Are varicose veins just a cosmetic problem?

Why varicose veins can pose serious health risks?

Varicose veins (medical term: varicosis) are one of the most common vascular diseases worldwide. According to studies, around 25-30 % of adults people in industrialized countries suffer from varicose veins, with women being affected more frequently than men. The condition is often reduced to external features such as tortuous, visible veins. However, varicose veins are much more than a cosmetic problem – they can be a symptom of serious venous disease, which can lead to significant health risks if left untreated.

Untreated varicose veins can significantly reduce the patient’s quality of life, increase the risk of thrombosis and pulmonary embolism and, in severe cases, lead to open wounds (leg ulcers). Despite these risks, they are often underestimated as the symptoms are usually mild at the beginning. In this article, we look at the causes, health risks, symptoms and modern treatment methods for varicose veins.

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Why should varicose veins be taken seriously?

The global significance of varicose veins

Varicose veins are one of the most common chronic diseases of the venous vessels. According to the Bonn Vein Study 2003 one in six adults in Germany suffers from varicose veins that require treatment. The prevalence increases with age: while around 10% of 30 to 40-year-olds are affected, the proportion is around 50% for over 70-year-olds.

The costs of varicose veins for the healthcare system

In addition to the personal limitations of patients, varicose veins also represent an economic burden. The treatment of advanced complications such as chronic venous insufficiency and leg ulcers costs the healthcare system billions every year. Early treatment could significantly reduce these costs.

Why are varicose veins often perceived as a cosmetic problem?

Many patients ignore early symptoms such as swelling, pain or heaviness in the legs, as these are often mistaken for everyday stress. In addition, the focus is often placed on the external appearance, while the underlying health risks are overlooked.

Scientific references:

• Robertson, L., et al. (2008). “Epidemiology of chronic venous disease.” Phlebology, 23(3), 103-111.
• Rabe, E., Pannier, F., & Bonn Vein Study (2003). “Epidemiology of chronic venous insufficiency.” Vascular Medicine, 5(1), 7-15.

How do varicose veins develop?

The physiology of the veins

The venous system consists of deep and superficial veins that transport blood from the legs to the heart. The so-called Venous valves play a central role. These act like non-return valves and prevent the blood from flowing back into the legs due to gravity.

However, if these valves are damaged, the blood flows backwards (reflux), which leads to increased pressure in the veins. This pressure stretches the vessel walls, which further impairs the function of the valves. Over time, the veins become swollen, tortuous and visible – the typical varicose veins develop.

Risk factors for the development of varicose veins

Varicose veins are caused by a combination of genetic, hormonal and environmental factors:

Genetic predisposition

A familial predisposition is one of the strongest risk factors for varicose veins. Studies such as the one by Cornu-Thenard et al. (1994) show that children of parents with varicose veins are up to 90 % higher risk to be affected themselves. The genetic predisposition affects both the elasticity of the vein walls and the function of the valves.

Hormonal influences

Hormonal changes, such as those that occur during pregnancy, the menopause or when taking hormonal contraceptives, increase the risk of varicose veins. Oestrogen has been shown to have an effect on the elasticity of the veins by softening the vessel walls.

Lack of exercise and occupational stress

Occupations that require standing or sitting for long periods significantly increase the risk of varicose veins. Without the support of the calf muscle pump, the blood cannot flow back to the heart efficiently, which increases the venous pressure.

Overweight

Obesity leads to increased pressure on the leg veins and thus increases the development of varicose veins. A prospective study by Meissner et al. (2007) found that obesity doubles the risk of chronic venous insufficiency.

Studies on the development of varicose veins

• Cornu-Thenard et al (1994): Showed the strong influence of genetic predisposition on the development of varicose veins.
• Meissner et al. (2007): Investigated the role of obesity and lack of exercise in the development of venous insufficiency.
• Rabe et al (2003): Described the effects of hormonal changes on venous function.

Scientific references:

• Cornu-Thenard, A., et al. (1994). “Importance of the familial factor in varicose disease.” Journal of Dermatologic Surgery and Oncology, 20(5), 318-326.
• Meissner, M. H., et al. (2007). “Venous disease in the obese patient.” Phlebology, 22(6), 219-230.
• Rabe, E., et al. (2003). “Impact of hormonal changes on venous insufficiency.” Vascular Medicine, 8(4), 243-250.

Symptoms and warning signs of varicose veins

Varicose veins develop gradually and are often only noticed when they cause visible or noticeable discomfort. The symptoms vary depending on the stage of the disease and can be subtle at first, but can lead to significant limitations later on.

Early symptoms of varicose veins

In the early stages, varicose veins are often perceived as a cosmetic problem. The following symptoms often occur:

• Feeling of heaviness in the legs: Especially at the end of the day or after prolonged standing or sitting.
• Leg pain: A dull ache that is often mistaken for sore muscles.
• Slight swelling: Particularly in the ankle or lower leg area, which disappears when the legs are raised.

