[2] Risk factors include obesity, lack of exercise, leg trauma, and family history of the condition.

[7] Varicose veins have been described throughout history and have been treated with surgery since at least the second century BC, when Plutarch tells of such treatment performed on the Roman leader Gaius Marius.

[16] Other related factors are pregnancy, obesity, menopause, aging, prolonged standing, leg injury and abdominal straining.

[17] Less commonly, but not exceptionally, varicose veins can be due to other causes, such as post-phlebitic obstruction or incontinence, venous and arteriovenous malformations.

[24] Varicose veins could also be caused by hyperhomocysteinemia in the body, which can degrade and inhibit the formation of the three main structural components of the artery: collagen, elastin and the proteoglycans.

Homocysteine permanently degrades cysteine disulfide bridges and lysine amino acid residues in proteins, gradually affecting function and structure.

These long-term effects are difficult to establish in clinical trials focusing on groups with existing artery decline.

[citation needed] Another cause is chronic alcohol consumption due to the vasodilatation side effect in relation to gravity and blood viscosity.

[25] Clinical tests that may be used include:[citation needed] Traditionally, varicose veins were investigated using imaging techniques only if there was a suspicion of deep venous insufficiency, if they were recurrent, or if they involved the saphenopopliteal junction.

In addition, since stripping removes the saphenous main trunks, they are no longer available for use as venous bypass grafts in the future (coronary or leg artery vital disease).

Their use in contrast to liquid sclerosant is still somewhat controversial[medical citation needed], and there is no clear evidence that foams are superior.

[47][48] There has been one reported case of stroke after ultrasound-guided sclerotherapy when an unusually large dose of sclerosant foam was injected.

"[51] It also found in its assessment of available literature, that "occurrence rates of more severe complications such as DVT, nerve injury, and paraesthesia, post-operative infections, and haematomas, appears to be greater after ligation and stripping than after EVLT".

[53] Two prospective randomized trials found speedier recovery and fewer complications after radiofrequency ablation (ERA) compared to open surgery.

Myers said these veins should be treated with endovenous techniques, citing high recurrence rates after surgical management, and risk of nerve damage up to 15%.

By comparison ERA has been shown to control 80% of cases of small saphenous vein reflux at 4 years, said Myers.

Complications for ERA include burns, paraesthesia, clinical phlebitis and slightly higher rates of deep vein thrombosis (0.57%) and pulmonary embolism (0.17%).

ELA is performed as an outpatient procedure and does not require an operating theatre, nor does the patient need a general anaesthetic.

[60] Follow-up treatment to smaller branch varicose veins is often needed in the weeks or months after the initial procedure.

Involving only a small incision and no hospital stay, medical super glue has generated great interest within the last years, with a success rate of about 96.8%.

[citation needed] In the field of varicose veins, the latest medical innovation is high-intensity focused ultrasound therapy (HIFU).

It has been seen in smokers, those who have chronic constipation, and in people with occupations which necessitate long periods of standing such as wait staff, nurses, conductors (musical and bus), stage actors, umpires (cricket, javelin, etc.