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Varicose veins are a common problem, affecting up to 1 in 3 adults in their lifetime. They are usually a sign of an underlying venous insufficiency.
Thread veins can appear anywhere on the body but are mostly evidenced on the legs and face. They are more common than varicose veins, affecting up to 80% of adults.
Leg ulcers appear as broken skin in the lower leg or feet. We have been successfully treating venous leg ulcers for over 20 years.
Upfront and fixed prices. Find out exactly what youâll pay before attending. Medical Insurance should fund varicose vein treatment.
We just do veins and are the most experienced clinic in Europe. We strive to provide patients with the best possible service in a friendly environment.
Walk in, walk out treatments typically take around an hour
UK’s largest network of specialist clinics
If a patient contacts us with post treatment queries, please follow the advice below.
To search for a condition press “CTRL and F” together and insert the search term you’re looking for e.g. Shortness of Breath and it will highlight all the times the term is mentioned on the page.
Click the + button next to the symptom the patient is experiencing to find the relevant advice.
If the patient is suffering with any of the below, provide the relevant advice to the patient and action accordingly.
Following and/ or during the call, speak to manager for further advice if required.
Add a call log & ideally, if you feel appropriate, email the patient with a summary and confirmation of the call which acts as a call log too.
If advice required from a clinician, ask the patientâs consultant to call the patient immediately. In the event that their consultant cannot be contacted (no response within 20 minutes) contact our other consultants until you reach one whoâs able to call the patient immediately. If within one hour no clinician can be found, advise patient that they must go to A&E; if we havenât already done so. Advise them to take their aftercare leaflet with them to give to the clinician at A&E. It outlines what treatment theyâve had and what normal post treatment symptoms are. Reminder: A D-Dimer Test is not sufficient to confirm/ rule out a DVT.
All patients are to be asked these questions irrespective of their concern.
Symptom – please click + button to see advice
SHORTNESS OF BREATH (SOB)? = query PE
Send the patient straight to A&E. Â Advise patient that the symptoms they are experiencing could be a sign of a Pulmonary Embolism (PE) and it is important they seek urgent medical assessment and/ or treatment. Advise the patient we will contact a clinician whoâll be in touch within the hour. Send confirmation via email of our instruction to go to A&E – use e-clinic template “Post-Treatment Symptoms”. The email also contains our Aftercare Leaflets. Also ask patient the *Core Symptom Questions.
At end of call please action all points in the *Emergency Call Actions* found below.
DIFFICULTY BREATHING? = query PE
Send the patient straight to A&E. Advise patient that the symptoms they are experiencing could be a sign of a Pulmonary Embolism (PE) and it is important they seek urgent medical assessment and/ or treatment. Advise the patient we will contact a clinician whoâll be in touch within the hour. Send confirmation via email of our instruction to go to A&E – use e-clinic template “Post-Treatment Symptoms”. The email also contains our Aftercare Leaflets. Also ask patient the *Core Symptom Questions.
NOT BEING ABLE TO GET WORDS OUTS? = query PE
CHOKING OR GASPING? = query PE
COUGHING UP BLOOD? = query PE
HAVE YOU COLLAPSED? = query PE
CHEST PAIN = query Heart Attack (A central dull chest pain like a crushing sensation, heavy weight or squeezing in your chest, pain spreading into jaw or arm)
Send the patient straight to A&E. Advise patient it is important they seek urgent medical assessment and/ or treatment as these symptoms could be a sign of a heart attack. Advise patient we will contact a clinician whoâll be in touch within the hour. Send confirmation via email of our instruction to go to A&E – use e-clinic template “Post-Treatment Symptoms”. The email also contains our Aftercare Leaflets. Also ask patient the *Core Symptom Questions.
FACE DROOPING on one side, weakness in arms or legs, difficulty speaking, loss of vision? = query Stroke
Send the patient straight to A&E. Advise patient it is important they seek urgent medical assessment and/ or treatment as these symptoms could be a sign of a Stroke. Advise patient we will contact a clinician whoâll be in touch within the hour. Send confirmation via email of our instruction to go to A&E – use e-clinic template “Post-Treatment Symptoms”. The email also contains our Aftercare Leaflets. Also ask patient the *Core Symptom Questions.
FITTING = query epileptic seizure â someone is shaking or jerking because of a fit, or is unconscious (canât be woken up)
Advise patient to call 999 and seek help from the emergency services.