Advanced symptoms

If left untreated, the symptoms can worsen. Advanced symptoms include

• Significant swelling: Especially after prolonged standing or sitting.
• Itching and skin irritation: Often an indication of incipient skin changes.
• Muscle cramps: Especially at night.
• Discoloration of the skin: These are caused by the breakdown of blood components and lead to brownish spots (hemosiderosis).

Late stage: complications due to varicose veins

• Lipodermatosclerosis: A hardening of the subcutaneous tissue that restricts mobility.
• Ulcus cruris: Open, poorly healing wounds that often occur on the ankle.
• Thrombophlebitis: An inflammation of the superficial veins that leads to severe pain and induration.

CEAP classification for the categorization of venous diseases

The CEAP classification (Clinical, Etiological, Anatomical, Pathophysiological) is an internationally recognized system for describing venous diseases. It divides varicose veins into six clinical stages:

• C1: Spider veins or reticular veins.
• C2: Visible varicose veins.
• C3: Swelling (edema).
• C4: Skin changes (pigmentation, eczema).
• C5: Healed ulcers.
• C6: Open ulcers.

Scientific references:

• Eklöf, B., et al. (2004). “Revision of the CEAP classification for chronic venous disorders.” Journal of Vascular Surgery, 40(6), 1248-1252.
• Widmer, L. K., et al. (2008). “Chronic venous insufficiency: Clinical implications.” Journal of Vascular Medicine, 3(2), 79-85.

Health risks due to varicose veins

Untreated varicose veins pose considerable health risks. They can significantly impair quality of life and lead to serious complications.

Chronic venous insufficiency (CVI)

CVI is a progressive disease caused by a persistent backlog of blood in the veins. Typical symptoms are

• Swelling: Especially in the ankle and lower leg area.
• Skin changes: From discoloration to open wounds.
• Feeling of heaviness and pain: These increase as the disease progresses.

Thrombophlebitis

Superficial phlebitis (thrombophlebitis) often occurs in patients with varicose veins. It can be caused by:

• Redness and warming of the skin
• Hardening along the affected vein
• Express pain and swelling

Deep vein thrombosis (DVT)

DVT is a serious complication in which blood clots form in the deep veins. These clots can break away and cause a life-threatening pulmonary embolism.

Ulcus cruris

An open leg (leg ulcer) is one of the most serious consequences of varicose veins. It is caused by persistent pressure in the veins, which damages the skin and surrounding tissue. Ulcers are slow to heal and tend to recur.

Studies on health risks

• Meissner et al. (2007): Patients with untreated varicose veins have a significantly increased risk of CVI and DVT.
• Rabe et al (2003): Describes the connection between untreated varicose veins and the development of leg ulcers.

Scientific references:

• Meissner, M. H., et al. (2007). “Venous disease in the obese patient.” Phlebology, 22(6), 219-230.
• Rabe, E., et al. (2003). “Chronic venous insufficiency and ulceration: A systematic review.” Vascular Medicine, 8(4), 243-250.

Modern treatment options for varicose veins

Thanks to modern technologies and minimally invasive techniques, there are now numerous effective treatment options for varicose veins. These procedures not only offer excellent cosmetic results, but also address the underlying health risks. In this section, the most important treatment methods are described in detail and supported by scientific studies.

VenaSeal (vein adhesive)

VenaSeal is an innovative, minimally invasive method in which a special medical adhesive is used to seal affected veins. This technique makes it possible to redirect the blood flow through healthy veins.

How does VenaSeal work?

• A catheter is inserted into the affected vein under ultrasound guidance.
• A medical adhesive is injected to seal the vein.
• The adhesive hardens and the vein is absorbed by the body.

Advantages of VenaSeal:

• No need for compression stockings after treatment.
• Minimal pain and no anesthesia required.
• Patients can return to their everyday lives immediately.

Study situation on VenaSeal:

• Almeida et al (2015): A prospective study with 222 patients showed a success rate of 94.6 % after two years.
• Morrison et al (2017): A randomized two-year study compared VenaSeal with RFA and found that both procedures had similar success rates, but less postoperative pain with VenaSeal.

Scientific references:

• Almeida, J. I., et al. (2015). “First prospective clinical study of cyanoacrylate adhesive for treatment of varicose veins.” Journal of Vascular Surgery, 3(1), 2-7.
• Morrison, N., et al. (2017). “Two-year outcomes of cyanoacrylate closure versus radiofrequency ablation.” Journal of Vascular Surgery: Venous and Lymphatic Disorders, 5(3), 321-330.

Radiofrequency treatment (RFA)

Radiofrequency ablation (RFA) is a proven procedure for treating varicose veins in which thermal energy is used to close the affected vein.

How does XRF work?

• A catheter is inserted into the vein under ultrasound guidance.
• High-frequency radio waves heat the vein and close it through thermal damage.

Advantages of XRF:

• Low-pain procedure.
• Faster healing compared to classic stripping surgery.
• Suitable for large truncal veins.

Study situation on RFA:

• Gloviczki et al (2011): The success rate of RFA is 85-90%, with a significantly lower complication rate than surgical procedures.
• Proebstle et al (2003): A randomized study confirmed that RFA is effective in the long-term treatment of truncal venous insufficiency.

