What are the stages of varicose veins?

Varicose veins develop in stages, beginning with mild spider veins and progressing to swollen, bulging veins, skin changes, and in advanced cases, leg ulcers. Doctors classify vein disease into six stages (C1–C6) based on visible symptoms and severity.

There is a lot of misinformation out there regarding how serious varicose veins can be, and in how they are related to vein disease (otherwise known as chronic venous insufficiency).

If your veins feel heavy or swollen, are causing pain or discomfort, or are visible on the surface of the skin, these could all be signs of chronic venous insufficiency. Many people suffering from varicose veins are not even aware of the fact they have vein disease. While they might suspect something is wrong, most assume that varicose veins are only a cosmetic issue or a natural part of aging. 

This attitude means the condition too often goes untreated for long periods of time, which can lead to more serious complications that are difficult to treat later on. This is why it is important for both patients and medical practitioners to understand the stages of varicose veins so that the condition can be identified and treated as early as possible.

What is Vein Disease?

Vein disease, or chronic venous insufficiency, is a condition resulting from blood not flowing properly because of the veins not functioning as they should do. Veins need to transport blood back to the heart and - particularly in the lower half of the body - have to work against the force of gravity to do so. This is aided by the small valves inside the veins, which help to ensure that the blood is flowing in the right direction.

When the small valves inside veins start to fail, blood starts to flow in the wrong direction (i.e. away from the heart) and can begin to pool, resulting in increasing pressure on the vein’s valves and walls. When the vein in question starts to swell as a result of increased blood volume inside, this can lead to varicose vein symptoms.

These symptoms vary in terms of visibility and severity and, in fact, the progression of varicose veins is categorised in stages by the European Society of Vascular Surgery and the National Institute of Clinical Excellence. 

While symptoms might not happen progressively in every case, and might not be identified by the patient or a general practitioner, they can still be considered as stages that should be taken seriously and treated appropriately.

Stage 1: Spider veins (C1)

These are small veins that may be red, blue or purple, and appear on the surface of the skin in the form of thin threads, webs or spiders, hence the name. 

They are most common on the legs and the face, and tend to affect more women than men. They are also not necessarily related to varicose veins, but are also caused by venous insufficiency.

Factors that can contribute to spider (as well as varicose) veins include: family history, pregnancy, menopause, obesity and having a sedentary lifestyle.

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Stage 2: Varicose veins (C2)

This is, in some respects, the first stage of vein disease since varicose veins are not necessarily preceded by spider veins. Varicose veins are enlarged, swollen and often twisted veins. They also often appear as purple or blue in colour, and can cause various kinds of discomfort such as aching, itching, burning, numbness or fatigue. 

They can be visible without causing any pain or discomfort, which is why so many people dismiss varicose vein treatment, thinking it is only a cosmetic issue and will go away on its own. However, getting treatment at this stage can stall the progression of vein disease, avoiding more complex, and even potentially deadly, complications further down the line.

Best treatments for Stage 1-2

Sclerotherapy and endovenous laser treatment are minimally invasive procedures used to treat varicose veins by sealing faulty veins and restoring healthy blood flow through our specialist vein treatments.

"Many patients are surprised to learn that early vein disease is often very treatable.  An ideal time to seek advice from a specialist is when symptoms such as visible veins, swelling, or discomfort first appear. At this stage, treatments are typically straightforward and minimally invasive, helping to relieve symptoms while also preventing the condition from progressing."

Mr Sanjay Patel, Consultant Vascular Surgeon, UK Vein Clinic

Stage 3: Swelling (C3)

In the third stage of varicose veins, the legs and ankles start to swell. While this stage will not necessarily show on the surface of the skin, the legs and ankles will start to swell as the impairment of the veins damages their ability to reabsorb fluid. At this point, elevation of the legs may help alleviate some of the symptoms, but will not treat the condition.

This stage of vein disease is considered by many specialists to be a more advanced stage and can significantly impact a patient’s quality of life. Additional symptoms at this stage can include muscle spasms, tightness in the calves or ankles, and pain while walking.

Stage 4: Skin Discolouration (C4)

As the disease progresses, the accumulating congestion of blood in the veins starts to affect how the skin looks, also known as Lipodermatosclerosis. It can start to appear more brown or white as the fatty tissue underneath the skin becomes inflamed and stained. The texture of the skin also starts to become dryer and more brittle, making it more vulnerable to breakage and injury, bleeding and inflammation.

By this stage of vein disease, most people can feel pain and itchiness.

Stage 5: Healed ulcers

This is the last and most dangerous stage of vein disease: when venous insufficiency causes ulcers and open sores to start to form. This is because insufficient blood flow starts to break down the skin tissue. Ulcers are sores that keep opening without healing properly. Since the blood cannot circulate effectively, it cannot deliver the nutrients that are necessary for the healing process to occur.

The pain that usually accompanies this stage of vein disease is often excruciating. The ulcers and open sores can also attract bacterial infections, causing other problems. The most frequent type of ulcer is Venous Stasis, which is a wound on the skin caused by pooled blood.

While not a direct consequence of varicose veins, some research has shown that people with untreated varicose veins are five times more likely to have deep vein thrombosis, a serious and potentially fatal condition that is caused by a blood clot in a vein deeper inside the body, away from the surface of the skin.

Stage 6: Active ulcers (C6)

Create new section and separate the above section to describe healed leg ulcers, leading into C6 where we discuss active leg ulcers.

Best treatments for Stages 3-6

For advanced vein disease (C3–C6), our treatments aim to improve circulation, relieve symptoms, and prevent complications like ulcers.

Common treatments include:

Radiofrequency ablation: Our clinic offers minimally invasive radiofrequency ablation to close faulty veins and redirect blood flow to healthier veins.

Foam sclerotherapy: Our treatment with foam sclerotherapy collapses affected veins so they can be absorbed naturally, helping reduce varicose veins and residual veins.

Ulcer management: Treatment for venous leg ulcers includes wound care, compression therapy, and addressing the underlying vein condition.

Acting before it’s too late

Varicose veins are often easier to treat when they are found early. By understanding the common stages of vein disease, more people may recognise the signs sooner and seek specialist advice if they need it.

Access to treatment through the NHS has become more limited in recent years. Since 2007, procedures such as sclerotherapy and radiofrequency ablation have been offered to fewer patients, and eligibility criteria have gradually become stricter. Today, NHS treatment is usually reserved for people with more severe symptoms, while those milder symptoms are often considered a lower priority. You can learn more about the NHS eligibilty criteria here.

Some patients choose to explore private treatment options, including clinics such as UK Vein Clinic and Dr Newman's Clinic. UK Vein Care also works with insurers including Bupa and AXA, meaning treatment may be covered depending on the details of a patient's policy. More information about medical insurance is available here.‍