Leg varicose veins are enlarged, tortuous superficial veins. For some people they are mainly a cosmetic concern; for others they may be associated with heaviness, pain, swelling, itching, cramps or skin changes. At Centro Medico Gargano in Naples, care begins with a clinical assessment and, when indicated, venous colour duplex ultrasound to understand how the circulation is functioning and choose treatment proportionate to the findings.
What symptoms can be associated with varicose veins?
Varicose veins do not cause the same problems for everyone. The most commonly reported symptoms include:
- heavy or tired legs;
- pain, tightness or burning along the course of the veins;
- swelling, especially towards the evening;
- itching or night cramps;
- skin changes, pigmentation or eczema in some advanced cases.
A visible vein alone does not establish how serious the problem is. Equally, swollen or painful legs may have non-venous causes. Diagnosis and treatment should therefore not be based on appearance alone.
Why diagnosis comes before treatment
Assessment includes taking a medical history and performing a clinical examination. When primary or recurrent varicose veins are suspected and treatment needs to be planned, colour duplex ultrasound examines the superficial and deep venous systems, confirms any reflux and defines its extent.
The examination helps distinguish, for example, an isolated tributary vein from saphenous insufficiency or a condition requiring further investigation. This avoids offering the same procedure to patients with different blood-flow abnormalities.
When to request a specialist assessment
An assessment is advisable for symptomatic or recurrent varicose veins, persistent swelling, pain, heaviness, itching, skin changes, hard and painful veins, or a leg wound that does not heal. Venous ulcers, whether healed or active, require specific assessment.
Bleeding from a varicose vein requires prompt assessment. A vein that suddenly becomes red, hard and painful may also indicate superficial vein thrombosis and should not be managed with home remedies alone.
Which treatments may be considered?
Treatment depends on the symptoms, venous anatomy, presence and distribution of reflux, and the person’s individual characteristics. Options include:
- monitoring and lifestyle advice when a procedure is not required;
- compression therapy when clinically appropriate;
- sclerotherapy for selected reticular veins, varicose veins or thread veins;
- endovenous treatment of the saphenous vein when indicated;
- ambulatory phlebectomy for certain varicose tributaries;
- surgical assessment when minimally invasive alternatives are unsuitable.
The availability of a technique does not automatically make it the best choice. Indications, expected benefits, limitations, possible side effects and alternatives should be discussed before proceeding.
Your care at Centro Medico Gargano
The assessment is carried out by Dr Ciro Gargano, a medical doctor and specialist in diagnostic radiology practising in angiology and phlebology. Clinical expertise is combined with ultrasound when needed to relate symptoms to the actual anatomy and function of the venous system.
After assessment, the options suitable for your case are explained. Monitoring may be sufficient for some patients, while others may require a single procedure or a course of several sessions.
Results, limitations and follow-up
No treatment can guarantee that new varicose veins will not develop in the future. It is important to distinguish the result in the treated vein from possible progression of venous disease elsewhere. Clinical and ultrasound follow-up is planned according to the procedure performed and the patient’s characteristics.
Frequently asked questions
Are varicose veins only a cosmetic problem?
No. They may cause no symptoms, but in some people they are associated with pain, swelling, itching, skin changes, thrombophlebitis, bleeding or ulcers. Assessment helps distinguish a cosmetic concern from a functional problem.
Is colour duplex ultrasound always necessary?
The need for the examination is determined by the clinical findings. It is central to confirming a diagnosis, investigating suspected reflux or planning treatment for primary or recurrent varicose veins.
Is surgery always necessary?
No. Conservative treatment, sclerotherapy, endovenous procedures and surgery are all options. The choice depends on the clinical indication and cannot be made appropriately without assessing the individual case.
Do compression stockings eliminate varicose veins?
No. Compression may help control symptoms or be indicated in specific situations, but it does not eliminate existing varicose veins. The style and compression class must be chosen appropriately.
Are treatment results permanent?
The treated vein may maintain a good result, but a predisposition to venous disease can lead to new varicose veins over time. It would therefore be misleading to promise that recurrence is impossible.
Further reading and sources
For independent information, see the NICE recommendations on the diagnosis and management of varicose veins. General guidance does not replace individual clinical assessment.
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