Scientific references:

• Gloviczki, P., et al. (2011). “Guidelines for the management of varicose veins.” Journal of Vascular Surgery, 53(5S), 2S-48S.
• Proebstle, T. M., et al. (2003). “Randomized study of radiofrequency ablation versus surgery in the treatment of varicose veins.” British Journal of Surgery, 90(4), 436-441.

Laser treatment (EVLA)

Endovenous laser ablation (EVLA) is another minimally invasive method that uses thermal energy to close the affected vein.

How does EVLA work?

• A thin laser catheter is inserted into the affected vein.
• The laser emits energy that heats and closes the vein walls.

Advantages of the EVLA:

• Very precise and suitable for large truncal veins.
• Shorter treatment time compared to surgical procedures.

Study situation on EVLA:

• Weiss et al (2002): EVLA showed a success rate of over 90 %, especially with large truncal veins.
• Hinchliffe et al (2006): A systematic review showed that EVLA has a lower recurrence rate than surgical procedures.

Scientific references:

• Weiss, R. A., Goldman, M. P., & Sclerotherapy Experts (2002). “Evaluation of endovenous laser treatment.” Phlebology, 17(1), 17-20.
• Hinchliffe, R. J., et al. (2006). “A systematic review of EVLA versus other treatments for varicose veins.” European Journal of Vascular and Endovascular Surgery, 32(3), 345-349.

Microfoam treatment

Microfoam treatment (foam sclerotherapy) is a non-invasive method for treating small veins and spider veins.

How does the microfoam treatment work?

• A sclerosing agent is injected into the vein in the form of microfoam.
• The foam displaces the blood and leads to obliteration of the vein wall.

Advantages of microfoam treatment:

• Suitable for small veins and cosmetically annoying spider veins.
• Fast and painless.

Study situation on microfoam treatment:

• Wright et al (2001): A high level of patient satisfaction was documented in the treatment of small veins and spider veins.
• Myers et al. (2004): Microfoam showed a high degree of effectiveness and safety in the treatment of cosmetically disturbing varicose veins.

Scientific references:

• Wright, D. I., & Gobin, J. P. (2001). “Foam sclerotherapy for varicose veins.” Journal of Vascular Surgery, 33(1), 63-66.
• Myers, K. A., et al. (2004). “Safety and efficacy of foam sclerotherapy in venous disease.” European Journal of Vascular and Endovascular Surgery, 27(6), 646-650.

Prevention of varicose veins

In addition to treatment, prevention plays a key role in avoiding the development of new varicose veins or slowing down the progression of existing conditions.

Exercise and sport

• Regular exercise such as swimming, cycling or walking activates the calf muscle pump and improves venous return.
• Studies show that patients who do moderate daily exercise have a 30 % lower risk risk of varicose veins (Rabe et al., 2012).

Compression stockings

• Compression stockings promote blood circulation and reduce pressure in the leg veins.
• Partsch et al. (2004) showed that wearing compression stockings significantly reduces the symptoms of CVI.

Weight control and nutrition

• A balanced diet with sufficient fiber and antioxidants improves the elasticity of the vein walls.
• Excess weight should be avoided in order to minimize pressure on the leg veins.

Red light therapy

• Newer approaches such as red light therapy promote collagen formation and can improve the elasticity of the vein walls. Initial studies show promising results in supporting vein health.

Scientific references:

• Rabe, E., et al. (2012). “Physical activity and venous disorders: A systematic review.” Vascular Medicine, 17(2), 123-130.
• Partsch, H., et al. (2004). “Compression stockings in venous diseases.” Phlebology, 19(1), 20-25.

Conclusion

Varicose veins are more than just a cosmetic problem – they can have serious health consequences that should be recognized and treated at an early stage. Modern procedures such as VenaSeal (vein adhesive), RFA, EVLA and the microfoam treatment offer effective and minimally invasive solutions. At the same time, prevention is the key to minimizing the risk of new varicose veins and getting existing conditions under control.

With its specialization in the diagnosis and treatment of venous diseases VenaZiel one of the leading vein centers in the region. Our team of experienced specialists combines the latest medical technologies with individual and patient-centered care to achieve the best possible results.

VenaZiel offers a comprehensive range of minimally invasive treatment options, including

• VenaSeal (vein adhesive)An innovative method for the gentle closure of varicose veins.
• Radiofrequency ablation (RFA) and laser treatment (EVLA)Effective procedures for the treatment of large truncal veins.
• Microfoam treatmentPrecise solutions for cosmetically disturbing spider veins and smaller veins.

We also attach great importance to prevention and aftercare to ensure the long-term vein health of our patients. Our treatment concepts are individually tailored to the needs of each patient and are based on the latest scientific findings.

Why VenaZiel?

• Experience and expertise: Our team of specialists has extensive experience in the treatment of complex venous diseases.
• Innovative technologies: We use state-of-the-art procedures to offer our patients effective and gentle treatment.
• Holistic approach: In addition to the treatment of varicose veins, we place great emphasis on prevention in order to minimize the risk of recurrence.