Varicose Veins in London 2026. When They Matter, What the Scan Shows and Which Treatment Works Best
Varicose veins affect around 1 in 3 adults in the UK, more often women and more often with age, pregnancy, standing occupations and a family history, and most people with them are told either that nothing can be done or that the NHS will not treat them. Both are partly true and neither is the whole picture.
Key points
Varicose veins are caused by failing valves in the leg veins, usually at the junction in the groin or behind the knee, so the visible veins are the consequence rather than the cause.
Venous duplex ultrasound maps exactly which valves are failing and where, and NICE guideline CG168 recommends it for anyone being considered for treatment.
Endovenous thermal ablation, closing the faulty vein from inside with heat through a catheter, is recommended by NICE as first-line ahead of surgical stripping, with faster recovery and comparable or better long-term results.
Compression stockings relieve symptoms but do not correct the underlying reflux, and NICE advises against offering them instead of intervention where intervention is suitable.
Want your veins properly assessed? Message a GMC-registered doctor on WhatsApp or email team@thewellnesslondon.com.
When do varicose veins need attention
Urgently where there is a sign of a clot or bleeding. A hot, red, hard, tender cord along a vein suggests superficial thrombophlebitis, which can extend into the deep system and needs assessment within days. Sudden swelling of 1 calf or leg with pain suggests deep vein thrombosis and needs same-day assessment. A varicose vein that bleeds heavily should be raised above the level of the heart with firm pressure applied, and needs urgent review because it can recur.
Soon where the skin is changing. Eczema over the lower leg, brown discolouration around the ankle, hardening and tightening of the skin, or a white scarred patch all indicate chronic venous hypertension. A wound that has not healed within 2 weeks is a venous ulcer until shown otherwise. These are the stages where treatment prevents progression, and NICE recommends referral for them.
On request where symptoms affect your life, including aching, heaviness, throbbing, itching, cramps or swelling that worsens through the day and on standing.
Purely cosmetic veins with no symptoms or skin change are not medically necessary to treat, although they can be treated privately.
What causes them and what makes them worse
The leg veins contain one-way valves that stop blood falling back down between heartbeats. When those valves fail, blood refluxes and pools, the vein stretches and the valve above it fails in turn. The commonest site of failure is the saphenofemoral junction in the groin, followed by the saphenopopliteal junction behind the knee.
Risk rises with age, female sex, pregnancy, particularly repeated pregnancy, a family history, excess weight, occupations involving long periods standing, and a previous deep vein thrombosis, which can damage the deep venous valves.
Spider veins, the fine red and purple threads on the thighs and ankles, are a separate cosmetic problem, though they can coexist with an underlying leaking valve that should be excluded before they are treated.
Compression stockings relieve symptoms and are important after treatment and in people unable to have intervention, but NICE is clear they should not be offered as treatment instead of intervention where intervention is suitable, because they do not correct the reflux.
Not sure if you need a scan? Ask on WhatsApp or email team@thewellnesslondon.com.
What a venous duplex scan shows
Duplex ultrasound combines an image of the vein with a measurement of blood flow. While standing, the leg is examined and the calf is squeezed, and the scan shows in real time whether blood flows backwards through a valve and for how long.
It maps which veins are failing, exactly where, and how extensive the reflux is, and it confirms whether the deep veins are healthy and free from previous clot. That map determines which treatment is suitable and where it should be performed.
It is also the reason recurrence after old-style treatment was so common. Removing visible veins without identifying and closing the leaking junction leaves the cause in place, and the veins return.
NICE guideline CG168 recommends duplex ultrasound for everyone referred with varicose veins to confirm the diagnosis and the extent of truncal reflux before treatment is planned. It is arranged at a specialist centre, performed by an experienced vascular sonographer and reported by a consultant.
Which treatment works best
Endovenous thermal ablation is first-line in NICE guideline CG168. A thin catheter is passed into the faulty vein through a needle under local anaesthetic and ultrasound guidance, and heat from radiofrequency or laser energy closes the vein from inside. It is done as a day case, most people walk out and return to normal activity within days, and long-term results match or exceed surgery with less pain and faster recovery.
Where thermal ablation is unsuitable, ultrasound-guided foam sclerotherapy is recommended next, injecting a foam that closes the vein, and non-thermal options including medical adhesive closure are also used. Surgical ligation and stripping is now reserved for cases where the other options are not appropriate.
Remaining surface varicosities are treated at the same time or afterwards with phlebectomy through tiny incisions or with sclerotherapy.
Compression is worn for a short period after treatment, and walking is encouraged from the same day.
Treating the underlying reflux before tackling visible veins or spider veins is the principle that prevents recurrence.
