Varicose veins affect about 25% of adults in the UK,1 with roughly equal prevalence in men and women, although women are more likely to present. Approximately 50% of varicosities involve the great saphenous vein (GSV), 30% the short saphenous vein (SSV), and 20% both.2 Patients may present to primary care with aesthetic concerns, or with symptoms including night cramps, itching, mild swelling of the ankles or a dull ache in the legs (usually exacerbated by standing for long periods and worse at night). The motivation for presentation should be sought as this will guide your management strategy.3 Varicosity size may not correlate with the severity of symptoms as reported by the patient.