A brief explanation of varicose veins

Varicose veins (medically known as varices); what are they and how do they develop?

Varicose veins or varices are worn-out veins, which are mostly to be found in the legs. Veins, that is the vessels which transport blood back to the heart, have substantially thinner walls than the arteries, which conduct the blood into the periphery. An innate weakness in the walls of the veins, which is generally associated with a mild, general weakness of the connective tissue, leads to the rapid fatigue in the thin walls of the veins.

This is additionally promoted through different factors such as

• Obesity
• Standing or sitting activities
• Reduced physical activity.

But varicose veins can also appear without these factors being present, even in slim athletes - although they are not common in such people.

Seen medically, are varicose veins dangerous?

In these pathologically dilated veins, blood accumulates in the periphery and, through inadequate exchange of the dissipated blood with fresh blood, leads to an accumulation of waste and acids, and to a deficiency in oxygen.

This can subsequently lead to reduced nutrition for the skin and subcutis, and consequently results in the development of leg ulcers ("varicose" or "stasis" ulcers, "ulcus cruris"). Aside from that, this standing column of blood in the varicose vein can easily coagulate and thereby result in so-called "thrombi". If a vessel is obstructed through such a thrombus, one speaks of thrombosis.

If such a clot is also torn away and then transported to the lungs via the bloodstream (along its natural route), it leads to a closure of pulmonary vessels. This is a process known as a pulmonary embolism and is associated with very severe, often fatal complications.

Superficial veins which are obstructed through a thrombus can become inflamed (superficial phlebitis or "thrombophlebitis") and are prone to purulence (the development of pus): Here, pyogenic organisms can then enter the bloodstream and trigger the development of the most severe of clinical situations, of "blood poisoning" or a "sepsis".

Varicose vein treatment

Varicose vein treatment varies depending on the stage and the severity of the condition.

We place the greatest value on a "stage-related" and individually customised therapy; that is to say, not always removing the same length of the truncal vein when only smaller segments of this vessel are seen to be unhealthy. It is guaranteed that only sick veins will be removed so that healthy portions remain available, for instance for their possible application in bypass surgery.

For your information, we therefore describe the different conditions and their respective therapeutic options.

Diagnostics of varicose veins

Already a simple orientational examination, through palpation and ultrasound, is sufficient for us to be able obtain a rather precise estimate of the required varicose vein treatment. Before major surgery, our patients are always examined in great detail by us with the help of "duplex sonography": In this way, the specialist can evaluate quite precisely which veins are disturbed and in what manner, and can then, together with the patient, design an individual, optimally-suited vein solution, with the best chances for success on the one hand, and the least burden to the patient on the other.

The "phlebography", an x-ray examination performed following the injection of a contrast medium into the veins, is today rarely performed. The results of the angiological investigation then define the further procedure precisely.

Varicose vein treatment procedures

Here, one sees a leg one day after a conventional "stripping" and with the removal of side branches by means of "crocheting": the haematoma to be observed following the procedure is still relatively minor.

• "Stripping" is the oldest procedure for the treatment of a truncal vein illness and stems originally from the year 1907. Here, the truncal veins are threaded onto a thick wire and then pulled from the leg with considerable force. Thereby, the side branches and the surrounding connective tissue, as well as the lymphatic vessels are torn open and may develop extensive haematomas. After the surgery, narrow compression stockings must be worn for at least 6 weeks. Patients are generally unable to work for 2 - 3 weeks. The procedure is the most commonly used and is generally accomplished under deep anaesthesia. Local removal of the varicose veins, without involving the truncal veins: Through an incision or a minute puncture (as performed by us), these veins are removed under local anaesthesia (see also above).

Conventional surgical instrument, a (coiled) stripping wire with the massive head, which is pulled through the leg, and the handle with which the surgeon pulls out the vein that is threaded on the wire.

• The "CHIVA method": Also an older method of varicose vein treatment (stemming from France), whereby the goal was to maintain the structure of the truncal veins as far as possible and to only eliminate the afflicted influxing vessels. The idea thereby was that the truncal veins could recover once again. Unfortunately, this idea, in practice, generally functions very poorly and the process demands an extremely large number of subsequent surgeries. For this reason it is no longer recommended by the specialist surgical societies today. With this method, not only are numerous incisions (causing subsequent scarring) required, but also a long period during which compression stockings must be worn.
• "Laser sclerosation of the inner surface of the vessel": Hereby, with anaesthesia as above, the sclerosation of the truncal vein is brought about through the positioning of a laser probe, as with stripping, with an introduction into the inner region of the afflicted truncal vein. Side branches, on the other hand, must be removed once again through small incisions/punctures.
• "Radiofrequency therapy": Here, the inner surface of the varicose vein, which is reached by way of a catheter, is treated with radio waves. This therapy is more accurate and more gentle than the laser method. High-frequency currents ("radio waves") are used to close the vessels with the aid of precisely controlled temperatures. The method is especially safe and gentle, and can also be performed on outpatients so superbly under local anaesthesia that patients can, for the most part, return to normal life the following day. Please also see "Laser and radiofrequency therapy"

Here, the director of the vein institute, Dr. Netzer, treats a patient by means of radiofrequency catheter: at the moment, he is injecting a saline solution, with some local anaesthetic, around the vein and the catheter, performed while under constant ultrasound monitoring. The process is extremely gentle; it does, however, require a great deal of lengthy experience to obtain the desired results.

• "Endoscopic removal of the truncal veins": Here, the affected truncal vein is removed from the leg very gently and carefully with the aid of an endoscope, without tearing side branches or other vessels - a result which always occurs during classical stripping. In this way, removal of the afflicted vein can be carried out without any bleeding and the patient can work again immediately and without wearing any stockings.

Substantial varicose veins in a 48-year-old cook: This patient was able to work again normally on the day after varicose vein treatment.

At the present, we only perform

• the radiofrequency therapy and
• endoscopic removal of the truncal veins.

These processes have proven to be so good that we have dispensed entirely with the classical stripping and the CHIVA methods of varicose vein treatment.

Only in this way are we able to achieve our ambitious goals:

• The absence of scarring
• Being immediately fit for work
• Being immediately able to resume participation in sports
• Optimal aesthetic results
• Optimal results from a medical standpoint
• The possibility of avoiding the wearing of compression stockings entirely or of having to wear them for only 24 - 72 hours
• Being able to be treated in midsummer as one wishes

If necessary, we also combine these processes with the

• laser treatment for spider veins and
• foam sclerotherapy (microfoam sclerotherapy) of side veins,

whereby we generally carry out the laser therapy along with the radiofrequency therapy or the endoscopic procedure during the course of the same treatment.

We generally recommend the microfoam treatment of side branches only after a three-month interruption following surgery, since many side branches disappear within this time without further treatment. The remainder can then be sclerosed very elegantly and carefully (a procedure which can often be carried out in the patient's home town).