Varicose veins and telangiectasia (spider veins) are dilated, elongated, tortuous superficial leg veins – the visible sign of reverse venous flow (venous insufficiency). Mild disease is uncomfortable or cosmetic; severe disease can threaten life or limb.

Symptoms and signs

• Symptoms: leg heaviness, venous claudication, pain or tenderness along a vein, itching, burning, restless legs, oedema, skin changes, paraesthesia.

• Signs: ulceration, lipodermatosclerosis, interdigital fungal infection, eczema, micro-ulcers, stasis dermatitis, prominent varicose veins, scars from earlier surgery or sclerosant injections.

Investigations

• Doppler ultrasound; magnetic resonance venography.

Management

• Conservative: compression stockings and external compression; worsening skin findings or symptoms despite this usually need intervention.

• Procedures (vascular surgeon or interventional radiologist): sclerotherapy (most widely used), laser and intense pulsed light, radiofrequency or laser endovenous thermal ablation, cyanoacrylate closure (VenaSeal), ClariVein, Varithena.

• Surgery for large veins: saphenofemoral junction ligation with stripping; phlebectomy through micro-incisions.