Varicose veins

• Synonyms in a broader sense

Synonyms in a broader sense

Medical: varicosis

• Varices
• Varicose veins

English: varicosis

Definition of varicose veins

Varicose veins, which are called varices in medical jargon, are superficial veins that are sack-shaped or cylindrical.
This phenomenon usually occurs on the legs. A distinction can be made between primary and secondary varices.
Primary varices are used when there is no underlying disease, while secondary varicose veins (varices) are always caused by a previous disease.

Also read our article: Vein problems.

Cause and development of varicose veins

With varicose veins, only the veins are affected.
Veins are the vessels that carry blood back to the heart. This is done, among other things, with the help of the so-called muscle pump. This means the fact that the veins are usually located in muscle boxes, i.e. between the muscles, and are thus compressed with every movement.
This supports the return of the blood to the heart.

Depending on the form of the varices (primary or secondary varicose veins), various causes come into play.

The following factors are responsible for the development of primary varicose veins:

• family burden (especially on the mother's side)
• congenital lack of venous valves (avalvulia)
• Insufficiency (insufficient function) of the venous valves
• Weakness of the vein wall
• Chronic constipation (constipation)
• Obesity (obesity)
• pregnancy

The secondary varicose veins are mainly caused by an outflow congestion of the blood within the venous system.
In cirrhosis of the liver, for example, the blood from the vein leading to the liver builds up (Portal vein), which is medically referred to as portal hypertension.
Bypassing circuits, so-called anastomoses, are formed to transport the used, oxygen-depleted blood back to the heart.
Varicose veins can typically form in the esophagus.
The medical term for this is esophageal varices (esophagus = esophagus; varices = varicose veins). If bleeding from this type of varicose vein occurs, life-threatening esophageal variceal bleeding occurs.
Another bypass route is through the veins in the abdominal wall around the navel. The varices created in this way are called the caput medusea. Caput medusea translated means: head of Medusa.
This name comes from the fact that Medusa wore a headgear made of snakes, which is very similar to the appearance of the varices around the navel.
Varicose veins also often occur as a result of thrombosis.

For more information on thrombosis, see our topic: thrombosis

Forms and stages

Different parts of the veins can be affected by the expansion.
For example, there is one:

• Truncal varicose veins (if the main branch is affected)
• Lateral branch varicose veins
• Perforative varicose veins (when the connecting veins between the surface and the depth are affected) or
• Spider veins (when the small superficial branches are dilated).

Different stages are distinguished depending on the extent of the varicose veins.
The further down the leg the varicose veins reach, the higher the stage. Stage II describes the insufficiency of the venous valves from the groin to a hand's breadth above the knee joint. In stage IV, the insufficiency extends to the ankle.

Varicose veins on the testicles

Varicose veins are enlarged vessels that can be found in different places. Mostly they are on the legs. However, varicose veins can also develop on the testicles.

The scrotum is supplied by a pronounced plexus of veins. These vessels can be palpably and visibly widened. Varicose veins on the testicles are also known as Varicocele. In most cases, varicose veins appear on the left side of the testicle. They are caused either by damaged venous valves, which means that the blood keeps flowing back in the wrong direction, or by an obstacle to drainage in the bloodstream.

Kick frequently Varicoceles without complaints and are only discovered as an incidental finding. However, the affected testicle side may feel heavy or painful, especially when standing. If such complaints arise, it makes sense to visit a urologist and have the cause clarified.

Varicose veins on the testicles cause blood to back up and thus warm the testicles, which disrupts sperm production. This can lead to infertility. There are different treatment options depending on what the cause of the varicocele is.

Varicose veins on the labia

Varicose veins on the labia are particularly common in women during pregnancy. The increased pressure leads to blood congestion. This can arise in the legs as well as on the anus or in the labia. With varicose veins on the labia or on the mons pubis, itching, pressure or swelling often occurs at the same time.

Treatment in the genital area can be difficult. Ointments and cooling compresses can relieve the discomfort. If pain occurs, this may be due to a blood clot and a doctor should be consulted for clarification.

If the varicose veins on the labia are a cosmetic problem, they can be removed by sclerotherapy. After pregnancy, the varicose veins usually regress on their own.

Varicose veins during pregnancy

As the uterus grows during pregnancy, the pressure in the abdomen increases. This also increases the pressure on the inferior vena cava, which receives the blood from the lower half of the body. This causes the blood to back up in the leg veins. The bigger the baby and at the same time the pressure, the more the varicose veins appear.

Another reason for varicose veins during pregnancy can be an increase in the amount of blood in the mother and thus an increase in the load on the blood vessels. In addition, the hormone progesterone ensures that the vessels relax and thus expand.

In addition, being overweight and having varicose veins in the family can be other factors.

