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Venenzentrum Zürcher Oberland
Dr. Hilde Berwarth

Frequently asked questions about varicose veins and spider veins

How are varicose veins actually removed?

Varicose veins are the diseased side branches of a diseased truncal vein, not the diseased truncal vein itself.

Varicose veins are therefore removed in two successive steps, but both can usually be done in one session. First the affected truncal vein is treated. This can be done with the classic operation, which is sometimes still necessary in severe cases, or with one of the modern endovenous procedures (EVT), which can be performed on an outpatient basis.

In the first step, the affected, diseased truncal vein is “switched off”, i.e. removed. If the therapy were to be stopped here, the diseased side branches of this truncal vein, i.e. the actual varicose veins, would still be visible. These varicose veins must therefore be removed in a second step by a so-called phlebectomy. The extent of the phlebectomy depends on the length, the course and the number of the diseased side branches (= varicose veins) and can range from a few cm to 2m. Before the actual varicose veins can be removed, the diseased truncal vein should first be treated.

By the way, a diseased truncal vein cannot be visually recognised from the outside. Only ultrasound diagnostics can detect a disease of the truncal veins. Varicose veins are an indicator of a disease of the truncal vein. This is why you should not wait too long before carrying out an examination after the first varicose veins have been detected. Generally speaking, the earlier the diseased truncal vein is detected and treated, the smaller the intervention will be.

 Is prolonged standing the cause of my varicose veins?

Healthy legs are an important prerequisite for coping with our everyday life, especially in an ageing society. Varicose veins are therefore not only aesthetically disturbing, they are also a medical problem. Walking upright has led to the venous system of the legs being put under too much strain. The venous valves no longer close sufficiently, which then leads to the well-known, ugly venous dilatations (varicose veins) due to the increased pressure.

Varicosis is therefore not acquired but is congenital. Blood congestion not only leads to varicose veins, but also to disruption of the oxygen exchange in the skin and subcutaneous tissue, which triggers inflammatory processes. This leads to swelling of the lower legs, skin changes, itching, pigmentation, hardening (sclerosis) and, in the worst case, to open legs. Once skin changes have occurred, they are often irreversible. This makes it all the more important to recognise the symptoms and take measures. Duplex sonography (ultrasound) can be used to diagnose the disease easily and reliably.

Whereas compression therapy used to be considered the gold standard, minimally invasive surgical treatments are now recommended at an early stage. These can be carried out without long periods of absence from work and are therefore cost-effective.

These include endovenous therapies such as ClosureFast, laser or radiofrequency as well as foam sclerotherapy. These procedures can be carried out on an outpatient basis under local anaesthesia. It is no longer necessary to wear compression stockings for weeks after the treatment. This is why these procedures are also carried out all year round.

Many people can thus be spared years of wearing compression stockings with all their unpleasant side effects. Older people or people who are handicapped by arthrosis in particular are often no longer able to wear compression stockings.

Shouldn’t you wait until you are old before having varicose veins removed?

Patients and also doctors often think that varicose veins come back again and again, so it makes sense to remove them as late as possible. However, this idea has no scientific basis whatsoever.

Correctly treated varicose veins have a chance of recurrence of about 5%. Since varicose veins are not only an aesthetic problem but can also lead to severe changes in the skin and subcutaneous tissue, they should be treated as early as possible. Once skin changes have occurred, they cannot be reversed.

Even if a recurrence does indeed occur, as varicose veins are called, which come back, treatment should be sought as soon as possible. The smaller the finding, the smaller the intervention.

Classical surgery or endovenous therapy?

The question often arises as to which therapy is the better one; classical surgery (crossectomy and stripping) or endovenous therapy?

Both forms of therapy have their justification. Which one comes into question depends on the individual diagnosis. The endovenous therapy methods have now been developed to such an extent that they can be used in the majority of cases.

It is also claimed that the classic operation is the “only true” method, as it is the most thorough and no recurrence will occur. With the endovenous methods, the veins would not close properly in 1/5 of the cases.

