Understanding varicose veins (varicosis): Causes, symptoms, stages & modern treatment methods

1 Introduction: What are varicose veins (varicosis)?

Varicose veins – also known medically as varicose veins or varicosis are permanently enlarged, tortuous superficial veins that mainly occur on the legs. They are caused by chronic venous insufficiency, in which the venous valves no longer close properly. The blood no longer flows efficiently back to the heart and builds up in the legs – resulting in the typical dilation of the veins.

Varicosis is not a harmless symptom of old age, but a chronic venous disease. Depending on its severity, it can lead to symptoms such as:

• Feeling of heaviness or tightness in the legs,
• itching and visible changes in the veins,
• swelling (especially in the evening or in summer),
• and in advanced stages can even lead to skin damage or open legs (leg ulcers).

1.1. What does “varicosis” mean in medical terms?

The term varicosis describes the clinical picture of varicose veins as a whole – not just individual dilated veins, but the chronic chronic disease of the superficial venous system. It mainly affects the great and small saphenous veins and can cause mild symptoms or serious complications, depending on how it progresses.

The medical term “varicosis” is often used synonymously, as both terms refer to the same thing: a pathological dilation of superficial veins as a result of vein wall weakness and valve insufficiency.

1.2. Varicose veins or spider veins – what’s the difference?

Many patients confuse spider veins with varicose veins – these are two two different forms of venous disease:

Spider veins are fine networks of small veinswhile varicose veins are significantly larger and often symptomatic. Both can occur individually or together – and are an expression of the same underlying venous weakness.

1.3. Why are varicose veins considered a widespread disease?

Varicose veins are extremely common – and therefore rightly a widespread disease. According to the Bonn Vein Study II of the German Society for Phlebology:

• over 60 % of adults in Germany show signs of venous disease,
• about 20 % suffer from varicosis requiring treatment,
• Women are more frequently affected, but many men also develop varicose veins in the course of their lives.

Risk factors such as lack of exercise, standing activities, obesity or hormonal changes favor the development – often for years. And yet varicosis remains untreated for a long time because the first symptoms are often dismissed as “normal”.

Note: Many patients think that varicose veins are just a cosmetic problem. However, if left untreated, varicosis can have serious consequences – from painful vein inflammation to chronic wounds.

In the following sections, we explain the causes, stages and state-of-the-art treatment options for this often underestimated condition – and what you can do yourself to actively protect your vein health.

2. causes and risk factors of varicose veins (varicosis)

Varicose veins – known medically as varicose veins – do not develop suddenly. They usually develop over many years due to the interaction of several factors. The most common cause is a congenital venous insufficiency – but lifestyle, hormones, pregnancy, age and diseases such as thrombosis also play an important role.

2.1. Genetic venous insufficiency (primary varicosis)

The most common cause of varicose veins is inherited weakness of the connective tissuewhich affects the walls and valves of the veins. Many patients show:

• A familial clusteringIf parents or siblings are affected, the risk is significantly increased.
• The vein walls are less elasticand the venous valves no longer close completely.
• This leads to blood pooling in the superficial leg veins sinksinstead of flowing back to the heart (reflux).

This form of varicosis is known as primary It occurs without any previous disease and affects about 80-90 % of cases.

2.2. Lack of exercise and standing activities

Our venous return is dependent on muscle movement – especially in the legs. If we sit or stand for long periods, this return flow is impeded:

• The muscle pump of the calves (especially the soleus muscle) comes to a standstill.
• The blood remains in the legs for longer – the veins gradually gradually overstretch.
• People in professions with a lot of standing or sitting (e.g. sales assistantssalespeople, hairdressershairdressers, office workers).

Practical tip: Regularly walking around, rocking your feet or lifting your calves while sitting activates the muscle pump and can significantly reduce the risk.

2.3. Pregnancy and hormonal changes

Varicose veins often occur for the first time during pregnancy for several reasons:

• Hormones such as progesterone loosen the vessel walls to make the tissue more elastic.
• The blood volume increases by up to 50 % – an enormous strain on the veins.
• The growing uterus can compress the compress the pelvic veinswhich hinders the return flow from the legs.
• In addition, the blood flow in the legs slows down, which also increases the risk of thrombosis.

Important: Many pregnancy varicose veins disappear after the birth – but may persist or worsen with further pregnancies if you are predisposed to them.