A lot of exercise is important to prevent varicose veins during pregnancy. Raising your legs or wearing compression stockings can also have a positive effect.

Complaints / symptoms

The symptoms include, among others

• Heaviness in the legs (improved by walking)
• Tension in the legs
• Pain in the area of ​​the varices (especially when standing)
• Ankle swelling
• Increase in discomfort with warmth
• Improvement of the symptoms when the legs are raised

The blood congestion leads to an insufficient supply of the tissue with oxygen. In the worst case, this can result in an “open” leg (ulcus cruris).

Here it goes to: Pain from varicose veins.

Pain from varicose veins

Varicose veins do not cause typical pain, although they can be at an advanced stage and have other complications. That is why those affected ignore the varices for a long time. However, typical are one Feeling of tension and heaviness. However, after long periods of standing or sitting, those affected may also feel pain in their legs. A Leg cramp on the other hand, varices are not a typical symptom, but can occur in connection with them, for example when the legs are improperly loaded.

Pain in the thigh

In most cases, varicose veins do not cause pain. However, if pain from varicose veins occurs, this can be due to different causes.

The pressure in the blood vessels can cause slight pain when standing. Another reason can be inflammation of the vessel wall (Varicoplebitits), which is noticeable by pain and a hardened varicose vein. If there is a blood clot in the vessel, blood transport is disrupted, which is also expressed in pain. In a so-called thrombosis, the symptoms are reduced by elevating the legs.

Pain after varicose vein surgery

Pain after varicose vein surgery is a common problem. Since the patient lies in bed for a long time after an operation, the blood flow in the legs is poorer. Normally, the blood is moved by the so-called "muscle pump", which drives the blood flow by tensing our leg muscles. If this fails due to lack of movement, the blood flow slows down.

This “blood congestion” can cause pain in the legs. The formation of blood clots should be prevented after an operation and when lying down for a long time. This is done in the form of compression stockings and thrombosis injections.

Pain when cold

Vessels expand when it is hot and decrease in diameter when it is cold. As a result, there are more symptoms in the heat, as the blood in the legs sinks due to the expansion of the veins and pain occurs.

Pain in the varicose veins rarely occurs in the cold. Cold is even used to treat varicose veins, as the narrowing of the vessels increases blood flow in the legs and transports blood back to the heart.

diagnosis

The examination of the patient reveals the following:
The varicose veins fill up while standing and can be easily stroked while lying down with the leg raised. If you squeeze the main vein of the leg (vena saphena magna) while lying down, you can determine whether the varices are being fed by this vein when you stand up again. Can be created by squeezing the perforating veins above the varicose vein (veins that connect surface and depth) Stop filling the varices, the cause is to be suspected here.

Apparatus methods are of course also available.
With the help of Doppler / duplex examination the pulses and flow directions of the vessel are determined (shape of the Ultrasound examination).
The venography (representation of the veins with the help of X-rays and contrast media) is another important examination, which serves primarily to rule out venous thrombosis.

therapy

Compression bandages and support stockings

Compression bandages and support stockings are used to relieve the venous system. They flood Water retention off 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 few days after an operation. In the longer term, support stockings are more useful and effective. Support stockings are generally used to relieve symptoms associated with water retention and varicose veins. The varicose veins cannot be removed this way, but this is the treatment of choice for mild and moderate symptoms. 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 different compression classes (Compression class I to IV), each adapted to the severity of the complaints.

Generally, varices develop when the blood flow in the leg veins is disturbed. You can relieve the stressed veins a little by using your legs in particular slightly elevated at night. This prevents too much blood from sinking into the legs. One should too to keep moving and Avoid standing or sitting for too long. In addition, extreme heat, such as in the sauna, should be avoided. A cold shower of the legs can also help alleviate the symptoms.

Stockings against varicose veins

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 in order to increase the blood flow in the vessels. This supports the effect of the “muscle pump” and prevents the blood from sagging.

Compression stockings usually cover the entire leg except for the thigh. However, existing varicose veins do not go away with compression stockings. Surgical intervention is required to remove varicose veins.

Which doctor treats varicose veins?

If varicose veins occur or have symptoms, the family doctor can be consulted first. Then there is a vein specialist, a so-called Phlebologist, the right choice of doctor.

Surgery for varicose veins

The Surgery of varicose veins is especially useful for larger varicose veins that cannot be treated otherwise. The sooner surgery is performed for chronic venous insufficiency, the better the deep vein system can recover and complications as well Secondary diseases avoided can be.