In more than 20 years of experience with all methods, I can only confirm that the modern, endovenous methods are equal to the classical method. Only if the endovenous forms of therapy are not carried out properly and thoroughly can it lead to the affected veins not closing completely and consequently not receding completely. This can happen if the catheter is withdrawn from the vein too quickly and too little heat is induced. However, thoroughness is also a top priority in a classic operation. The small side branches also need to be removed so that no recurrences can form there later.

It is also occasionally claimed that recurrences only occur after endovenous therapies, but not with conventional therapy. This is also not true. Recurrences occur again regardless of the method of the initial therapy, recurrences are mainly genetic.

Do I have spider veins because I cross my legs?

Many patients believe that their spider veins are caused by crossing their legs when sitting. This is not correct. Even after standing a lot, you do not get spider veins. Spider veins are rather rare as a result of varicose veins. They usually develop completely independently of diseased veins. Even young people can suffer from spider veins.

But they are more common in older people. A genetic disposition (heredity) is usually the deciding factor.

Varicose veins are not only a cosmetic problem

Varicose veins should be treated at an early stage because they can lead to complications such as phlebitis, skin changes and even open legs. It does not make sense to postpone the treatment of varicose veins, as this would only make the operation more extensive.

It is not unusual for deep varicose veins to be affected as well. Although their pathological changes are not as obvious, their effects should not be underestimated. Circulatory disorders then lead to skin changes up to the so-called “open leg”, although superficially no tortuous varicose veins can be detected.

Where does the blood flow to when a diseased vein is removed?

If a diseased, superficial vein (i.e. varicose vein) has been surgically removed or sclerosed with one of the endovenous therapies, many patients ask themselves the question where the blood then flows to? What alternative options does the venous blood then have?

The superficial venous system is a highly branched “network” of veins. If one truncal vein fails, the blood finds numerous other, healthy veins through which it flows back to the heart. You can think of the system as communicating tubes. Even if several diseased truncal veins are removed or obliterated, this has no negative effect on the return flow of blood.

Do varicose veins always recur?

The recurrence of varicose veins after therapy is called recurrent varicosis. Only varicose veins that recur in a place that has already been operated on are called recurrent varicose veins.

The probability of recurrence after a few years is less than 5% if the initial treatment is carried out carefully. This is then called neoangiogenesis. These recurrences often occur in the groin or back of the knee.

However, most recurrences occur if mistakes were made during the initial treatment. These are not real recurrences. Reasons for recurrences of varicose veins are diseased sections of veins that have not been removed. If a recurrence occurs, regardless of the cause, it should be treated as early as possible. In this way the intervention can be kept small.

What does a venerologist actually do?

A venereologist does NOT deal with veins, as one would expect.

A venereologist deals with venereal diseases. Venereology is the study of sexually transmitted (venereal) diseases (the word comes from “Venus”, Venus was the Roman goddess of love, erotic desire and beauty). A doctor who treats varicose veins is called a phlebologist.

You wouldn’t have thought so, would you?

Compression stockings do not eliminate varicose veins

Wearing compression stockings for varicose veins is often recommended as therapy. Wearing them alone often relieves symptoms such as heaviness and swelling, but it does not generally eliminate visible varicose veins. Compression stockings must be worn for life.

The disadvantages of compression therapy are the lack of comfort in hot weather, and it is no longer possible for many people, especially old or sick people, to put them on on their own.

If there is a disease of the deep vein system or the lymphatic system, wearing compression stockings is the only possible therapy. After an operative intervention (surgical or endovenous), wearing compression stockings supports the healing process. Usually a few days are sufficient for this.

There are different compression classes (I-III), whereby compression class I is the weakest. Health insurance companies only pay for compression classes II and III. Two pairs are reimbursed per year. There are also support stockings, which exert even less pressure but are often sufficient to prevent slight swelling. These are also not reimbursed by health insurance companies.

What does a phlebologist do?

The word phlebology is made up of the Greek word phleps (= blood vein) and logos (= teaching). The phlebologist deals with vascular diseases, especially those of the venous system.

If the phlebologist is also a surgeon, he can carry out all the necessary therapies, including the classic operation “crossectomy and stripping”. This has the advantage that a complete therapy plan can be developed and carried out by the same doctor in the optimal sequence as a holistic therapy.