2.4. Overweight and increased venous pressure

Obesity is a significant risk factor:

• The more body weight there is on the leg veins, the greater the hydrostatic pressure when standing.
• In addition, there is a mechanical strain on the venous valves.
• Visceral fat in the abdomen also acts like a compression belt on the pelvic veins – the return flow is congested.

Already a body mass index (BMI) over 25 can measurably increase the risk of varicosis.

2.5. Other aggravating factors: smoking, age, medication

The following triggers also worsen vein function:

• Smoking directly damages the vascular walls – leading to loss of elasticity, microcirculatory disorders and inflammatory processes.
• AgeWith increasing age, the elasticity of the connective tissue decreases. The number of functioning venous valves also decreases.
• Hormone preparations (e.g. the pill, hormone replacement therapy) increase vein wall permeability and influence coagulation.

Women are statistically more frequently affected – especially between 35 and 55 years.

2.6. Secondary causes: Thrombosis and phlebitis

Not every varicosis is primary. There are also secondary varicose veinswhich occur as a result of other diseases:

• Deep vein thrombosis (DVT)A blocked or damaged deep vein in the leg can block the drainage – the pressure backs up into the superficial system.
• Phlebitis (inflammation of the veins)Inflamed vein sections can leave scars and valve insufficiency.
• Chronic venous insufficiency (CVI) can be caused by both processes – with symptoms such as swelling, skin changes and ulcers.

Secondary varicosis often occurs unilateralsuddenly and in conjunction with other symptoms (e.g. pain, overheating) – and should be urgently clarified by a doctor.

2.7. Why knowledge of causes is crucial

The causes of varicose veins are varied – but can often be influenced. If you recognize risk factors early and take targeted countermeasures, you can significantly slow down the development.

Recommended measures for prevention:

• Daily exercise and vein training
• Avoid prolonged sitting or standing
• Maintain a normal weight
• Wear compression stockings at an early stage
• Quit smoking and conscious use of hormone preparations

In the next section you will find out which symptoms indicate varicosis – and what you should look out for in everyday life in order to react early.

3. symptoms and complaints of varicose veins (varicosis)

3.1. Visible tortuous veins as the first sign

Varicose veins (medical term: varicosis) often first become apparent through visible, tortuous veins noticeable. Typically, bluish-purplish colorations appear on the calves or inner sides of the legs, uneven veins under the skin emerge. Initially, these dilated veins are mainly a cosmetic problem and cause No or hardly any complaints. However, many sufferers find the nodular, thickened veins disturbing and avoid showing their legs in public, for example.

Heavy, tired legs and a feeling of tension

As the venous disease progresses, the following often occur heavy, tired legs on. Those affected report that their legs feel particularly sore after prolonged standing or sitting. lead heavy and tire more quickly. Often a Feeling of tension or pulling in the calves. These symptoms typically become more noticeable towards the evening if the legs have been strained during the day. Standing for long periods – for example at work – further exacerbates the symptoms. Many patients then complain of “heavy legs” and an unpleasant feeling of pressure. Pain in the legs may also occur, usually as a dull ache or burning sensation along the affected vein. Elevating the legs (e.g. on the sofa in the evening) or exercise usually provides relief.

Swelling and thick ankles

Another common symptom is Swelling of the feet or anklesespecially during the course of the day. The reason for this is that the blood congestion causes more fluid to escape from the veins into the tissue. Initially, such Edema The swelling is particularly noticeable in the evening – for example, sock marks on the ankles. Over time, swelling can become more severe and also affect the calves. Important: If one side of the leg suddenly swollen leg on one side there is a suspicion of deep vein venous thrombosis (clot in a deep vein). In this case you should seek medical help immediately seek medical help immediately.

Itching and skin changes

Varicose veins can affect the skin and cause itching can lead to this. Some sufferers experience dry, tight skin on the lower legs, which often itches. The cause is Stasis dermatitis (stasis dermatitis)The chronic congestion of blood means that the skin is less well supplied with nutrients, resulting in reddish or brownish discoloration and scaly areas. Typical are brownish Skin discoloration on the ankle or shin, caused by the deposition of blood breakdown products (hemosiderin). Also Eczema (itchy skin rashes) may occur. In advanced stages, there is hardening of the subcutaneous tissue (lipodermatosclerosis) and whitish, scar-like areas of skin known as Atrophy blanche. Such skin changes are warning signs of chronic venous insufficiency and should be examined by a doctor.

