• Appearance of heavy, bulging veins most commonly in the lower leg
• Discolored veins, often blue or dark purple in colour
• Pain, heaviness, cramping, itching and aching around the veins
• Bleeding from the veins which can lead to formation of ulcers
• Inability to sit or stand for a long time due to pain

Symptoms: The symptoms of varicose veins may include:

1. Twisted, bulging veins that often appear like cords on the legs
2. Veins that are blue or dark purple in color
3. Leg pain
4. Heavy feeling in the legs
5. Throbbing, burning, swelling, and muscle cramping in the lower legs
6. Pain that worsens after standing or sitting for a long time
7. Changes in the color of the skin around a varicose vein
8. Itching that occurs around one or more of the veins
9. Ulcers
10. Skin irritation
11. Skin discoloration

The following diagnostic tests may be performed before a varicose vein surgery:

1. Physical examination: The doctor examines the patient physically and checks the legs for swelling while standing. The doctor will inquire about the pain and aching in the legs.
2. Venous Doppler ultrasound: It is a non-invasive test in which sound waves are used to view the blood flow through the valves in the veins. A leg ultrasound can help in detecting a blood clot. 
3. Blood tests: These tests help to check for the presence of any underlying medical conditions.
4. Urine tests: These tests help to check for underlying urine infections.
5. Chest x-ray: This test helps to check for the condition of the heart and lungs before surgery.
6. Electrocardiogram (ECG): This test helps in measuring the electrical activity of the heart and checking for underlying heart conditions.

The different treatment approaches for varicose veins include:
1. Conservative treatment:
This form of treatment includes self-care, like exercise, raising the legs while lying down or sitting, and wearing compression stockings.
Compression stockings squeeze the legs and help the leg muscles and veins to move the blood more efficiently.

2. Varicose vein surgeries and other procedures: When self-care and compression do not work, the doctor may recommend surgery or other procedures.
The different ways to close the varicose veins include:

1. Sclerotherapy:

• This procedure involves injecting a solution into the vein which leads to its scarring.
• This causes the blood to change its route and go through the healthier veins instead.
• The collapsed vein is then reabsorbed into the surrounding tissue.
• Several such treatments are required, normally 4 to 6 weeks apart, to close off a vein completely.
• The procedure is usually done without anesthesia, and the patient only feels small needle pricks sensation from the injections.
• The patient needs to wear compression stockings for some weeks after each treatment procedure.

2. Microsclerotherapy:
This procedure is similar to sclerotherapy, but a smaller needle is used for the treatment of smaller varicose veins.

3. Laser therapy:

• The doctor closes off the vein using bursts of high-intensity light.
• No cuts or needles are used in this procedure.
• This procedure is usually done in cases of small varicose veins.

4. Endovenous ablation therapy:

• Radio waves or a laser is used in this form of treatment to close the varicose vein.
• The doctor first number the area around the vein using local anesthesia.
• A small cut or incision is then made in the skin to insert a thin tube.
• This tube has a device that uses radio waves or laser to create heat to close the vein.
• The patient’s leg is wrapped in a compression bandage following the procedure and the patient usually goes home after a few hours.

5. Endoscopic vein surgery:

• This procedure involves the use of an endoscope, which is a tiny tube with a small camera on one end.
• The doctor threads the tube into the vein through a cut in the skin.
• A surgical device is used at the end of the tube to close the vein.
• This procedure is generally not needed unless the varicose veins lead to severe skin ulcers.

The different ways to remove varicose veins include:
1. Ambulatory phlebectomy:
This procedure is used to remove the varicose veins close to the skin surface.
The doctor numbs the area using local anesthesia and removes the veins through small cuts or incisions.

2. Vein stripping and ligation:
This procedure is generally performed under general anesthesia, that is, the patient is put to sleep during the procedure.
This procedure is usually performed for most serious varicose vein cases.
The doctor makes at least two cuts in the skin, ties off the veins, and then removes them.

The following complications may be associated with a varicose vein surgery:

• Pain 
• Infection
• Bleeding
• Allergic reaction to the anesthesia used
• Blood clot formation
• Lump development under the wound
• Damage to the nerves
• Tingling sensation or numbness
• Continued varicose veins
• Swelling of the leg
• Development of thread veins
• Injury to the blood vessels of the legs

• Depending on the type of procedure being performed, the patient may be discharged on the same day of the procedure or the following day after the surgery.
• Recovery may take approximately one to five weeks, depending on the type of procedure performed, the size of the vein operated upon, the after-care procedures followed, and the overproduction health of the patient.
• It is normal to have some pain and discomfort after the surgery. The doctor may suggest pain-relieving medications for the same.
• It is normal to have some bruising and a change in skin color after the procedure.
• The patient can resume his/her daily activities a few days after the procedure.
• It is important to check for signs of infection or blood clot formation after the procedure, and visit the doctor immediately if such symptoms are seen.
• It is necessary to quit smoking and limit the consumption of alcohol after the procedure.
• The patient is asked to wear compression socks to keep the varicose veins under control and help in quick recovery after the surgery.
• Physiotherapy and mild exercises are recommended after the procedure to improve circulation to the legs.
• Yoga, stretching, and walking are recommended following a varicose vein surgery.