There is currently several surgical methods. As a standard method is the so-called Stripping (Eng. "pull") to call, in which the vein is removed by a probe after both ends are separated and the Side branches deserted were.
To the risk of recurrence, so to a Recurrence After the treatment, it will usually decrease at the same time a so-called crossectomy (French: crosse - bishop's staff (visually resembles the curved, confluent section of the great saphenous vein in the venous star); Greek: ectomy - to cut out). Here on Venous star of the thigh near the groin, the mouth of the large, superficial great saphenous vein and adjacent smaller side branches in the deep leg vein (vena femoralis) is tied off.

Ligature and removal of varices

Varicose veins are treated with so-called "minimally invasive“Procedure removed. Minimally invasive procedures aim to cause wounds to be as small as possible in order to allow for quick and uncomplicated healing. To treat varicose veins, the altered veins are tied off or removed. That usually has no negative consequences for blood flow in the leg as there are numerous veins there. However, it is important that the blood flow in the deep and large leg veins is not disturbed.

A distinction is made between different methods for removing varicose veins. The first procedure is called "Vein stripping". With 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. Ultimately, the probe is used to pull it out of the skin. This operation can take general anesthetic, Local anesthesia or Partial anesthesia occur. Often a stripping fails Crossectomy Ahead. A crossectomy refers to the tying off of the veins of the so-called Venous star in the bar. At the venous star, the superficial leg veins flow into the deep venous system. This procedure is performed to prevent varicose veins from forming again.

Seldom also finds a procedure called Perforation ligature instead of. The perforating ligature is used to ligate so-called perforating veins. These are connecting veins between the superficial and deep venous systems. The procedure is used to restore normal blood flow. It is a very time-consuming process, but one for it low recurrence rate This means that after this procedure is successfully performed, new varicose veins rarely appear.

A new stripping process is the so-called Cryostripping. During cryostripping, the two saphenous veins (Great saphenous vein and Vena saphena parva) removed with virtually no cuts on the leg. As a result, there are of course no scars, which is very desirable for the patient. Only a small incision is required on the groin, which allows a special one to be inserted Cold probe serves. This cold probe is cooled using liquid nitrogen. The diseased vein is frozen solid and removed within seconds. The recurrence rate with this procedure is very lowwhich is another advantage of this technique. With conventional stripping, however, incomplete removal of the trunk vein can easily lead to new diseases.

Another way of treating varicose veins is that Sclerotherapy. With sclerotherapy, the diseased vein is not removed but stuck together. This is done either through thermal or chemical influence on the inner lining (Endothelium) of the vessel. This will stop the blood flow. This form of therapy also includes Laser therapy and the Radiofrequency therapy. Here the vein is thermally desolated and ultimately broken down by the body itself. Usually there is only one here local anesthesia of necessity. The obliteration by means of chemical influences takes place through the injection of Inflammatory agents or one intumescent sclerosing agent.

Desolation of varicose veins

Sclerosing varicose veins is another therapeutic option. This is especially with smaller venous vessels, like spider veins, promising, as this is where the recurrence rate is lowest. The Desolate is with the help of thermal and chemical agents possible. The aim is not to remove the veins, but to completely cut off the blood flow by sclerosing them. In this way, the blood is passed on to larger veins and can be better transported away.

The thermal method includes the Laser therapy and the Radiofrequency therapy. Here it comes to desolation, i.e. the inner layer of the blood vessels sticking together, and subsequent breakdown by the body.

The chemical possibility includes a Injection of a sclerosing agent how Polidocanol or a 40% glucose solution in liquid form, or better as a fine-bubble foam, as the exposure time is longer and larger varicose veins can be treated.
After the treatment, compression stockings must be worn continuously for the next 48 hours and then usually during the day to ensure good treatment success.

Remove with the laser

Sealing varicose veins with the laser is an alternative to surgical vein stripping. In this procedure, the varicose vein is closed by a laser that is located inside the vein and emits energy or heat.

Before the operation, an ultrasound examination of the vessels is carried out to determine the course and diameter. This allows the laser energy emitted to be matched to the diameter of the varicose vein. The operation is performed under local anesthesia, general anesthesia is not necessary. However, the patient may be given sedatives beforehand.

A puncture is usually performed at the beginning. A small skin incision is rarely made on the knee or ankle. The laser catheter is then inserted into the varicose vein and pushed to the beginning of the vessel. As the laser energy is released, the catheter is withdrawn and the varicose vein is closed from the inside.

Complications of the operation are, for example, secondary bleeding and nerve injuries. It can also cause allergic reactions to the narcotic.

Duration of the operation

The operation time varies depending on how pronounced the varicose veins are. If many secondary vessels also have to be removed, the duration can be greatly increased. The surgical method also determines the duration of the procedure.

The actual operation time is usually between 25 to 60 minutes. In addition, there is the preparation and follow-up time with induction and discharge of anesthesia. Overall, the procedure can take between 2 to 3 hours.

