Varices

The venous system in the legs consists of both a superficial and a deep system.

• The superficial system consists of small veins that form a network around the leg. About 10-20% of the blood from this system collects into two larger main veins: the vena saphena magna (VSM) and the vena saphena parva (VSP). These empty into the deep system at the groin and the popliteal fossa (behind the knee).
• The deep system carries 90% of the blood and is embedded in the leg muscles. Blood is transported from the superficial to the deep system via connecting veins (perforating veins).

The function of veins

Veins ensure the return of blood to the heart. This is done through the muscle pump, where the contraction of muscles during movement pushes blood upward into the deep veins. The calf muscle pump is the most important in this process. Even while sitting, foot movement can help promote blood circulation.

Veins have valves that prevent blood from flowing backward.

How do varicose veins form?

When veins dilate, the valves no longer close properly. This can also happen if the valves are damaged, for example, by thrombosis. This results in a backflow of blood, leading to increased pressure and further dilation of the vein. This process continues and causes varicose veins.

Several factors play a role in the development of varicose veins:

• Heredity – Varicose veins often develop due to a congenital weakness of the connective tissue.
• Gravity – Because people stand upright, varicose veins mostly develop in the lower legs.
• Pregnancy – Hormonal changes and pressure from the growing uterus on the veins increase the risk of varicose veins.
• Hormonal factors – The effect of hormones (e.g., birth control pills) is not fully understood, but many women experience worsened varicose veins around their menstruation.
• Standing profession – Jobs that require prolonged standing and lifting (e.g., hairdressers, factory workers) increase the risk of varicose veins.
• Thrombosis leg – Previous thrombosis can damage deep veins and lead to increased pressure in the superficial system, resulting in varicose veins.
• Overweight – This increases the chance of varicose veins due to additional pressure on the blood vessels.

What are the complaints and symptoms?

Varicose veins can cause symptoms, including:

• A tired, heavy, or achy feeling in the legs.
• Itching, tingling, or restless legs.
• In rare cases, pain or bleeding from a varicose vein.
• Edema (fluid retention) around the ankles due to poor blood return.
• In severe cases, pigmentation spots, eczema, skin thickening, or even an open leg (ulcus cruris venosum).

However, many people experience no symptoms and find varicose veins mainly cosmetically disturbing.

How is the diagnosis made?

The doctor assesses varicose veins through a physical examination while standing. Additional tests are done to determine the function of the deep veins and choose the best treatment method.

Important tests include:

• Doppler examination – A painless test where blood flow in the veins is made audible using ultrasound waves.
• Duplex examination – A combination of Doppler and ultrasound, which makes the function of valves and the presence of possible blood clots visible.

Treatment options

Varicose veins can be treated in several ways.

1. Compression therapy
   Elastic bandages or stockings help with blood circulation and reduce symptoms.
2. Sclero-compression therapy (sclerotherapy)
   The varicose veins are injected with a liquid or foam that sticks the vein walls together, causing them to shrink.
3. Surgical removal

• Ambulatory phlebectomy – Small varicose veins are removed under local anesthesia through mini-incisions.
• Crossectomy and stripping – The main vein is closed at the groin or behind the knee with a small incision and removed with a stripping wire.

4. Endovenous techniques (catheter treatments)

• Radiofrequency ablation (RFA) and endovenous laser therapy (EVLT) – The vein is sealed from the inside using a catheter. This is less invasive than stripping and provides quick recovery.

Often, various methods are combined for the best result.

Complications

Most treatments are successful, but possible complications include:

• Bruising and mild pain after treatment.
• Skin discoloration and, in rare cases, damage to surrounding tissues.
• Very rarely: thrombosis or pulmonary embolism.

What can you do yourself?

• Move regularly, walking helps.
• Avoid standing or sitting for long periods and excessive heat.
• Raise your legs when sitting for long periods to promote blood circulation.

What are the prospects?

The success of treatment depends on the cause and extent of the varicose veins. In some people, varicose veins return after a few years, while in others, they remain gone for a long time. Treatment removes existing varicose veins but does not prevent new ones from developing.