3.2. Nocturnal calf cramps and restlessness in the legs

Less obvious symptoms include Muscle cramps in the calvesespecially at night. Many patients with varicose veins report frequent nocturnal calf cramps. These can be very painful and disturb sleep. There can also be a feeling of Restlessness or tingling in the legs occur. Those affected then feel a barely suppressible urge to move their legs to get rid of the feeling of restlessness. Also Sensitivity to heat is typical: In warm weather, the legs feel uncomfortably hot more quickly. overheated to. Such symptoms are easily overlooked in everyday life or attributed to other causes, but are associated with the disturbed blood flow in varicosis.

3.3. Worsening of symptoms: in the evening, in summer and during pregnancy

Varicose vein symptoms show a typical daily pattern: Towards evening the symptoms are usually most severe. After standing or sitting for a long time, blood and tissue fluid collect in the legs, which leads to an increased feeling of heaviness and swelling. Summer heat further exacerbates this problem. At high temperatures, the blood vessels dilate so that the body can release heat. However, this causes more blood to pool in the leg veins, and feet and ankles often swell significantly in the heat. Many people with vein problems are familiar with the phenomenon “fat feet in summer”. Cooling measures (e.g. cold showers on the legs) and elevating the legs can help.

Also hormonal influences also play a role: During pregnancy certain hormones loosen the vein walls, and the growing weight puts additional strain on the leg veins. This is why varicose veins often develop during pregnancy, or existing vein problems temporarily worsen. Some women also report increased symptoms shortly before menstruation – presumably due to hormonal changes.

3.4. “Open legs”: leg ulcers as a warning sign

If chronic venous disease remains untreated for years, it can lead to poorly healing wounds on the lower leg. Doctors refer to this as Ulcus cruris venosumcolloquially “open leg”. The permanent congestion and reduced blood flow mean that even the smallest skin lesions no longer heal. The result is an open ulcer in which tissue dies off. A leg ulcer is a clear warning sign of severe venous disease. Affected areas on the leg should be treated immediately by a doctor to avoid infection.

3.5. Phlebitis and thrombosis – serious complications

Varicose veins promote Inflammation of the superficial veinsa so-called thrombophlebitis. Signs of this are Redness, overheating and a painful hard cord along the vein. Phlebitis should be taken seriously, as a blood clot can form in the inflamed vein. If such a clot moves into the deep veins, there is a risk of deep vein thrombosis. Warning signs of a thrombosis are a Sudden severe swelling and tension pain in the leg (often on the calf or thigh). In such cases, immediate medical attention is required. If a clot even reaches the lungs, it can be a pulmonary embolism a potentially life-threatening emergency.

Tip: If unusual severe pain, swelling or redness occurs in the leg, a doctor should be consulted immediately. In case of sudden Shortness of breath or chest pain call the emergency doctor immediately (emergency number 112), as there is a suspicion of thrombosis with pulmonary embolism.

3.6. When is it advisable to see a doctor?

The basic rule is: The earlier a doctor is consulted in the event of vein problems, the better. It makes sense to consult your family doctor or a vein specialist (phlebologist) at the first signs of venous insufficiency – for example, a persistent feeling of heaviness, visible varicose veins or recurring swelling. Early diagnosis and treatment can slow down the progression of varicosis and prevent complications. At the latest with clear skin changes (brownish discoloration, eczema) or pain in the legs, medical advice should be sought. These signs indicate chronic venous insufficiency, which should be treated in order to avoid serious consequences such as leg ulcers. Also Severe complaintsthat restrict the quality of life (such as permanently swollen legs or nocturnal cramps) should be medically clarified.

3.7. Tips for alleviating the symptoms

Those affected can take many measures themselves to alleviate the symptoms of varicose veins or prevent them from progressing:

• Incorporate exercise: Regular exercise and vein gymnastics in everyday life promote blood flow. Avoid sitting or standing for long periods – change position frequently or walk a few steps in between. Activate the calf pump from time to time by doing foot exercises (e.g. wiggling your toes).
• Elevate your legs: Elevate your legs as often as possible – whether you are sitting or lying down. This helps the blood to flow back to the heart and reduces swelling. Raising your legs can bring noticeable relief to tired legs, especially in the evening.
• Cool applications: Shower your legs in cool water in warm weather or take alternating showers. Cool temperatures cause the blood vessels to contract and reduce the “feeling of heaviness”. Cold calf compresses can also relieve itching and tightness.
• Wear compression stockings: Special support or compression stockings exert pressure on the leg veins and improve the function of the venous valves. They help to reduce swelling and prevent new varicose veins. Ask your doctor or medical supply store for advice.
• Weight and lifestyle: Being overweight puts strain on the veins – so try to aim for your normal weight to take the strain off your legs. A balanced diet and drinking enough fluids (approx. 2 liters a day) also support vein health. If possible, avoid smoking, as nicotine can damage the blood vessels.

