Varicose veins are enlarged, twisted veins that appear when the one-way valves inside leg veins stop closing properly, allowing blood to pool. They affect around 20 to 30% of adults, are more common in women, and are largely driven by genetics, standing occupations, pregnancy and age. Modern treatment is minimally invasive — laser or radiofrequency ablation, foam sclerotherapy or medical adhesive — and most people walk out the same day.
Key facts
- The cause is valve failure, not “bad circulation” in a general sense. Blood flows backwards and pools under gravity.
- Genetics is the strongest single risk factor. If both parents had them, your risk is high regardless of lifestyle.
- Spider veins are not varicose veins. They are smaller surface vessels, usually cosmetic, treated differently.
- Compression stockings manage symptoms but do not cure. They slow progression and reduce aching; they do not repair a failed valve.
- Vein stripping is largely obsolete. Thermal ablation and adhesive closure have replaced it in most cases, with faster recovery and less pain.
- Left untreated, a minority progress to skin discolouration, eczema and venous ulcers, which are far harder to treat than the veins were.
What causes varicose veins?
Leg veins carry blood upward against gravity. They rely on one-way valves and on the pumping action of calf muscles. When a valve leaks, blood refluxes downward and pools in the vein below, stretching it. The stretched vein makes the next valve down fail too. It is a cascade, which is why varicose veins tend to worsen slowly rather than suddenly.
Risk factors that matter:
- Family history — the dominant factor
- Female sex — hormonal effects on vein wall elasticity
- Pregnancy — increased blood volume plus pressure from the uterus; veins often improve after delivery but not always
- Prolonged standing or sitting — teachers, surgeons, retail staff, hospitality workers, long-haul travel
- Age — valves degrade over decades
- Obesity — increased abdominal pressure
- Previous DVT — damaged deep veins push load onto surface veins
What are the symptoms?
Visible bulging veins are the obvious sign, but symptoms often arrive first:
- Aching or heaviness in the legs, worse at the end of the day
- Swelling around the ankles
- Night cramps
- Itching over the vein
- Restless legs
- Skin changes: brown staining around the ankle, dry or eczematous patches
- Legs that feel better when elevated and worse after standing
The pattern is diagnostic. Venous pain is worse with standing and better with elevation. Arterial pain is the opposite.
When are varicose veins more than cosmetic?
Escalate to a vascular assessment if you have:
- Skin discolouration — brown pigmentation around the ankle signals chronic venous hypertension
- Venous eczema — dry, itchy, inflamed skin over the vein
- Lipodermatosclerosis — hard, tight, narrowed skin above the ankle
- An ulcer — a break in the skin near the ankle that will not heal
- Bleeding from a vein — thin overlying skin can rupture and bleed briskly
- Superficial thrombophlebitis — a hard, hot, red, tender cord along the vein
A hot, swollen, painful calf with no visible varicosity is a different problem. That is a possible deep vein thrombosis and needs same-day assessment.
How is it diagnosed?
A duplex ultrasound scan is the standard. It is painless, takes 20 to 30 minutes, and does two things: maps which veins are refluxing, and confirms the deep veins are patent. No treatment decision should be made without it, because treating surface veins when the deep system is blocked can make things worse.
What treatments are available?
Conservative management. Graduated compression stockings, leg elevation, calf exercise, weight management. Reduces symptoms, does not reverse the disease. Reasonable first step, and required by many insurers before they approve intervention.
Endovenous laser ablation (EVLA) / radiofrequency ablation (RFA). A thin catheter is passed into the faulty vein under ultrasound guidance and heat seals it closed. Local anaesthetic, day case, walking immediately, back to desk work within a day or two. Closure rates above 90% at five years. This is the current standard of care.
Cyanoacrylate adhesive closure. A medical glue seals the vein. No heat, so no tumescent anaesthesia needed, and no compression stockings required afterwards in many protocols. Slightly newer, similar results.
Foam sclerotherapy. A foamed sclerosant is injected to collapse the vein. Useful for tributaries, recurrence and smaller veins. Often used alongside ablation rather than instead of it.
Ambulatory phlebectomy. Bulging surface veins are removed through tiny punctures, usually at the same session as ablation. Leaves almost no scarring.
Surgical stripping. Now reserved for specific anatomical situations. More pain, longer recovery, higher recurrence than the alternatives.
What does recovery look like?
Most people are walking within minutes and back to office work within 24 to 48 hours. Expect some bruising and tightness along the treated vein for two to three weeks. Compression stockings for one to two weeks are typical after thermal ablation. Avoid heavy gym work and long flights for around two weeks. Walking is actively encouraged from day one.
Cosmetic improvement is gradual. The bruising fades before the result appears, so the leg often looks worse at week two than it did before treatment. This is expected.
Can varicose veins come back?
Yes. Treatment closes the veins you have; it does not change the genetics that produced them. Around 20 to 30% of people develop new varicosities over five to ten years, often in different veins. Recurrence is usually treatable with sclerotherapy rather than repeat ablation. Compression during long flights, staying active and weight control all reduce the rate.
What actually helps day to day
Walk. Calf muscle contraction is the pump that empties leg veins, and it is more effective than anything you can buy. Elevate legs above heart level for 15 minutes a few times daily. Wear compression on long flights, which matter in the UAE where long-haul travel is routine. Avoid prolonged motionless standing; shift weight, flex your calves. Manage weight. None of this reverses existing varicose veins, but all of it slows what comes next.
Frequently asked questions
Are varicose veins dangerous? Most are not, but they are progressive. A minority develop complications: skin discolouration, venous eczema, bleeding from thin overlying skin, superficial thrombophlebitis, and venous leg ulcers. Skin changes around the ankle are the signal to get assessed rather than to keep waiting.
What is the difference between spider veins and varicose veins? Spider veins are tiny surface vessels, red or blue, flat, usually under 1mm, and generally cosmetic. Varicose veins are larger than 3mm, bulge above the skin, and reflect failure of the underlying vein valves. Spider veins are treated with sclerotherapy or laser; varicose veins usually need the feeding vein closed first.
Do compression stockings cure varicose veins? No. They reduce aching, swelling and heaviness, and slow progression, but they cannot repair a failed valve. They are useful for symptom control, during pregnancy, on long flights, and while awaiting treatment. Many insurers require a documented trial of compression before approving intervention.
How long does varicose vein treatment take to recover from? Most people walk out the same day and return to desk work within one to two days. Bruising and tightness along the vein last two to three weeks. Compression stockings are usually worn for one to two weeks. Cosmetic results become visible over one to three months.
Will varicose veins come back after treatment? New varicose veins develop in roughly 20 to 30% of people over five to ten years, because the underlying tendency remains. Recurrence is usually milder and treatable with sclerotherapy. Staying active, using compression on long flights and maintaining a healthy weight reduce the risk.
Does insurance in the UAE cover varicose vein treatment? Coverage depends on whether treatment is deemed medically necessary rather than cosmetic. Documented symptoms, skin changes, a duplex ultrasound showing reflux and a trial of compression usually support approval. Purely cosmetic spider vein treatment is generally excluded. Check your policy and request pre-approval.
Can I prevent varicose veins? You cannot change genetics, but you can reduce risk and slow progression: regular walking, avoiding prolonged standing without movement, maintaining a healthy weight, elevating legs when resting, and wearing compression during pregnancy and long flights.
Ready to take the next step? Book an appointment at Thumbay University Hospital today to consult with our expert Consultant Vascular Surgeon.
