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Varicose Veins: Causes, Symptoms & When to See a Vascular Surgeon in Pakistan

  • Prof. Dr. Zahid Mahmood
  • July 25, 2026

Introduction

Do your legs feel heavy and achy by the end of the day? Do you notice twisted, bulging blue or purple veins on your calves or thighs? You are not alone. Varicose veins are one of the most common vascular problems seen in clinical practice, especially among people who stand for long hours, women who have had multiple pregnancies, and those with a family history of vein disease.

While many people consider varicose veins a purely cosmetic issue, untreated vein disease can progress to pain, swelling, skin changes, and in some cases, leg ulcers. Fortunately, modern varicose veins treatment in Pakistan ranges from simple lifestyle measures to minimally invasive procedures with quick recovery.

This guide explains what causes varicose veins, how to recognize the warning signs, when to see a vascular surgeon, and what treatment options are available.

Prof Zahid Mahmood, General and Colorectal Surgeon in Lahore, in scrubs
Prof. Dr. Zahid Mahmood — General, Laparoscopic & Laser Surgeon

What Are Varicose Veins?

Veins carry blood back to the heart using a system of one-way valves. When these valves become weak or damaged, blood does not flow efficiently upward and instead pools inside the vein. Over time, the affected vein stretches, twists, and becomes visible under the skin as a varicose vein.

Common Symptoms

  • Visible, twisted, bulging blue or purple veins
  • Aching, heaviness, or throbbing in the legs
  • Swelling around the ankles, especially by evening
  • Itching or skin discoloration near the veins
  • Muscle cramps, especially at night
  • A burning or tingling sensation along the vein

Symptoms typically worsen after long periods of standing and improve when the legs are raised.

What Causes Varicose Veins?

Varicose veins develop when the valves inside the superficial leg veins fail, allowing blood to flow backward and pool instead of returning to the heart. This increased pressure gradually weakens and enlarges the vein wall.

Risk Factors for Varicose Veins

  • Prolonged standing or sitting (common in teachers, surgeons, drivers, and factory workers)
  • Pregnancy, especially multiple pregnancies
  • Family history of varicose veins
  • Increasing age
  • Obesity
  • Previous deep vein thrombosis (DVT)

When to See a Vascular Surgeon

Mild varicose veins with no symptoms are often just a cosmetic concern and can be monitored. However, certain signs mean it is time to book a consultation rather than wait.

Warning Signs You Should Not Ignore

  • Skin changes near the ankle — darkening, hardening, or eczema
  • A leg ulcer or sore that has not healed within two weeks
  • Bleeding from a varicose vein
  • A tender, red, cord-like vein (thrombophlebitis)
  • Sudden swelling or pain, which can occasionally signal a blood clot

An early evaluation can prevent complications and often means simpler, less invasive treatment.

How Are Varicose Veins Diagnosed?

Diagnosis usually begins with a clinical examination of the legs while standing, to assess the pattern and extent of the affected veins. A venous duplex ultrasound is the standard test used to confirm valve incompetence, map the affected veins, and rule out deep vein thrombosis before planning treatment.

Varicose Veins Treatment Options in Pakistan

Treatment has moved far beyond traditional vein stripping. The right option depends on the size and severity of the veins, symptoms, and overall health.

Lifestyle and Conservative Management

  • Compression stockings to support circulation
  • Regular walking and leg elevation
  • Avoiding prolonged standing where possible
  • Maintaining a healthy weight

These measures help manage mild symptoms but do not reverse existing varicose veins.

Sclerotherapy

A special solution is injected into smaller varicose or spider veins, causing them to collapse and fade over time. This is done in clinic with no downtime.

Endovenous Laser Treatment (EVLT)

A thin catheter is inserted into the affected vein under local anaesthesia, and laser energy seals it shut. It is minimally invasive, has a high success rate, and most patients walk out the same day.

Radiofrequency Ablation (RFA)

Similar to laser treatment, RFA uses heat generated by radiofrequency energy to close the diseased vein, with less discomfort and a quick return to daily activities.

Surgical Vein Removal

Larger or more complex veins that are not suitable for minimally invasive techniques may still require surgical removal (vein stripping or ambulatory phlebectomy), performed as a day case.

Can Varicose Veins Be Prevented?

Varicose veins cannot always be prevented, particularly when genetics are involved, but the following habits reduce risk and slow progression:

  • Stay active and avoid long periods of standing or sitting without breaks
  • Elevate your legs when resting
  • Maintain a healthy body weight
  • Wear compression stockings during pregnancy or long travel

Conclusion

Varicose veins are common, often manageable with simple measures, and highly treatable when they progress. Ignoring symptoms rarely helps — an early evaluation can prevent complications such as skin ulcers or clots later on.

If your legs are giving you trouble, do not wait for it to get worse. Book a consultation with Prof. Dr. Zahid Mahmood to discuss which treatment is right for you.

FAQs

1. What is the main cause of varicose veins?

Varicose veins are mainly caused by weak or damaged vein valves, which allow blood to pool in the legs instead of flowing back to the heart. Prolonged standing, pregnancy, age, and family history increase the risk.

2. Are varicose veins dangerous?

Most varicose veins are not dangerous and are primarily a cosmetic or comfort issue. However, untreated cases can occasionally lead to skin changes, ulcers, bleeding, or clot formation, so persistent symptoms should be assessed.

3. When should I see a vascular surgeon for varicose veins?

See a vascular surgeon if you notice skin discoloration or hardening, a non-healing ulcer, bleeding from a vein, a tender red vein, or sudden leg swelling.

4. What is the best treatment for varicose veins?

Treatment depends on vein size and severity. Options include compression stockings, sclerotherapy, endovenous laser treatment, radiofrequency ablation, and surgical removal for larger veins.

5. Can varicose veins come back after treatment?

Recurrence is possible, particularly if risk factors like prolonged standing or obesity persist, but modern minimally invasive treatments have high long-term success rates.

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