Diagnosis
The examination of the patient reveals the following findings:The varicose veins fill up in a standing position and can be easily stroked out in a lying position with the leg raised.If the main vein of the leg (vena saphena magna) is squeezed while lying down, it is possible to determine whether the varices are fed by this vein when getting up again. If the perforating veins above the varicose vein (veins connecting surface and depth) can be squeezed to prevent filling of the varices, the cause can be assumed. Apparative procedures are of course also available. With the help of the Doppler-Duplex examination, the pulses and flow directions of the vessel are determined (form of ultrasound examination). Phlebography (depiction of the veins with the aid of X-rays and contrast medium) is another important examination, which serves primarily to rule out venous thrombosis.
Therapy
Compression bandages and support stockings serve to relieve the venous system. They flush out water accumulations and reduce the pressure in the tissue. This has the advantage that the venous valves close better and the veins become slimmer.
Compression bandages are often used in the first days after an operation. In the longer term, however, support stockings are more sensible and effective. Support stockings are generally used to alleviate symptoms associated with water retention and varicose veins.
Although varicose veins cannot be removed in this way, this is the treatment of choice for mild and moderate complaints. The support stockings relieve the veins and stabilize the weakened vein walls. This means that less blood sinks into the leg and less water accumulates in the tissue.
There are support stockings of various compression classes (compression classes I to IV), each of which is adapted to the severity of the complaints. In general, varicose veins develop when the blood flow in the leg veins is disturbed. You can relieve the strain on the veins themselves by positioning the legs slightly elevated, especially at night.
This will prevent too much blood from accumulating in the legs. You should also keep moving and avoid standing or sitting for too long. You should also avoid excessive heat, such as in the sauna.
Cold showers can also help against the symptoms. So-called compression stockings are often used to treat varicose veins. Compression stockings are tight-fitting stockings that compress the varicose veins from the outside to increase the blood flow in the vessels.
This supports the effect of the “muscle pump” and prevents the blood from settling. Compression stockings usually cover the entire leg except the thigh. Existing varicose veins do not disappear with compression stockings, however.
To remove varicose veins a surgical procedure must be performed. If varicose veins occur or if there are complaints, the patient can first consult the family doctor. Then a vein specialist, a so-called phlebologist, is the right choice of doctor.
The operation of varicose veins is especially useful for larger varicose veins that cannot be treated in any other way. The earlier an operation is performed for chronic venous insufficiency, the better the deep vein system can recover and complications and secondary diseases can be avoided. There are currently several surgical methods available.
The standard method is the so-called stripping (English “pulling”), in which the vein is removed by a probe after both ends have been severed and the side branches have been sclerosed. In order to reduce the risk of recurrence, i.e. a recurrence after treatment, a so-called crossectomy (French: crossectomy) is usually performed at the same time. Crosse – bishop’s crook (similar to the curved, confluent section of the V. saphena magna in the venous stars); Greek: crosse – bishop’s crook.
Greek: ectomy – cutting out). In this procedure, the large, superficial saphenous vein of the thigh near the groin and the adjacent smaller side branches are prevented from opening into the deep leg vein (femoral vein). Varicose veins are removed using so-called “minimally invasive” procedures.
The aim of minimally invasive procedures is to create wounds that are as small as possible, thus ensuring fast and uncomplicated healing. To treat varicose veins, the altered veins are prevented or removed. This usually has no negative consequences for the blood flow in the leg, as there are numerous veins in the leg.
However, it is important that the blood flow of the deep and large leg veins is not disturbed. A distinction is now made between different procedures for removing varicose veins. The first procedure is called “vein stripping”.In vein stripping, the entire varicose vein is removed using a special probe.
The probe is inserted into the vein, then the varicose vein is cut at its upper and lower ends and fixed on the probe. Finally, the probe is used to pull the varicose vein out of the skin. This operation can be performed under general, local or partial anesthesia.
A stripping operation is often preceded by a crossectomy. A krossectomy refers to the blocking of the veins of the so-called venous star in the groin. At the venous star, the superficial leg veins open into the deep venous system.
This procedure is performed to prevent the formation of new varicose veins. A procedure called perforator ligation is also rarely performed. The perforator ligature is used to prevent so-called perforating veins.