SEVERE ALLERGIC REACTION â symptoms include sudden, rapid swelling of the eyes, lips, mouth, throat or tongue and sometimes also wheezing or shortness of breath = query PE
Send the patient straight to A&E. Advise patient that these could be a sign of an allergic reaction or possibly a Pulmonary Embolism and it is important they seek urgent medical assessment and/ or treatment. Advise patient we will contact a clinician whoâll be in touch within the hour. Send confirmation via email of our instruction to go to A&E – use e-clinic template “Post-Treatment Symptoms”. The email also contains our Aftercare Leaflets. Also ask patient the *Core Symptom Questions.
LEG PAIN = query DVT
Q: Is the pain localised to the treated area or generalised over the whole calf or whole leg?
If localised, it is common, indeed entirely normal, to have aches and pains over the veins that have been treated. If you have no other symptoms then this is nothing to be concerned about. You may find that Ibuprofen helps relieve this and sometimes putting your stocking back on also helps. This will settle with time so please donât worry. Post procedure pain is expected for the first two weeks post treatment â most prevalent around days 5-7 when the veins treated with EVLA start to contract within the leg and the dead tissue is absorbed. If the swelling increases or they develop any further symptoms* advise the patient to go to A&E and contact us. Also ask patient the *Core Symptom Questions.
If generalised over the whole calf or whole leg, this is rather unusual after our treatments and could indicate a DVT especially if also accompanied by generalised hot feeling of the leg and tenderness of your calf. If this is the case, we would encourage you to attend your local A&E department. Advise patient we will contact a clinician whoâll be in touch within the hour. Send confirmation via email of our instruction to go to A&E – use e-clinic template “Post-Treatment Symptoms”. The email also contains our Aftercare Leaflets. Also ask patient the *Core Symptom Questions.
LEG SWELLING = query DVT
Q: Is the swelling localised to the treatment area or is the swelling more generalised over the whole calf or whole leg?
If localised: If the swelling is localised to the treatment area, it is common, indeed entirely normal to have swelling localised to the veins that have been treated. Check if the patient is experiencing any other symptoms*. If no, then this is likely nothing to be concerned about. This will settle down in time so please donât worry. If the swelling increases or they develop any further symptoms advise the patient to go to A&E and contact us. Also ask patient the *Core Symptom Questions.
If generalised: Send the patient to A&E. If the swelling is more generalised over the whole calf or the whole leg, that is rather unusual after our treatments and could indicate a DVT especially if also accompanied by generalised hot feeling of the leg and tenderness of your calf. Advise patient we will contact a clinician whoâll be in touch within the hour. Send confirmation via email of our instruction to go to A&E – use e-clinic template “Post-Treatment Symptoms”. The email also contains our Aftercare Leaflets. Also ask patient the *Core Symptom Questions.
WARM/HOT LEG (S) = query Phlebitis – often accompanies Tender Legs & Redness of the skin â check if patient also suffering with these.
If localised: If the hot feeling is localised to the area treated, it is common, indeed entirely normal, to have a hot feeling over the veins that have been treated. Check if the patient is experiencing any other symptoms*. If no, then this is nothing to be concerned about. The patients may find that Ibuprofen (o other over the counter painkiller) helps relieve this and sometimes putting your stocking back on also helps. Ensure you donât have any contraindications to taking ibuprofen or other painkiller. This will settle with time, so please donât worry. If the swelling increases or they develop any further symptoms advise the patient to go to A&E and contact us. Also ask patient the *Core Symptom Questions.
 If generalised: Send patient to A&E. If the hot feeling is generalised over the whole lower leg from knee down, this is rather unusual after our treatments and could indicate a DVT especially if also accompanied by generalised swelling of the leg and tenderness of your calf. Advise patient we will contact a clinician whoâll be in touch within the hour. Send confirmation via email of our instruction to go to A&E – use e-clinic template “Post-Treatment Symptoms”. The email also contains our Aftercare Leaflets. Also ask patient the *Core Symptom Questions.
TENDER LEG (S) â query Phlebitis – often accompanies Warm/Hot Leg(s) & Redness of the skin â check if patient also suffering with these.
Q: Is the tenderness localised to the treatment area or is it more generalised over the whole calf or whole leg?
If localised: If the tenderness is localised to the area on your leg that has been treated, it is common, indeed entirely normal, to have tender patches over the veins that have been treated. Check if the patient is experiencing any other symptoms*. If no, then this is nothing to be concerned about. If no, then this is nothing to be concerned about. You may find that Ibuprofen helps relieve the tenderness and sometimes putting your stocking back on also helps. This will settle with time, so please donât worry. Also ask patient the *Core Symptom Questions.
