Everyone over the age of 20 has heard of them, and every woman over the age of 30 is in fear of them. While some may despair of ever showing bare legs in fair weather again, modern techniques are proving increasingly effective in treating the unwanted road map of bumpy blood vessels known as varicose veins.
Veins become varicosed when their valves do not function properly. Circulation is then hindered, causing the blood vessel to stretch or cave in. The result is the swollen, cherry-like knots that commonly gnarl their way down the back of the leg, often accompanied by aches and pains, swelling, itching and a heavy feeling in the legs. Spider, or thread, veins, the purplish web-like lines that form on the legs, hands and face, also are formed by bloated or broken blood vessels close to the surface of the skin.
While they do not normally pose a serious health threat, varicose veins may cause ulceration, bleeding under the skin, blood clots or an eczema-like condition adjacent to the distended area.
More difficult to cope with are the emotional and psychological aspects of the condition. Patricia Molloy, the clinical director of Derma Laser Clinic in Blackrock, Co Dublin, notes that women are particularly embarrassed by them. "Some women will not wear anything but trousers because of their situation," she says. "They just won't expose their legs or even go on holidays. It's a huge problem with them, particularly young girls."
Sandra Magee, from Co Down, is one woman who struggled with the pain and physical limitations caused by varicose veins. Two years after a skiing accident when she was 16, a friend noticed a bulge on Magee's left leg. As the friend happened to be a nurse, Magee followed her advice to see a specialist, and eventually underwent a painful operation in hospital to strip the vein from her leg.
Now in her early 30s, Magee goes to the Derma Laser Clinic for regular preventive maintenance. An active hillwalker, she began to notice a little more than a year ago that blue veins were developing on her legs. Worried that they would become varicosed, she sought help through the National Health Service in Northern Ireland.
"A lot of specialists were not willing to treat me, because the veins were not bad enough," she says. "I had been through all the normal medical channels. I was in so much discomfort I didn't want to go mountain-walking. It put me off the inclination to exercise and I was even turning down social activities. I frantically looked for someone to treat it before it became varicosed."
Eventually she discovered the clinic in Blackrock, where Molloy confirmed what Magee already suspected: the return blood flow wasn't working. Two weeks later, she went in for laser treatment and noticed an immediate change.
"After three days, I had no throbbing sensation from climbing stairs," she says. "I can't say enough how surgery is not the answer. The operation was terribly intrusive. I would say to others, don't let it get so bad that it needs to be stripped."
Theories differ as to what induces varicose veins. The only recognised link is pregnancy, as the hormones produced during a term can cause vein walls to relax. Causes may include a lack of exercise, heredity, oral contraceptives, hormone replacement therapy, heart failure and obesity. About one in five women will get them, particularly if they have borne children. Men are about a third less likely to be afflicted than women.
While the veins usually crop up in people between the ages of 30 and 60, even teenagers may develop them.
Once symptoms appear, they will not improve on their own. Whether for cosmetic reasons or out of sheer physical discomfort, those who opt for medical treatment have three basic choices, although no method is a guaranteed success, and more veins may develop later.
A technique known as sclerotherapy involves injecting a chemical solution into the veins, causing them to close. In use since the 1930s, this procedure should cause varicose veins to fade over a period of several months. Side effects can include bruising, stinging, swelling or brown spots where the solution was injected. In most cases, symptoms disappear within a few minutes, but they may take as long as six months to heal - if at all.
Another option is laser treatment. The process takes less than 30 minutes and involves cauterising the vein. "People are concerned when they hear a vein is taken away," says Molloy, "but they forget that it has already been compensated [for]. The peripheral circulation has already taken over, so the system is working and there is no need to worry."
The laser feels about as painful as an elastic band snapped against the skin. A leg can be treated in one session, which costs an average of £150, and the patient can walk normally immediately afterwards.
Laser treatment is not suitable for everyone, however. If there is no colour in the veins or they are particularly tumescent, patients may be sent on to a surgeon. Molloy refers clients to vascular surgeons about as often as they refer them back to her for cases that are less severe.
Surgery is the third choice. Increasingly carried out on a day-case basis, the process typically entails making a small cut in the groin to disconnect the vein, which may or may not need to be stripped out of the thigh. A number of cuts are then made over the vein in order to tease it out.
Stephen Sheehan, a vascular surgeon at St Vincent's University Hospital in Dublin, says small areas of numbness may occasionally occur due to bruising of the nerve, but they mostly settle down.
Surgery could set you back between £1,000 and £1,200 per leg, but private insurance covers nearly all of the costs, and vascular surgeons tend not to charge more than the agreed rate.
It is worth noting that litigation is common after varicose-vein surgery, due to patients' expectations. People may be disappointed with the results if they have had surgery for purely cosmetic reasons.
"The important thing is that the patient should be well-informed," says Sheehan. "People need to have a clear understanding of what is involved in the surgery and post-operative care, and particularly what to expect afterwards."