These are connecting veins between the superficial and the deep vein system. The procedure is used to restore normal blood flow. It is a very complex procedure, but it has a low recurrence rate, which means that new varicose veins rarely appear after successful completion of this procedure.
A new stripping procedure is the so-called cryostripping. In cryostripping, the two truncal veins (vena saphena magna and vena saphena parva) are removed virtually without making any incisions in the leg. This of course does not leave any scars, which is very desirable for the patient.
Only a small incision on the groin is required to insert a special cold probe. This cold probe is cooled with liquid nitrogen. The diseased vein is thus frozen solid and removed within seconds.
The recurrence rate is very low with this procedure, which is another advantage of this technique. With conventional stripping, on the other hand, incomplete removal of the truncal vein can easily lead to new infections. Sclerotherapy is another option for treating varicose veins.
In sclerotherapy, the diseased vein is not removed, but glued. This is done either by thermal or chemical influence on the inner lining (endothelium) of the vessel. This stops the blood flow.
Laser therapy and radiofrequency therapy also belong to this form of therapy. Here, the vein is thermally sclerosed and ultimately degraded by the body itself. As a rule, only a local anaesthetic is required.
Sclerotherapy by means of chemical influences is carried out by injecting inflammatory agents or a foaming sclerosing agent. Sclerotherapy of varicose veins is a further therapeutic option. This is particularly promising for smaller venous vessels, such as spider veins, as the recurrence rate is lowest here.
The obliteration is possible with the help of thermal and chemical agents. The goal is not to remove the veins, but to completely stop the blood flow there by obliterating them. In this way, the blood is passed on to larger veins and can be better removed.
The thermal method includes laser therapy and radio frequency therapy. This is where sclerotherapy occurs, i.e. the inner layer of the blood vessels sticks together and is then broken down by the body. The chemical option includes the injection of a sclerosing agent such as polidocanol or a 40% glucose solution in liquid form or better as a fine-bubble foam, since the exposure time is longer here and thus larger varicose veins can also be treated.
After the treatment, compression stockings must be worn continuously for the next 48 hours and then mostly during the day to ensure good treatment success. Closing varicose veins with a laser is an alternative to surgical vein stripping. In this procedure, the varicose vein is closed by a laser, which is located inside the vein and emits energy or heat.
Before the operation, an ultrasound examination of the vessels is performed to determine the course and diameter. This allows the laser energy emitted to be adjusted to the diameter of the varicose vein. The operation is performed under local anesthesia, general anesthesia is not necessary.
However, the patient can be given sedatives beforehand. Usually a puncture is performed at the beginning. A small skin incision is rarely made at the knee or ankle.
The laser catheter is then inserted into the varicose vein and pushed to the beginning of the vessel. While releasing the laser energy, the catheter is retracted and the varicose vein is closed from the inside.Complications of the procedure include postoperative bleeding and nerve damage. Allergic reactions to the anesthetic may also occur.
Depending on the extent of the varicose veins, the duration of the operation varies. If many secondary vessels also have to be removed, the duration can be considerably longer. The surgical method also determines the duration of the procedure.
The pure operation time is usually between 25 and 60 minutes. In addition, there is the preparation and follow-up time with anesthesia induction and discharge. In total, the operation can take between 2 to 3 hours.
Directly after the operation, the patient remains under observation for a few hours and can then go home. However, the patient should not drive a car on the day of the operation. It is important that the patient activates his or her “muscle pump” as early as possible by moving his or her legs to stimulate the blood flow.
Wearing adapted compression stockings for three to six weeks is advisable, depending on the extent of bruising. Lighter sports, such as hiking or cycling, can be resumed after about a week. More intensive sports activities should be avoided for about four weeks.
In order to counteract a weakness of the connective tissue, which can sometimes cause varicose veins, Schüssler Salt “Calcium Fluoratum D12″ can help. Furthermore, “Aesculus D6” can be used for heavy legs and dilated veins. This can also be taken prophylactically during long-distance flights. Pulsatilla” can provide relief for chronic complaints. Horse chestnut, butcher’s broom and magic shrub leaves in the form of a tea can also be used.
