Varicose Veins Are Not Just Cosmetic
Varicose veins are not always just a cosmetic concern. Bulging veins can be a sign that the one-way valves in the leg veins are not working effectively. For some people, this is associated with aching, heaviness or swelling; others notice changes to the skin around the ankle.
In this video, I explain how the leg veins return blood to the heart, what happens when their valves fail and why an ultrasound assessment can be useful. The starting point is understanding your symptoms: not all varicose veins need treatment.
How do the veins in your legs work?
Arteries carry blood away from the heart, while veins return it. In the legs, returning blood has to move upwards against gravity. When you walk, your calf muscles squeeze the veins and help push blood towards the heart. A series of one-way valves helps prevent it from flowing backwards.
This differs from the arterial problem described in my previous video about leg pain when walking and claudication. Both affect circulation, but the underlying problem and the assessment are different.
What is venous reflux?
Venous reflux means that blood flows backwards through veins whose valves are not closing properly. This can increase pressure in the veins, particularly when you are standing. Superficial veins may become enlarged and twisted, producing the visible bulges we call varicose veins.
The appearance alone does not tell us how much reflux is present or whether treatment would help. I consider the symptoms, skin changes and ultrasound findings together when assessing varicose veins and venous disease.
Which symptoms deserve a closer look?
Symptoms and changes associated with venous disease can include:
Heaviness or aching: legs that feel uncomfortable, especially after prolonged standing.
Swelling: often noticeable around the ankle or lower leg.
Bulging veins: enlarged veins visible beneath the skin.
Skin changes: brownish discolouration, itching or eczema around the lower leg.
Ulceration: a break in the skin that may be slow to heal in more advanced disease.
These findings are reasons to seek an assessment, rather than assume the problem is only cosmetic. They can also have other causes, so symptoms or photographs alone cannot confirm venous reflux.
What does a duplex ultrasound show?
A venous duplex ultrasound is a non-invasive scan that uses sound waves to examine the veins and the direction of blood flow. It can identify reflux and help map which veins are affected. This information supports the diagnosis and, where appropriate, treatment planning.
During the consultation, I would also ask when your symptoms started, what makes them worse and whether you have had previous vein treatment or blood clots. The examination and scan findings help determine the next step.
Do all varicose veins require treatment?
No. Mild or symptom-free varicose veins may need advice and observation. If symptoms affect daily life, or there are skin changes or ulcers, treatment options can be discussed in more detail.
Depending on the findings, management may include suitable activity, leg elevation, appropriately prescribed compression or a procedure to treat refluxing veins. Compression can help selected symptoms, but it does not repair faulty valves and should be chosen with your circulation and other health conditions in mind. Treatment is individual; a visible vein does not automatically mean an operation is necessary.
When is leg swelling more urgent?
Longstanding venous symptoms are different from new swelling in one leg, particularly with pain, warmth or tenderness. This needs urgent medical assessment for possible deep vein thrombosis (DVT). Do not assume a sudden change is simply your usual varicose veins.
Sudden breathlessness, chest pain or fainting requires emergency care. In Singapore, call 995 for a life-threatening emergency rather than waiting for a clinic appointment.
Varicose vein assessment in Singapore
If aching, swelling or skin changes sound familiar, contact Andrew Choong Vascular Surgery to discuss an assessment at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563.
This article provides general education and does not replace an individual medical assessment.