If generalised: If the tenderness is generalised to the whole leg, this is very unlikely anything to do with your treatment. Please contact NHS 111 or visit your local A&E department.
REDNESS OF THE SKIN â query Phlebitis – often accompanies Tender Legs & Warm/Hot Leg(s) â check if patient also suffering with these.
Redness of the skin is common over veins that have been injected. It indicates inflammation (not infection) which is almost inevitable after vein treatment. This is usually only over small areas. This will settle down with time and no active treatment although Ibuprofen will help settle inflammation and is especially useful to relieve and associated pain. Also ask patient the *Core Symptom Questions.
Q: Is the redness covering more than 10% of your skin i.e. what weâd consider extensive?
If the redness of the skin is extensive covering 10% or more of the skin of your leg, it increases the chance that this is an infection. This is very rare after EVLA and foam sclerotherapy. Mark the edges of the redness with a biro or felt tip pen. Take some photos and email them to us. Also ask patient the *Core Symptom Questions.
Q: Is the redness increasing rapidly?
Send the patient to A&E. If the redness increases in area especially if rapidly then advise the patient to attend their local A&E department. This is especially important if you have other signs of infection such as feeling unwell generally, having a fever or vomiting. Advise patient we will contact a clinician whoâll be in touch within the hour. Send confirmation via email of our instruction to go to A&E – use e-clinic template “Post-Treatment Symptoms”. The email also contains our Aftercare Leaflets. Also ask patient the *Core Symptom Questions.
PHLEBITIS â Advice re what phlebitis is and our recommendations âŚ
Phlebitis (also called thrombo-phlebitis) is inflammation in a varicose vein, usually after treatment with foam sclerotherapy but also spontaneously in a patient with varicose veins. The vein will feel hard and lumpy and can often look very red and is warm to the touch. The treatment is anti-inflammatory medication, usually ibuprofen 2-400mg three times a day with food for 7-10 days if patient able to take this medication. Ibuleve gel can also be helpful but not to be taken together with tablets. Often patients will see other doctors who may diagnosis infection and start antibiotics, this is almost always not required. Aspiration of blood from the inflamed vein can also help settle symptoms. Phlebitis can occur both early and late after treatment (ie up to a few months after treatment) and can be very painful.
Spontaneous thrombophlebitis can put patient at risk of DVT if it involves the great or saphenous veins up to the junction with the deep veins, although this is relatively uncommon, however all patients with recent phlebitis are recommended extra blood-thinning medication after treatment (usually one week) to prevent DVT after treatment. If patient has definite phlebitis after treatment and no calf swelling then very unlikely to also have a DVT.
How do you distinguish between phlebitis and DVT after treatment?
Phlebitis is common and is painful, lumpy veins, sometimes red and warm to the touch. DVT is a swollen (>3cm over baseline or other leg) and painful lower leg. If patient has definite phlebitis and no leg swelling DVT is very unlikely.
If definite phlebitis and no swelling unlikely to be DVT and needs advice on managing phlebitis.
If no symptoms of phlebitis and leg swelling needs urgent review (blood-thinners and scan).
If any symptoms of PE needs urgent review that day in GP/out-of-hours/A&E.
LUMP UNDER THE SKIN
Q: Are the lumps on the leg?
If yes, after varicose vein treatment it is normal to feel hard or semi hard lumps under the skin especially where the varicose veins were â this is a good sign that the veins have responded to the treatment. The veins are not removed from the body, they are killed within it. The bodyâs response to the trauma of both the ablation and chemical treatments we use is for the vein wall to thicken as it becomes inflamed and the blood within the vein will clot. This will give the appearance of hard lumps under the skin. To touch they may feel like frozen peas or marbles. These hard lumps will reduce in size over 3-6 months as your body breaks down the dead cells. Also ask patient the *Core Symptom Questions.
 If no, if the lumps in other places on your body apart from the leg/s we have treated, weâd advise you make an appointment to see your GP. Also ask patient the *Core Symptom Questions.
BLEEDING
Q: Is the bleeding persistent?
Bleeding Stopped: If no and the bleeding has stopped, please keep a dressing over where the blood was coming from with tape to provide some pressure. If frank red profuse bleeding returns despite the dressing please attend your local A&E department. Also ask patient the *Core Symptom Questions.
