Varicose Veins

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What are varicose veins?

Varicose veins are abnormal, dilated blood vessels caused by a weakening in the vessel wall. Your veins carry blood back to the heart. In your leg, this means the blood has to flow upward, against gravity. Consequently, these veins have one-way valves to prevent the blood from back flowing. Over time these valves can fail to close tightly allowing blood to pool and causing the bulging and twisting characteristic of varicose veins.

What causes varicose veins?

High blood pressure inside your superficial leg veins causes varicose veins. Factors that can increase your risk for varicose veins include having a family history of varicose veins, being overweight, not exercising enough, smoking, standing or sitting for long periods of time, and having a history of Deep Vein Thrombosis (DVT). Women are more likely than men to develop varicose veins. Varicose veins usually affect people between the ages of 30 and 70.

Pregnant women have an increased risk of developing varicose veins, but the veins often return to normal within 1 year after childbirth. Women who have multiple pregnancies may develop permanent varicose veins.

What are the symptoms of varicose veins?

Some people do not have symptoms but may be concerned about the appearance of the veins. If symptoms occur, they may include:

  • Swollen legs
  • Muscle cramps, soreness or aching in the legs
  • Tiredness, burning, throbbing, tingling or heaviness in the legs
  • Soreness behind the knee
  • Itching around the vein
  • Brown discoloration of the skin, especially around the ankles

Symptoms often worsen after prolonged standing or sitting. In women, symptoms may be worse during menstruation or pregnancy. Sometimes the condition leads to more serious problems, such as, a painful blood clot, referred to as superficial phlebitis (inflammation of a vein), or skin ulcers.

How are varicose veins diagnosed?

During a physical exam, the doctor will check your legs while you are standing. You will also need to attend the vascular lab for a non-invasive duplex ultrasound scan to check the blood flow in the superficial veins (near the skin's surface) and deep veins.



You can browse some of the videos of procedures that have been carried out by Mr. Sultan at the links below:


  1. Mwaura B, Hynes N, Connolly CE, Sultan S. The impact of differential expression of extracellular matrix metalloproteinase inducer, matrix metalloproteinase-2, tissue inhibitor of matrix metalloproteinase-2 and PDGF-AA on the chronicity of venous leg ulcers. Eur J Vasc Endovasc Surg. 2006 Mar; 31(3):306-10. PMID: 16169261
  2. Hoary M, Sultan S. Advances in Ablation of the greater saphenous vein in the 21st Century: Development of an Endovenous Upward Perforate Invaginate (EUPIN) stripping device and procedure based on best medical practice. Vascular 2008 16 (2) S103
  3. Hynes N, Sultan S. Comparison of Endovenous Upward Perforate Invaginate Stripping (EUPIS), Downward Invaginate (DIS) and High-energy Endovenous LASER ablation (HE-EVLA) for Varicose Veins: Factors Influencing Complication Rate, Long-term Recurrence, Quality of Life and Cost-effectiveness. Vascular 2008 16 (2) S154-155:
  4. Tawfick W, Sultan S. Early Results of Topical Wound Oxygen (TWO2) Therapy in the Management of Refractory Non-Healing venous Ulcers (RVU); superior Role over Conventional Compression Dressings (CCD) Vascular 2008 16 (2) S156-157:
  5. Hynes N, Sultan S. The down slope of endovenous laser therapy for primary varicose veins. Technology is still lacking. J Cardiovasc Surg (Torino). 2007 Jun;48(3):S1;50