Varicose veins (varices)

Varicose veins – cause and development

How do varicose veins develop? Through the expansion of superficial veins – predominantly on the legs. The medical term for varicose veins is varices. When referring to the condition, it is called varicosities. In Europe, every second woman and every fourth man suffers from varicose veins. Every 8th adult is affected by an already advanced chronic varicosity.

• Overweight
• Excessive standing (e.g., in the profession)
• Pregnancy
• Lack of physical activity

Varicose veins – symptoms & complications

Varicose veins often cause no discomfort. If varicose veins cause pain, it is usually expressed through the following symptoms:

• Leg swelling
• Feeling of tension
• Heavy legs
• Muscle cramps
• Inflammations
• Thrombosis
• Pulmonary embolism
• Chronic venous insufficiency
• Open leg

To avoid complications such as pulmonary embolism or chronic venous insufficiency, you should seek proper varicose vein therapy promptly if symptoms occur.

Varicose veins – therapy & removal

There are different medical treatments for varicose veins – with or without surgery. Dr. med. Andreas Franczak can offer you treatment methods that are best for your individual diagnosis.

Vein sclerotherapy/Foam sclerotherapy

Sclerotherapy is low-risk and minimally burdensome for the patient. Sclerotherapy is suitable for removing the following varicose veins:

• Branch and spider varices
• Remaining varices after surgery

Even trunk varicosities can be treated with foam sclerotherapy. However, the recurrence rates here are higher than with other methods. The latest studies showed that the relapse rate (pathological reflux) after foam sclerotherapy of the great saphenous vein (vena saphena magna) is 60% after 3 years.

Varicose vein surgery

The traditional treatment method fortrunk varicosities is surgery. The following procedures can be used to remove varicose veins:

• Crossectomy (ligation and division of the diseased vein and all side branches at the junction to the deep vein)
• Stripping (removal of the diseased vein using a probe introduced from the inside)
• To minimize bruising, stripping can be done from the outside (so-called external phlebectomy)
• Endoscopic fasciotomy (minimally invasive and suitable in advanced stages with ulcer formation)
• ESPD (Endoscopic Subfascial Perforans Dissection is minimally invasive and ties off perforator veins deep within)

Varicose vein surgery is mostly performed under spinal anesthesia. Additionally, side branches can be removed through small skin incisions.

Compression treatment

If surgery is not a therapy option for varicose veins, elastic wraps or compression stockings can help alleviate symptoms of varicose veins. Temporary compression treatment is also suitable for a few weeks after surgery.

Varicose vein laser treatment

Laser or radiofrequency treatments are less invasive, where the varicose veins are not removed. Instead, the diseased vein is closed endoluminally (from the inside) and remains in the body. The heat application during radiofrequency ablation (RFA) (e.g., RFiTT-Celon) causes the vessel to shrink, sealing the inner walls of the veins and naturally rerouting blood flow through healthy veins. This method is suitable for treating certain forms of varicose veins. Long-term results of laser therapy or RFA show low recurrence rates and a better cosmetic outcome.

Medical treatment for varicose veins with VenaSeal or MOCA

This is an new method of less invasive, endovascular treatment of varicose veins. MOCA means mechanochemical endovenous ablation and is performed in that way, that under ultrasonography control a catheter is introduced in the sick vein and a simultaneous irritation of the inside wall of the vein and the administration of sclerotherapy is achieved. It leads to the closure of the sick vein. The adventage over the RFA or laser is that no heat is produced and at this way is eliminated the risk of nerval irritation. We prefer this treatment in suitable cases of varicosis ( http://youtu.be/-RBhpGdmH7I )

• No heat is applied
• Skin nerves are not irritated
• Purely local anesthesia is possible

Author: Dr. Andreas Franczak, specialist in surgery, vascular surgery and visceral surgery