If you have varicose veins, the doctor will check whether conservative treatment measures are sufficient or whether surgery is necessary. Decisive for which treatment is carried out is the type of varicose veins, in addition to the severity of the disease.
Types of varicose veins
In general, the following types of varicose veins are distinguished:
- Spider veins are dilations of the smallest skin veins.
- Reticular varicose veins are dilations of the smallest skin veins, which are distributed in a network and have a slightly tortuous shape.
- Truncal varices are dilations of the main veins (truncal veins) of the superficial venous system. They include the great rose vein on the inside of the legs and the small rose vein on the back of the calf. Dilatation of the truncal veins is particularly common, affecting these veins in about 85 percent of all cases.
- Side branch varices are extensions of the side branches of the truncal veins. They are often strongly tortuous and easily visible through the skin.
- Perforating varices are extensions of the connections between the superficial and deep veins.
Physical therapy and vein remedies
There are several options for the treatment of varicose veins. Physical therapy may be considered as an adjunctive measure. This conservative treatment includes, for example, light leg massages. However, these must not be performed in the case of inflamed veins or thrombosis. In addition to massages, Kneipp treatments also have a positive effect on the veins. Running, walking and vein gymnastics also help to promote blood circulation and strengthen the function of the muscle pump. Often, just 10 minutes of daily exercise is enough to significantly alleviate symptoms. So-called vein remedies are also among the conservative treatment methods. Just like physical therapy, they are used as an adjunct. Vein remedies usually have a decongestant effect and are available in the form of capsules, sprays, ointments and gels. Common active ingredients include horse chestnut extracts, red vine leaf extracts and arnica.
Treating varicose veins: Compression therapy
In the case of incipient venous weakness, the development of varicose veins can be prevented or at least delayed by timely compression treatment. Even if the disease is already advanced, symptoms can be relieved by wearing compression stockings. Compression supports the function of the venous valves and the muscle pump. This prevents the blood from pooling in the legs. For optimal effect, compression stockings should be individually fitted and replaced after about six months.
Removing varicose veins
If conservative methods are no longer sufficient and the varicose veins need to be removed, there are various procedures to choose from:
- Sclerotherapy
- Laser therapy
- Radio wave therapy
- Operation
Sclerosing varicose veins
Sclerosing varicose veins (sclerotherapy) involves injecting a sclerosing agent into the bulging vein. A liquid agent is used for small spider veins, and a foaming agent is used for larger veins. It causes the inner walls of the vein to stick together and a connective tissue-like strand to develop over time. In general, sclerotherapy is particularly suitable for spider veins, reticular varicose veins and side branch varicose veins. For larger varicose veins, on the other hand, surgery is more advisable. Even with smaller varicose veins, several sessions may be necessary until the treatment is completed. Afterwards, compression stockings usually have to be worn for a certain period of time.
Laser and radio wave therapy
In laser therapy, a thin laser probe is inserted into the affected varicose vein. The laser causes the vein walls to heat up considerably and close up. This method is particularly suitable for truncal varicose veins that are not too pronounced and have a straight course. The procedure can usually be performed on an outpatient basis under local anesthesia. After treatment, patients must wear compression stockings for about four weeks. Radio wave therapy is similar to laser therapy. Here, too, the dilated veins are closed by heat. With both procedures, only one intervention is needed in more than 90 percent of cases to close the affected vessel.
Removing varicose veins surgically
By removing varicose veins completely or partially (stripping/partial stripping), there is very little risk of recurrence after surgery. During the procedure, a small probe is inserted into the affected vein and pushed out at the end of the varicose vein. The vein is then cut and pulled out with the help of the probe. Alternatively, the varicose vein can be removed using a cold probe. The operation is performed in a minimally invasive way, so that hardly any scars remain. The operation can be performed either on an outpatient or inpatient basis. If there are several varicose veins, they can also be removed in one operation. Discuss with your doctor whether a local anesthetic is sufficient or whether a partial anesthetic is necessary. After the operation, you should always follow the doctor’s instructions to prevent complications. In most cases, compression stockings must be worn for several weeks.
Overview of other treatment options
In addition to the procedures presented so far, there are other ways to treat varicose veins:
- CHIVA method: in this method, the doctor uses ultrasound to look for varicose veins and ties off the diseased sections of vein. This causes them to regress and sclerose over time. However, this procedure should not be used in cases of very pronounced varicose veins.
- External valvuloplasty: in mild cases of truncal varicosis, the orifice of the rose vein can be somewhat narrowed by attaching a small polyester sleeve. This allows the venous valves to regain their function without having to remove part of the vein.
- Miniphlebectomy: If there are only small dilated side branches, these can be removed with the help of miniphlebectomy. Through small incisions, the veins are removed similar to a crochet hook.
- Crossectomy: Crossectomy involves cutting the connections between the superficial and deep leg veins that open into the deep veins. The operation is often performed immediately before vein stripping.
Prevent varicose veins
If there is a genetic predisposition, it is not always possible to prevent the development of varicose veins with certainty. However, certain precautions can significantly reduce the risk:
- Exercise regularly: endurance sports such as running, swimming or cycling are particularly suitable for preventing varicose veins. Sports such as tennis or badminton, as well as weight training, however, are less recommended for an already existing venous weakness.
- Watch your weight: by being overweight, the development of varicose veins can be favored.
- Go Kneipp: Wading a round through a cold Kneipp pool can do wonders. Otherwise, do it also cold lower leg and knee casts or an alternating shower.
- Vein gymnastics helps: strengthen your veins through targeted gymnastic exercises.
- Standing little: Standing or sitting for long periods of time has an unfavorable effect on the leg veins. The same applies to wearing tight clothes and high shoes.
- Elevate legs: by elevating the legs, the blood can flow more easily and a blood congestion in the veins is prevented.
- Avoid high heat: In heat, the vessels dilate and the blood flow slows down. This can favor the development of varicose veins.
These behaviors will not only help you prevent the development of varicose veins, but they are also recommended if varicose veins have already been removed.
