Varicose veins and their management

Varicose veins are a common condition, affecting up to a quarter of the UK population. They have been shown to negatively impact on patients' quality of life and are an important cause of morbidity. The management of varicose veins may be conservative (including lifestyle changes and compression hosiery) or surgical. Operative treatment aims to disconnect the superficial and deep venous systems at the sites of venous incompetence; traditionally saphenofemoral and saphenopopliteal junction ligation with or without stripping were the mainstay of treatment. In the last decade surgical treatment has been moving towards minimally invasive endovascular techniques, including thermal ablation (by means of radiofrequency, laser technology, steam), cryoablation and mechanochemical ablation. These are less invasive than open surgery and may be done under local anaesthesia.This article discusses the epidemiology, diagnosis and management of varicose veins, including the latest endovascular and targeted open surgical techniques such as haemodynamic surgery and variceal ablation.