Where we are
Portman Square, Marylebone
The Wellness is at 10 Portman Square, London W1H 6AZ, adjacent to Harley Street and 3 minutes from Baker Street.
Belgravia
Our second clinic is at the Light Centre, 9 Eccleston Street, London SW1W 9LX, close to Victoria.
What varicose vein treatment costs
Consultant vascular surgery appointments in the Harley Street district run £250 to £450 for a first consultation. Private venous duplex scanning runs £300 to £600 as a standalone scan. Endovenous ablation commonly runs £2,500 to £5,000 per leg, with foam sclerotherapy and phlebectomy adding to that. Cosmetic spider vein treatment runs £250 to £500 per session.
At The Wellness the examination, the scan coordination, the consultant reporting and the review are one fee. All figures are from prices.
Executive Health Programme, the most comprehensive assessment with coordinated imaging including lower limb vascular assessment, from £11,995.
Executive Body Scan, consultant-reported imaging including lower limb vascular assessment, with full bloods and consolidated review, from £5,995.
Venous duplex ultrasound of 1 leg, including examination, consultant reporting and review, from £995, with both legs from £1,495.
Comprehensive Blood Panel where clotting, iron or metabolic factors are relevant, with consultation and interpretation, from £495.
Extended 45-minute consultation for complex venous disease, skin change or ulceration, from £395.
In-person consultation with examination, from £220. Same-day video consultation for initial advice, from £150. Mini consultation from £59.
Endovenous ablation, foam sclerotherapy, phlebectomy and vascular surgery referral to a named consultant arranged with the appointment booked.
Appointments within the week at 10 Portman Square, Marylebone.
Ask what your plan would cost. Message us on WhatsApp.
Why The Wellness is the best place in London for varicose veins
Because the scan comes before the treatment. Venous duplex identifies exactly which valve is leaking, and treating visible veins without that map is how recurrence happens. It is arranged at the specialist centre best equipped for vascular work, performed by an experienced vascular sonographer and reported by a consultant.
Because the medically important veins are separated from the cosmetic ones. Skin change, eczema, discolouration and non-healing wounds signal venous hypertension that progresses, and they are escalated rather than dismissed.
Because clots are looked for. A hot tender cord or a swollen painful calf is assessed promptly rather than attributed to varicose veins, since superficial thrombophlebitis can extend and deep vein thrombosis needs treatment the same day.
Because treatment follows the evidence. Endovenous ablation is first-line in NICE guideline CG168, and referral goes to a named consultant with the appointment booked, rather than to whichever technique a clinic happens to own.
And because we own no scanner and no clinic that performs ablation, so our advice about whether you need treatment is independent of whether we deliver it.
Related reading
Private ultrasound scans explains how imaging is arranged and reported, the ultrasound packages guide covers which scan to book, executive health screening covers the fuller assessment, and private specialist referral explains how consultant appointments are arranged.
Book a vein assessment. Message us on WhatsApp, email team@thewellnesslondon.com, or call +44 20 3951 3429.
Frequently asked questions about varicose veins
Do varicose veins need treatment?
Where they cause symptoms such as aching, heaviness, swelling or itching, or skin change such as eczema, brown discolouration, hardening or a wound not healing within 2 weeks, treatment is worthwhile and NICE recommends referral. Purely cosmetic veins with no symptoms are not medically necessary to treat, though they can be treated privately.
What is a venous duplex scan?
An ultrasound combining an image of the vein with a measurement of blood flow, performed standing, which shows exactly which valves are leaking, where and how extensively. NICE guideline CG168 recommends it for everyone considered for treatment.
What is the best treatment for varicose veins?
Endovenous thermal ablation, closing the faulty vein from inside with heat through a catheter under local anaesthetic, which NICE guideline CG168 recommends first-line ahead of surgery. Foam sclerotherapy and adhesive closure are alternatives, and stripping is now reserved for cases where these are unsuitable.
Do compression stockings cure varicose veins?
No. They relieve symptoms and are important after treatment and for people unable to have intervention, but they do not correct the leaking valve, and NICE advises against offering them instead of intervention where intervention is suitable.
When is a varicose vein an emergency?
A heavily bleeding vein should be raised above the level of the heart with firm pressure and reviewed urgently. A hot, red, hard, tender cord suggests thrombophlebitis needing assessment within days, and sudden swelling of 1 calf with pain suggests deep vein thrombosis needing same-day assessment.
This article is for information and does not replace personal medical advice. Sudden painful swelling of 1 leg, breathlessness or chest pain needs urgent assessment, and in an emergency call 999. All treatments at The Wellness are performed by GMC-registered doctors. Reviewed by [GMC-REGISTERED DOCTOR NAME, GMC NUMBER TO CONFIRM], The Wellness. Last updated September 2026.
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