Varicose veins (varices) – an overview

Varicose veins are a common reason for seeing a surgeon in Denmark, and the course differs from person to person. This page gives you the overview: what varicose veins are, which symptoms they can cause, why they appear, how we examine them and which options exist. From here you can go straight to the page that answers your own question.

Our clinic is in Charlottenlund, just north of Copenhagen. We treat patients referred by their GP as well as self-paying patients. The clinic holds a provider number under the Danish public health insurance and receives referred patients for services covered by the current agreement; whether a specific service is covered is clarified before the course of treatment.

Find what you are looking for

• Symptoms of varicose veins — heaviness, swelling, itching and skin changes
• Causes of varicose veins — heredity, pregnancy, age and other factors
• Treatment of varicose veins — methods, pathway and what to expect
• Laser treatment (EVLT) — endovenous laser step by step
• Price and referral — coverage, referral and self-pay prices
• Compression stockings — compression, classes and individual assessment
• Thread veins — fine skin vessels that are not varicose veins
• Venous insufficiency — the underlying vein disease

What are varicose veins?

Varicose veins, or varices, are veins in the legs that have become widened and twisted. You can often see them as bluish cords under the skin. Behind the visible change lies a mechanical fault: the small valves inside the vein, which normally push blood up toward the heart, no longer close properly. Blood flows the wrong way, pools in the leg and stretches the vein wall. The medical term is venous insufficiency.

Varicose veins are not the same as thread veins, the fine red and purple webs of tiny vessels in the skin. The two can appear together and partly share the same cause, but they are assessed and treated differently.

What are the symptoms of varicose veins?

Some people have no symptoms at all and only notice the veins because they can be seen. Others experience heaviness, aching, itching or swelling, often toward the end of the day or after long hours standing. These symptoms are nonspecific and can have explanations other than the veins:

• Heaviness and tiredness in the legs
• Swelling around the ankles
• Itching or burning over the vein
• Night cramps or restless legs
• Skin discolouration at the ankle in long-standing disease
• Venous ulcers or venous eczema in long-standing disease

The pattern is interpreted together with your history, the clinical examination and the duplex scan. Read more about signs of varicose veins.

Are varicose veins dangerous?

Uncomplicated varicose veins are usually not dangerous, and they do not need treatment simply because they are visible. Assessment and possible treatment may be relevant for troublesome symptoms, skin changes, a venous leg ulcer, bleeding from a vein or suspected superficial venous thrombosis. The decision rests on the clinical examination together with the duplex findings and your own goals. Are varicose veins dangerous? covers the risks in more detail, including venous ulcers and superficial phlebitis.

Treatment can relieve symptoms and treat documented venous reflux. The course varies, and treatment cannot guarantee symptom relief, that the condition will not progress, or that new varicose veins will not appear.

When should you seek help?

Contact your GP or call us if you have:

• Pain, swelling or heaviness that affects daily life
• Skin changes, brown discolouration or eczema at the ankle
• A developing or open sore near the ankle
• A tender, red and warm vein (this can be superficial phlebitis)

Seek urgent help for sudden swelling of one whole leg, which can be a deep-vein blood clot, and for significant bleeding from a vein: lie down, elevate the leg and press directly on the site. For breathlessness or chest pain, contact the acute medical helpline immediately (1813 in the Capital Region, otherwise your local out-of-hours service), and call 112 for severe breathlessness or chest pain.

Why do varicose veins develop?

Heredity is a clear factor. If your parents had varicose veins your own risk is higher, though it does not mean you will get them. Beyond genes, the condition is more common with:

• Pregnancy, especially repeated pregnancies
• Increasing age
• Overweight
• Standing or sedentary work with little movement
• A previous deep-vein blood clot (post-thrombotic syndrome)
• Hormonal influence (contraceptive pill, hormone replacement)

The full background is in our article on causes of varicose veins.

How is the diagnosis made?

Every course of care starts with a consultation and a duplex ultrasound scan of the leg. Pressure from the probe can be felt, but the scan is not usually associated with significant pain. The reflux assessment is performed standing when practically possible, and the findings are interpreted together with your history and the clinical examination. We map which veins are leaking, where the valves have failed, the diameter of the affected veins and whether the deep veins are working normally.

The result helps decide which method suits your legs. Two patients with the same visible veins can need two different treatments. Duplex ultrasound is the recommended first-line examination for venous insufficiency in both European and American guidelines (ESVS 2022; SVS/AVF/AVLS 2022).

Which treatments exist?

Care at the clinic is minimally invasive and performed under local anaesthesia. Which methods are relevant for you, and whether they are carried out in one or more sessions, is agreed with you based on the findings, your symptoms and your goals (ESVS 2022, recommendation 48 on shared decision-making). In brief:

• Endovenous laser ablation (EVLT) — a thin laser fibre closes the affected trunk vein from the inside.
• Classic varicose-vein surgery — the diseased vein is removed through small incisions when endovenous treatment is not technically possible.
• Microphlebectomy — visible, winding branches removed through 1-2 mm punctures. See removal of varicose veins.
• Foam sclerotherapy — a medical foam closes smaller veins and residual branches.
• Compression stockings — not a cure, but they can ease symptoms in some people. Class and duration are assessed individually.

The full picture of the pathway and the choice of method is on treatment of varicose veins, and the laser pathway itself on laser treatment (EVLT).

Price, referral and coverage

The clinic holds a provider number under the Danish public health insurance and receives referred patients for services covered by the current agreement; whether a specific service is covered is clarified before the course of treatment. As a self-paying patient you can attend an initial assessment without a referral, and the clinic confirms in writing what the price covers and whether additional services may apply before you accept. Current prices and terms are gathered on the page about the price of varicose vein treatment.

What happens after treatment?

A slightly sore leg after a procedure is common, and how long it lasts differs from person to person. You may walk straight away, and walking activates the calf muscle pump. Whether a compression stocking is needed afterwards, and for how long, is decided individually (ESVS 2022, recommendation 24) and is stated in the instruction you take home, along with advice on showering, exercise and pain relief. Whether and when a check-up with a new duplex scan is needed is also agreed individually. The details are on treatment of varicose veins.

Can you do anything yourself?

An inherited tendency cannot be changed, and there is no evidence that varicose veins can be reliably prevented. The following is generally sensible and may ease symptoms for some people:

• Move every day. Walking, cycling and swimming activate the calf muscle pump.
• Elevate your legs when you have the chance during the day.
• Compression stockings may relieve symptoms for some people during long periods of sitting, long journeys or standing work. Whether this is relevant for you, and in what class, is assessed individually.
• Keep a healthy weight where weight is a factor for you.

These measures can also ease symptoms for patients who are waiting for treatment or who prefer not to have a procedure.

Contact the clinic

Want your legs checked? You are welcome to call us during phone hours or send an email. The current waiting time for non-urgent patients with no suspicion of cancer is approximately 6-8 weeks. Waiting times can vary.