels.

Skin changes

Advanced cases may lead to changes in skin texture and colour around the affected veins. The skin may become drier, thinner, or discoloured over time.

Restless legs

Some people report an urge to move their legs frequently, particularly when resting. This restlessness may increase in the evening or when lying down.

Causes and Risk Factors

Varicose veins develop when vein valves malfunction and blood flow becomes compromised. Several factors may contribute to the development of this condition.

Age

The natural ageing process weakens vein walls and valves over time. As these structures lose elasticity, blood can pool more easily, explaining why varicose veins become more common with advancing age.

Gender

Women develop varicose veins more frequently than men. This disparity relates to hormonal influences, particularly oestrogen, which can relax vein walls and compromise valve function.

Pregnancy

The increased blood volume during pregnancy places additional pressure on veins, while hormonal changes can relax vein walls. The growing uterus also exerts pressure on pelvic veins, further impeding blood flow from the legs.

Family history

Genetic predisposition influences varicose vein development. If close family members have the condition, an individual’s risk increases substantially.

Prolonged standing or sitting

Occupations or lifestyles that require extended periods of standing or sitting impede normal blood circulation in the legs. This static positioning allows blood to pool in the veins rather than return efficiently to the heart.

Obesity

Excess weight places additional pressure on veins and can impair blood flow. The extra strain makes valves work harder and increases their likelihood of failing over time.

Previous blood clots

A history of deep vein thrombosis or other venous obstructions can damage valves and lead to varicose veins. These clots may permanently alter blood flow patterns in the affected limb.

Lack of exercise

Insufficient physical activity reduces muscle contractions that normally help push blood through the veins. Regular movement promotes circulation and helps prevent blood from pooling in the lower extremities.

Diagnostic Methods

  • Duplex Ultrasound: This non-invasive imaging technique combines traditional ultrasound with Doppler flow assessment to evaluate blood flow patterns and venous anatomy. Duplex ultrasound can identify valve dysfunction, blood clots, and reflux (backward flow) in the veins.
  • Venous Reflux Examination: This specialised test evaluates the efficiency of venous valves by measuring blood flow in different positions. During the examination, blood flow is monitored while the patient performs specific manoeuvres such as standing and contracting leg muscles. The test helps quantify the severity of valve dysfunction and identifies specific veins requiring treatment.
  • Clinical Assessment: Standardised classification systems such as the CEAP (Clinical, Etiology, Anatomy, Pathophysiology) and VCSS (Venous Clinical Severity Score) help categorise disease severity and track treatment outcomes. These assessment tools combine physical examination findings with patient-reported symptoms to create comprehensive disease profiles that guide treatment decisions.

Treatment Options

Varicose vein treatment approaches range from minimally invasive outpatient procedures to more advanced interventions based on disease severity and patient factors. Each option targets the underlying venous dysfunction through different mechanisms.

Compression Therapy: Medical-grade compression stockings apply graduated pressure to the legs, strongest at the ankle and decreasing upward. This external pressure assists the vein valves in returning blood to the heart and reduces swelling in the lower extremities. Compression therapy serves as both a primary treatment for mild cases and an adjunct therapy following procedural interventions to maintain results.

Lifestyle Modifications: Strategic changes to daily habits can significantly improve symptoms and slow disease progression. Regular walking activates the calf muscle pump, improving venous return from the legs. Weight management reduces pressure on the venous system, while leg elevation throughout the day counteracts gravitational forces that impede blood flow from the lower extremities.

Medications: Venoactive drugs may help reduce symptoms by improving venous tone and decreasing inflammation. These medications strengthen vein walls, reduce capillary permeability, and can alleviate symptoms such as heaviness, swelling, and discomfort associated with varicose veins.

Sclerotherapy: This procedure involves injecting a specialised solution directly into the affected veins, causing them to collapse and gradually fade. The sclerosing agent irritates the vein lining, triggering a controlled inflammatory response that leads to vein closure. Blood flow naturally redirects through healthier veins, and the treated vessels are eventually reabsorbed by the body.

Endovenous Thermal Ablation: This catheter-based procedure uses heat energy to seal malfunctioning veins from within. After administering local anaesthesia, a thin catheter delivers controlled heat (via laser or radiofrequency) to the vein wall, causing it to collapse and seal shut. The procedure requires only a tiny entry point and allows patients to resume normal activities within 24 hours.

Embolisation: This technique involves introducing specialised materials through a catheter to block blood flow in targeted veins. Using imaging guidance, the procedure addresses problematic vessels that may be difficult to treat with other methods. Embolisation effectively eliminates varicose veins by permanently occluding them, redirecting blood through healthier pathways in the venous system.

Prevention and Management

Maintaining venous health involves strategic daily practices that support proper circulation. Regular physical activity, particularly walking and exercises that activate calf muscles, helps pump blood from the legs back to the heart. Managing weight reduces pressure on leg veins, while avoiding prolonged sitting or standing prevents blood from pooling. When sitting for extended periods, taking breaks to move around enhances circulation. Wearing loose-fitting clothing prevents unnecessary constriction of veins, and avoiding high heels allows natural calf muscle engagement during walking. For individuals with diagnosed venous issues, consistent use of prescribed compression stockings helps maintain treatment results and prevent recurrence.

Dr Suresh Babu

Dr Suresh Babu

Senior Consultant Vascular and Interventional Radiologist

Dr Suresh is one of the leading specialists in vascular and non-vascular radiological interventions, interventional oncology, pain relief in interventional radiology and neuro interventional procedures in Singapore and Southeast Asia.

  • MBBS (Madras)
  • DMRD (Liverpool)
  • FRCP (Dublin)
  • FRCR (London)
  • FCIRSE (Europe)
  • EBIR (Europe)
  • MBA (Birmingham)

His training includes comprehensive programmes in Radiology and Interventional Radiology in the UK and Canada, equipping him with the skills to manage even the most complex procedures.

Read Full Bio

Reach Out To Us

We are committed to providing a one-stop experience, where you’ll receive a meticulous consultation and high-quality service in a comfortable environment.

Get Started

Book An Appointment





    image

    • Book An Appointment

    • Media Enquiry

    • Partnership Opportunity



    image

    For faster response, Call Us

    (65) 6733 3383



    Our clinics are under the following

    insurance panels

    For Singaporeans, Singapore Permanent Residents and Foreigners.
    Please speak to our friendly clinic staff about using your insurance plans.

    Varicose Veins

    Frequently Asked
    Questions

    How long does recovery take after sclerotherapy?

    Most patients resume normal activities immediately after sclerotherapy treatment. Walking is encouraged right away to promote circulation, though strenuous exercise should be avoided for 1-2 weeks. The treated veins gradually fade over 3-6 weeks as the body reabsorbs them, with complete results visible after several months.

    Will varicose veins return after treatment?

    While treatment effectively addresses existing varicose veins, it cannot prevent new ones from developing. Patients may develop new varicose veins over time due to underlying venous predisposition. Following post-procedure guidelines and maintaining preventive measures reduces this likelihood.

    What happens if varicose veins remain untreated?

    Untreated varicose veins may lead to complications over time. These include skin changes like dermatitis and discolouration, superficial thrombophlebitis (vein inflammation with clotting), bleeding from thin-skinned areas over veins, and in severe cases, venous ulcers that can be difficult to heal.