What does the aftercare look like?

Immediately 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 "muscle pump" as early as possible by moving his legs in order to drive the blood flow.

It makes sense to wear adapted compression stockings for three to six weeks, depending on the extent of the bruising.

Lighter sports such as hiking or cycling can be resumed after about a week. Doing more intense sporting activities should be avoided for about four weeks.

homeopathy

In order to counteract a weak connective tissue, which can sometimes cause varicose veins, the Schüssler salt can be used "Calcium Fluoratum D12" help.

It can also be used for heavy legs and dilated veins "Aesculus D6" be applied. This can also be taken prophylactically on long-haul flights.

Can be used for chronic complaints "Pulsatilla" Provide relief. Horse chestnut, butcher's broom and magic shrub leaves can also be used in the form of a tea.

forecast

Like all surgical interventions, these also involve certain risks (bleeding, infections, pain, allergies, etc.).
The forecast However, once the varicose veins have been successfully removed, it is good because the symptoms are usually eliminated.
However, a recurrence of the varicose veins cannot be ruled out, as only the symptoms, but not the cause was treated. Regular follow-up examinations are therefore recommended.

Complications from varicose veins

The insufficient exchange of oxygen between blood and tissue, which is caused by the build-up, leads to an accumulation of waste products and a lack of oxygen.
In the worst case, the result is an "open" leg (Leg Ulcer). In addition, clots can easily develop in the congested column of blood, which can lead to thrombosis.
If these clots dissolve and are carried away with the bloodstream and follow it into the lungs, pulmonary embolism can occur. This is a serious, often fatal, complication.
Superficial veins, which are caused by a thrombus (Blood clots) are closed, inflame (thrombophlebitis = superficial phlebitis).
Furthermore, pus bacteria can accumulate here, which are transported through the bloodstream and can trigger blood poisoning (sepsis).

You might also be interested in: Phlebitis in the calf

Thrombosis risk

The risk of thrombosis in varicose veins is increased. Because the blood flow is slowed in the enlarged vessels, blood clots can form.

Symptoms of thrombosis include a sharp pain in the leg and redness and swelling below the affected area. A particularly unpleasant pressure pain in the sole of the foot is also often described. Raising the leg usually relieves the symptoms.

The higher the thrombosis is on the leg, the more pronounced the symptoms. In the case of thrombosis, there is a risk that the clot will detach and trigger what is known as a pulmonary embolism in the pulmonary circulation.

Preventive measures are compression stockings and thrombosis injections.

prophylaxis

Varicose veins can be prevented by taking appropriate measures. That is important physical activity, especially the alternating tensing and relaxing of the leg muscles to activate the so-called muscle pump. This means that the muscles help the veins to pump the blood back towards the heart and help prevent vein overload.

Furthermore should Alternating showers or baths are used to strengthen the venous muscles and to improve the blood flow in the veins and the blood supply to the body. Standing or sitting for long periods should be avoided as far as possible.

One should as often as possible walk barefoot and avoid wearing high-heeled shoes. In addition, one should not expose oneself to high outside temperatures for too long, e.g. in the sauna, in order to avoid excessive dilatation of the veins and a consequent slowing down and possible stagnation of the blood flow.

How can you prevent varicose veins?

Varicose veins can be prevented with exercise, for example. Endurance training strengthens the muscles and the “muscle pump” that drives our blood flow in the legs is activated. Accordingly, the blood cannot sink into the legs. Leg and vein exercises also have a preventive effect.

A healthy diet and sufficient fluid intake also have a positive effect. Sitting or standing for long periods of time should be avoided. The change from heat to cold increases the elasticity of the vessels. For example, after a warm shower, the legs can be showered with cold or cold foot baths can be taken. Putting your legs up increases the flow of blood back to the heart and also prevents the blood from sagging. Wearing flat shoes and loose clothing is also recommended. Pants that are too tight can pinch blood vessels in some places, such as the back of the knees, and prevent the even flow of blood.

If varicose veins occur, it makes sense to see a doctor early to prevent the disease from progressing and complications.

What to do if a varicose vein bursts

Since around 80 percent of a person's blood is in the venous system and varicose veins usually have an enlarged diameter, if a varicose vein bursts it can bleed very heavily. Since the wall of a varicose vein is very weak, a small injury can easily tear it open. To stop the bleeding, a pressure bandage should be applied and the person should be placed in a lying position.

To further reduce the pressure, the corresponding leg can be raised. In the case of a ruptured varicose vein, it is definitely advisable to consult a doctor in order to ensure safe healing of the wound and appropriate therapy. For treatment, either compression therapy is used or a minor surgical procedure to remove the affected vessel is performed. If varicose veins on the leg are at great risk of bursting, they should be removed prophylactically or obliterated.