Phlebology: Treatment, Effect & Risks

Phlebology is a medical subspecialty that deals with venous disorders such as varicose veins, thrombosis or phlebitis. To make a diagnosis, phlebology uses standard procedures such as Doppler sonography or duplex sonography. Compression therapies and stripping are among the most important phlebological treatment measures.

What is phlebology?

Phlebology is a medical subspecialty that deals with venous disorders such as varicose veins, thrombosis or phlebitis. Phlebologists deal with the prevention, examination, treatment and rehabilitation of venous diseases. One of the best known of these is varicose veins. In Germany, phlebology is not an independent specialty. Instead, the title of phlebologist can be acquired through further training after the actual specialist training. Both trained general practitioners, as well as dermatologists, specialists in internal medicine or surgeons can become phlebologists. The main requirement for participation in advanced training is at least two years of clinical practical experience. The advanced training usually lasts 1.5 years and takes place in an institution authorized to provide training. In addition to the handling of phlebological equipment, the advanced training also includes the treatment of various venous diseases. Angiology is to be distinguished from phlebology. In addition to venous diseases, this branch of internal medicine also deals with lymphatic diseases and arterial diseases.

Treatments and therapies

In addition to varicose veins, the specialty of phlebology includes, for example, spider veins, phlebitis, thrombosis and chronic venous insufficiency. In the latter case, the outflow from the leg vein is disturbed. The lower legs and feet swell or lie open. This so-called ulcus cruris is understood as a complication of venous insufficiency and causes oozing wounds in the late stage. Often, venous insufficiency is the result of a recurrent thrombosis. Untreated venous insufficiency can cause such leg vein thrombosis. In addition to venous insufficiency, venous thrombosis can also have life-threatening consequences. Leg vein thrombosis usually results from slowed blood flow or vascular damage. A blood clot forms. If this clot breaks loose, it can lead to a pulmonary embolism, which is often fatal. In phlebology, compression therapy is often used to prevent venous clots. This physical compression is a conservative therapy. It forms the basic therapy for virtually all venous disorders and even accompanies surgical procedures. Both compression bandages and compression stockings are part of compression therapy. They accelerate the blood flow in the veins and maintain it. In addition to this conservative therapy method, phlebologists also use drug therapies in the context of some vein diseases. Varicose vein sclerotherapy, for example, can be performed with medication. Intravascularly, 27-percent saline solution is applied. An intentional sclerus or thrombus forms and closes the vascular structures. On the other hand, an unwanted thrombus can be dissolved in an equally controlled manner by drug therapies. This is the goal of thrombolysis, in which a thrombus-dissolving drug is given intravascularly. Important drugs for phlebology are analgesics, anti-inflammatory anti-inflammatory drugs, anticoagulants and venous strengthening venotonics. In addition to conservative and drug therapy measures, phlebology also includes surgical treatment measures. Among the most important are phlebotomy, perforator ligation, and stripping. In microsurgical phlebextraction, varicose veins are operated out piece by piece through small punctures. In perforant ligation, the connections between the depths and the surfaces of a vein are cut off. This is usually done as part of a stripping procedure, which pulls long and straight varicose veins out of the body in one piece with the help of a steel wire. Meanwhile, phlebology also uses thermal methods to treat venous disorders, such as vein-sclerosing laser procedures in particular.

Diagnosis and examination methods

The most important examination and diagnostic methods in phlebology are Doppler sonography, duplex sonography, photophlethysmography, phlebodynamometry, and venous occlusion plethysmography.During Doppler sonography, the phlebologist examines the superficial venous valves by creating an ultrasound image of the vessels. He can thus determine the flow velocity of the blood in the veins. Doppler sonography is considered a standard diagnostic tool for all vascular diseases. During the examination, the physician also detects varices, for example. These are superficial veins with pathological dilatation, indicating a thrombus. The diagnostic instrument of photophlethysmography, on the other hand, measures the blood filling of the lower leg. This measurement takes place externally. Thus, the lower leg does not need to be opened for this imaging procedure. The result of this photophlethysmography helps the physician to assess the extent of the damage and the consequences on the entire venous system. To be distinguished from photophlethysmography is phlebodynamometry, which measures venous pressure during exercise. The patient walks or does knee bends during the pressure measurement. The physician measures the pressure at the dorsal vein of the foot with a pressure transducer and can thus assess the functional efficiency of the venous valves. The effects of varices can also be guessed in this way. In order to determine the vein functions in more detail, the phlebologist, on the other hand, tends to use vein occlusion plethysmography. A blood pressure cuff is placed around the patient’s thigh. On his lower leg there are silicone rings with a resistance foot. This prevents the venous blood from leaving the leg vein. The accumulated blood is released by loosening the cuffs. The faster it drains, the less likely the vein will be blocked. A final, standard diagnostic procedure has become color-coded duplex sonography for phlebology. This method of ultrasound examination accurately depicts the vein walls without any stress for the patient. Vein calcifications and phlebitis can be diagnosed in the early stages using this examination method. A good phlebologist can also already detect some venous disorders by means of visual diagnosis, such as leg ulcers or other serious complications.