Varicose Veins

Varicose veins are dilated, tortuous superficial veins, usually in the legs, caused by failure of the one-way valves that normally keep blood moving toward the heart. Risk rises with age, family history, pregnancy, prolonged standing occupations and higher body weight, and they affect a substantial proportion of adults. Many are a cosmetic concern only. Others progress along a recognised path of chronic venous insufficiency: aching and swelling, then skin changes around the ankle including brown pigmentation and hardening, and eventually venous ulceration in a minority - which is the reason for taking skin changes seriously rather than waiting. The honest framing on treatment is that existing varicose veins do not reverse. Endovenous thermal ablation, foam sclerotherapy and surgery close or remove the refluxing vein and are the only options that eliminate them. Everything else - graduated compression stockings at 20-30 mmHg, walking, elevation, weight management, avoiding prolonged motionless standing - manages symptoms and slows progression, which is still worthwhile. Supplements sit firmly in the symptomatic category: horse chestnut seed extract standardised to escin has good evidence for leg pain and oedema, and flavonoid preparations such as micronised diosmin have supporting data. Neither changes the vein itself.