Why venous valves gradually weaken, how to notice the problem in time and why modern treatment is no longer a major operation.
How a healthy vein works
Veins carry blood from the legs up to the heart against gravity. To keep blood from flowing back, there are tiny valves inside the veins: they open, allowing blood to flow upwards, and close, preventing it from returning. When walking, the leg muscles work as a pump, pushing the blood further. As long as this system is coordinated, the legs feel light.
What goes wrong with varicose veins
Over time, vein walls and valves lose elasticity. A valve may no longer close fully, allowing blood to flow backwards — known as reflux — and pool lower in the leg. Pressure rises, the vein stretches and its wall thins, producing visible bulging, twisted veins. The process is gradual, so early signs are often overlooked for years.
Why does it not go away by itself?
A stretched vein will not return to normal by itself, and abnormal blood flow places more strain on neighbouring veins. Without treatment, the condition usually progresses: more veins become affected and symptoms become more noticeable.
Risk factors
Varicose veins rarely have a single cause, usually it is a combination of several factors:
- Heredity. If the parents had varicose veins, the risk is significantly higher, the weakness of the venous wall is inherited.
- Work "on your feet" or sitting. Prolonged standing or sitting impairs blood flow.
- Pregnancy. Hormones and increased blood volume add to the load on the veins.
- Age. Over the years, vein tissue naturally loses its elasticity.
- Excess weight. Increases pressure in leg veins.
Symptoms to look out for
Varicose veins often begin not with veins, but with sensations. The most typical early signs:
- Heaviness and fatigue in the legs, increasing towards the evening.
- Swelling of lower legs and ankles, traces of socks.
- Night cramps in the calves, itching of the skin over the veins.
- Later, visible bulging veins and varicosities.
If several of these symptoms sound familiar, see a phlebologist even if no veins are bulging yet.
How it is diagnosed
A visual examination is not enough: the doctor needs to see how the valves work and where blood is pooling. Duplex ultrasound provides a map of venous flow and reflux. Treatment is selected from this scan because each person's vein anatomy differs.
How varicose veins are treated today
Open surgery with incisions and general anaesthesia is no longer the only option. Modern phlebology uses minimally invasive treatments that close the affected vein from within through a needle puncture, under local anaesthesia. Main options include:
- Endovenous laser ablation (EVLA), using a 1470 nm laser to close the vein.
- Radiofrequency ablation (RFA), using controlled heat delivered by Medtronic equipment.
- VenaSeal medical adhesive closure, which does not use heat and often does not require compression stockings afterwards.
- Sclerotherapy for spider veins and small tributary veins.
After these procedures, patients usually go home the same day and return to their normal routine quickly.
Outlook
The earlier varicose veins are identified, the simpler and more comfortable treatment is likely to be. Advanced disease can lead to thrombophlebitis and venous leg ulcers, which are harder to treat. Have your veins checked when the first signs appear rather than waiting for complications.