 Bleeding Persistent: If yes, we would encourage you to lie down and lift your leg in the air if you havenât already tried this. Apply pressure to the area with an absorbent cloth of some sort. If bleeding stops, apply a dressing over where the blood was coming from. If bleeding does not stop attend your local A&E department or call 999 if simply cannot get there unaided. Advise patient we will contact a clinician whoâll be in touch within the hour. Send confirmation via email of our instruction to go to A&E – use e-clinic template “Post-Treatment Symptoms”. The email also contains our Aftercare Leaflets. Also ask patient the *Core Symptom Questions.
NUMBNESS
Q: Is the numbness localised to a small pat of your leg?
If localised, it is common to have some localised numbness after treatment for varicose veins. No urgent treatment is required and it will normally fully recover but can take many weeks. Also ask patient the *Core Symptom Questions.
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Will the numbness get better?
A:Â The numbness should get better and may start to feel a bit tingly. Although most numbness will fully resolve there will be a very small number of people that are left with a persistent numb patch.
Q: Did the numbness suddenly occur to one side of your face, one arm or one leg?
If yes, this should be investigated urgently especially if a large area is affected as it could be a sign of you suffering with a stroke. Please attend your local A&E department or call 999 if simply cannot get there unaided. Also ask patient the *Core Symptom Questions.
STOCKINGS
Q: How long ago was the treatment? Patients to wear stockings for 7 days post-treatment.
Query Allergic to the stockings â sore leg at top
The stockings are hypoallergenic (do not contain latex). We have a tendency to want to pull the
stockings up our legs. This causes the stocking to âdrag downâ on the leg and can cause a rash/
blisters to appear. If this happens, sit the stocking a little lower on the leg to avoid it pulling
down/ dragging on the skin. If it persists, try turning the stocking top down or placing gauze dressing in between elastic and the skin.
Stocking falling down
The top of the stocking can get dead skins cells and soap stuck to it and hence it can often not
stick to the leg and it falls down. Iâd advise you fold over the top of the stocking âthe plasticky looking bitâ and get a damp cloth and wipe away the dead skin cells and any soap residue. This is common if the patient decided to shower in the stockings. If this doesnât help, advise patient to use a suspender belt or put a pair of tights/ tight shorts (like cycling shorts) over the stocking to hold them up. Send new stockings to patient. Advise patient to contact us if they havenât received them.
Hole/ Ladder in Stockings
Advise patient not to fret, it will not affect treatment outcome. Send new stockings to patient first class.
Advise the patient that the stockings are delicate and to treat them like a delicate pair of tights.
Tell them to try and avoid putting their fingers through them HOWEVER please remind them if
the new pair ladders/ gets a hole in them this will not affect the treatment outcome.
Blood stain on stocking.
Q: First, ask patient if leg is still bleeding?
If yes, or if staining getting larger, advise patient to put their leg in air and apply pressure. Contact their consultant* and advise we will get their consultant or another clinician to contact them.
If no flowing blood and stain not increasing, reassure them it wonât affect treatment. Send new pair of stockings to patient first class. Advise to clean area. Send info to consultant to see if any other further action needed.
Stocking very tight and progressively getting worse â refer to Leg Swelling
COUGHING
If the cough is persistent, it could be related to COVID and we would encourage you follow the governmentâs latest advice https://www.nhs.uk/conditions/coronavirus-covid-19/ or call NHS 111. If the cough is not persistent, and you have no other symptoms, it is unlikely to be anything to do with your recent treatment. Also ask patient the *Core Symptom Questions.
BRUISING
Q: Is the bruising (brown marks) on the legs overlying where the veins used to be.
This is what is referred to as skin staining. About 6 weeks after foam sclerotherapy treatment 50% of patients present with a degree of skin staining. About 15% of patients are concerned by this. It usually fades quickly over the next few months. About 10% of patients will continue to experience some skin staining 6 months after treatment although this will continue to gradually fade. There is a very small minority of patients that the skin staining will not fully resolve. Although this is incredibly unlikely, we cannot guarantee that it will completely resolve. Although this can feel frustrating when discussing the risks during the consultation period, patients feel that the small chance of skin staining is much better than the bulging unsightly veins that have now disappeared.
Q: Is the bruising covering a large area?
If yes, this is post treatment bruising. It will turn purple, yellow etc. Varies significantly from patient to patient and should fully resolve 3 weeks post treatment.
**ACTIONS FOLLOWING THE CALL**
(in addition to those listed in the advice section)
If we send a patient to A&E, we must:
Dependent on the patientâs diagnosis, an Adverse Incident Form is to be completed see Adverse Incident Policy.
