Vein diseases – a widespread health-related and aesthetic condition

Varicose veins – called “varices” in medical language – are the most frequent consequence of venous dysfunction. They are mostly considered unattractive and disturbing.
However, this is not only an aesthetic problem but also a serious health problem. Therefore a clarification and, if necessary, appropriate treatment should be performed in time.

How do varicose veins develop?

At the calves varicose veins mostly bulge in curved structures under the skin, sometimes also on the thighs. The strands usually shimmer blue and are curvatures of the veins where the blood is congested.
The reason for the superficially passing and tortuous veins is in most cases a weakness of the vascular wall tissues and the venous valves which do not close properly any more. Especially when sitting or standing, the blood often changes its direction of flow and the leg veins are dilated. Tender, dilated, reddish to bluish small blood vessels, so-called spider veins, can be first indicators of such a functional disorder.

Who is affected?

It is especially the warm season, when legs are shown, that reveals what usually remains hidden: varicose veins.
Every second female and every third male is affected to a greater or lesser extent. Various factors like a job where you stand most of the time, overweight, smoking or pregnancy favor the development of varicose veins. They occur more frequently with increasing age, though even young people are often affected.

Varicose veins should not be played down

Varicose veins lead to discomfort including swollen legs, a feeling of tension and heaviness, sometimes light pain, burning or prickling. The risk of vein inflammation (phlebitis) or thrombosis also increases. Over time, persistent eczema and very painful subcutaneous tissue hardening may occur as well. Ultimately, even an ulcerated leg (“venous ulcers”) may develop.

When is the right time for a treatment and which treatment is appropriate?

When you are affected by a vein disease or notice irregularities which indicate vein troubles, you should have yourself examined and get advice. Numerous treatment methods and techniques are available, if necessary.
In any case we decide individually, i.e. depending on the manifestation of the varicose veins and/or vein disorders, the general condition and the age, making sure that every patient gets the treatment suitable.

What risks does a treatment involve?

Every intervention in the vein system may lead to unwanted side-effects or even complications. However, most side-effects, such as bruises, mild inflammation, tissue hardening that is sensitive to pressure or discoloration of the skin, recede quickly. More serious complications like persistent discoloration, scarring or thrombosis are very rare.

Diagnostics by means of duplex sonography (ultrasonic blood flow measurement)

Venous duplex sonography is used for the assessment of the veins’ function and for imaging the veins’ patterns and flow conditions. This examination is necessary prior to interventions in the vein system and has replaced x-rays using a contrast medium (phlebography) as the method of choice. In addition, with imaging ultrasound it is possible to identify also vein inflammations, deep vein thrombosis or congenital vascular malformations. This examination should be carried out prior to every treatment of venous conditions.

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(Foam) sclerotherapy of spider veins and branch varicosities

In this obliteration technique liquid sclerosant or sclerosant mixed with air (foamed) is injected into the spider veins or the branch varicosities with a very fine needle. This causes an inflammatory closure of the varicose vein in the following days; it shrivels up because the blood flow is interrupted and finally becomes invisible. The treatment is practically painless though it often takes several sessions to achieve perfect results. Compression stockings are recommended for a few days after the treatment.

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Foam sclerotherapy of the saphenous vein using guided ultrasound

The so-called echo-sclerotherapy of the saphena vein is based on the same principle as the above mentioned sclerotherapy of branch varicosities. However, it is always performed by means of ultrasonic control because the diseased main vein often cannot be located through the skin. The vein specialist will always use foamed sclerosing agent, which reaches better adherence in large vessels. This technique is also painless and not associated with restrictions in every-day activities. Only intensive physical exertion should be avoided at least until the check-up after a few days.

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Mini-phlebectomy (exheresis of branch varicosities, mini-stripping) of branch varicosities

The mini-surgical excision of branch varicosities is a simple, ambulatory operation without complications, in which the visible parts of diseased veins are extracted by means of a small hook through tiny incisions in the skin. The operation is carried out under local anesthesia and can also be performed as a complement to the obliteration of the main veins or the classic stripping operation. It is necessary to wear a bandage for a few days;extreme physical exertion or sports should be avoided during this time.

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Minimally invasive catheter occlusion of the main vein by means of radio frequency (RFITT) or laser

In recent years several minimally invasive catheter techniques have been developed as substitutes for the classic operation. The affected vein is punctured with a needle as for blood samples and, by means of this access, a radio frequency or laser probe is placed in the vein to be treated – in most cases at the calf. Under local anesthesia, the vessel may then be closed from within through the probe by the effects of heat produced. Contrary to the (foam) sclerotherapy, this result can always be reached by only one treatment. In case there are branch varicosities in addition to the main vein, these can be treated by other techniques in the same intervention or at a later point of time. A complete regression of the diseased branches by the catheter treatment of the main vein alone can rarely be expected. Until the first check-up after one week the patients wear a stocking or bandage and should avoid strenuous physical activity.

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V-block vein stent in combination with foam sclerotherapy of the main vein

This is an enhancement and/or modification of the ultrasound-guided foam sclerotherapy of the main vein. Prior to the injection of the obliterating foam a small metal umbrella is placed through a catheter access at the calf into the diseased vein, in front of the junction with the deep vein system. This prevents the foam from entering circulation and intensifies the effect of the obliterating liquid. The stent remains in the vein, folds up like a small umbrella in the course of the scarred contraction of the treated vessel and this way it reduces the risk of recanalization, i.e. the re-opening of the vessel. For the aftercare of v-block-supported treatment the same measures apply as to foam sclerotherapy alone.

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Classic varicose vein surgery (crossectomy, stripping of truncal veins and exheresis of branch varicosities)

In classic varicose vein surgery, the vein is not closed but completely removed. The surgery is performed on an in-patient basis and under general anesthesia. For crossectomy and subsequent stripping of truncal veins an incision of a few centimeters is made in the popliteal area or the groin and the truncal vein is exposed at the junction with the deep vein system. Then the diseased veins are cut off and divided, finally a probe is inserted into the superficial main trunk of the vein and used for extracting the problematic vein. The small skin incision is closed with a few sutures. In case there are still branch varicosities, in most cases these are removed by the means of mini-stripping (see above) in the same intervention. Until the suture removal after 7 to 10 days a stocking or bandage is recommended and physical activities should be avoided. Normally every-day activities should not cause any problems.

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