I'm Professor Bruce Campbell and I'm a vascular surgeon in Exeter.
I deal with arteries and veins,
but I've always had a particular interest in varicose veins
because they're perhaps the commonest condition any vascular surgeon sees
and they cause people a lot of worry.
How common are varicose veins?
Well, the answer is they're very common.
About one in three people have them by the time they reach retiring age,
many people much younger.
Do they cause harm or damage? Hardly ever.
Most people with varicose veins
have no medical problems from them throughout their lives.
What are varicose veins?
They're the enlarged tortuous veins that you can see in many people's legs.
These enlarged veins contain valves
which ought only to let the blood flow upwards,
but when the veins become enlarged
the valves stop working properly, so blood can flow downwards.
And that means that all the time you're standing or your foot's on the ground,
there's a head of pressure on the varicose veins further down.
That causes them to bulge,
it can cause them to ache, to itch,
the leg can feel heavy, it can throb,
and those are the typical symptoms that people get from varicose veins.
Do they ever cause more serious problems?
Well, just occasionally.
In some people, the head of pressure in the veins
can gradually cause damage to the skin at the ankle,
and that usually shows up first with skin rashes like eczema,
so-called varicose eczema,
and if that's neglected eventually the area can deteriorate,
so if it's damaged the patient then gets an ulcer that can be chronic.
Many people are worried about getting varicose ulcers
but they are very uncommon among all the people who have varicose veins.
The likelihood of getting one is small
and if a person's going to get one, they usually have plenty of warning signs
that something is wrong with the skin at the ankle.
How can varicose veins be treated?
The first thing to say is that the vast majority of varicose veins
don't need to be treated from a medical point of view,
only if they're causing symptoms.
Symptoms can be relieved simply by wearing support hosiery,
support tights, support stockings,
even below-the-knee support stockings like flight socks.
If people have more severe symptoms,
then they may present to hospital for treatment.
There are two main forms of treatment that have been used over the years.
Injection treatment, sclerotherapy of varicose veins,
which in general works best for small varicose veins below the knee,
The commonest form of surgery deals with the long saphenous vein,
the vein passing up towards the groin.
The valves in that often become incompetent
and allow a head of pressure down that vein
onto the varicose veins further down. That's what causes symptoms.
In treating the long saphenous vein,
the traditional way to do that is an operation under a general anaesthetic
and remove it through a tiny incision at the knee.
That's called stripping the long saphenous vein.
Alternatives to stripping the long saphenous vein
have become popular recently.
Laser treatment or radiofrequency
are both ways of heating the inside of the long saphenous vein
and causing it to seal off.
Whether the long saphenous vein is stripped,
whether it's destroyed with laser or radiofrequency,
all of those are simply ways of getting rid of that vein.
Thereafter the varicose veins which can be seen need to be dealt with,
and that's most commonly done
by making tiny incisions over them and removing them.
There's one other relatively recent treatment
which is used for varicose veins, called foam sclerotherapy,
so that extensive veins and larger veins than before can be treated.
It does mean having the leg bandaged up for a week or two afterwards,
but that is a way of treating varicose veins
without the need for a full operation or a general anaesthetic.
In general, varicose vein treatments are very safe
and the chance of getting any serious problem after a varicose vein operation,
whether that's with standard surgery, laser or radiofrequency,
is very low.
Overall, varicose vein treatments are very seldom associated
with serious medical problems
and usually most patients recover quite quickly.