These tips can significantly reduce the symptoms of varicose veins. However, they are no substitute for medical treatment: if the symptoms persist or worsen, medical advice should always be sought.

4. varicose veins in the genital area: forms, causes, symptoms and tips

4.1. Vulvar varicosis (varicose vein on the vulva) – the most common form

Under vulvar varicosis varicose veins in the vulva area, i.e. dilated veins on the labia. These occur particularly frequently in pregnant women and in most cases are regarded as harmless. The tortuous, bluish-purple veins can be visible on both the labia majora and labia minora and usually appear as swollen and nodular. Medically, varicose veins on the labia are also known as vulvar varices or vulvar varicosis labeled. Many women are initially frightened by the unusual appearance, but it is important to know: Vulvar varicose veins usually disappear on their own a few weeks after giving birth.

Vulvar varicose veins often remain undetected during pregnancy as they often do not cause any severe discomfort. In addition, the growing baby bump makes it increasingly difficult to notice changes in the pubic area at all. However, some women find the nodular veins on the labia so unpleasant or embarrassing that they initially shy away from going to the doctor. It is important to emphasize that Shame is unfounded is unfounded – medical staff are familiar with such findings and it is worth having changes clarified at an early stage.

4.2. Other forms in the genital area

In addition to vulvar varicose veins, there are other Varicose veins in the genital area:

• Perineal varices: Varicose veins in the perineal area (area between the vagina and anus). They can occur together with vulvar varices, especially if there is a lot of blood congestion in the pelvis.
• Vaginal varices: Varicose veins in the vagina themselves. These are not visible from the outside, but can be detected during gynecological examinations, for example. Those affected often only notice that the labia swell slightly due to the veins involved. The good news is that these bulges in the genital area usually disappear on their own after the birth.
• Rectal varices (hemorrhoids): Varicose vein-like vascular cushions can also form in the anal area. This is usually referred to as haemorrhoidsa special form of Varicose veins in the rectum. Hemorrhoidal complaints are particularly common during pregnancy – it is estimated that up to 70 % of pregnant women have problems with hemorrhoids. Haemorrhoids are characterized by itching, a feeling of pressure or bleeding, but are usually harmless and often disappear after the birth.

In addition, pronounced venous insufficiency can also lead to varicose veins in adjacent regions become visible, e.g. in the groin, thighs or buttocks. Such unusual localizations are often related to a backlog in the pelvic veins. Overall, varicose veins in the genital area occur mainly in connection with pregnancy or pelvic vein problems and may not always be visible from the outside.

4.3. Causes and risk factors

Pregnancy is by far the most common cause of varicose veins in the genital area. Several factors come together during pregnancy that Promote venous disorders: The hormone level (especially progesterone) rises sharply and relaxes the vascular wallswhich causes the veins to dilate more easily. At the same time, the amount of blood in the body increases significantly and the growing uterus presses on the pelvic veins – the blood can no longer flow back to the heart as freely and becomes more congested.

This combination of hormonal changes, increased blood volume and increased venous pressure The pressure from the child causes veins in the pelvic area and on the labia to dilate and varicose veins can develop. Vulvar varicose veins often only become apparent in the second trimester of pregnancy (approx. 12 to 24 weeks of pregnancy) – in first-time mothers this tends to be later, but in subsequent pregnancies due to the previous damage it is usually more common earlier and more pronounced. The more pregnancies a woman has experienced, the greater her risk of such intimate varicose veins.

In addition to pregnancy, individual individual predispositions a role. There is a genetic disposition – Venous disorders occur more frequently in some families. Women are generally affected more often than men (around three times as often), which is partly due to hormonal factors and pregnancies. Other risk factors are anything that affects the Increased venous pressureFor example, prolonged standing or sitting, obesity or chronic pressing (e.g. constipation), which particularly promotes the development of hemorrhoids.

Also hormonal influences Factors outside of pregnancy – such as taking oestrogen (the pill, hormone replacement therapy) – can promote the development of varicose veins. Oestrogen affects the connective tissue and vein walls, making them more flexible.

Finally pelvic vein disease can be a factor: In rare cases, varicose veins in the genital area develop independently of pregnancy, for example as part of a pelvic vein congestion syndrome (pelvic congestion syndrome).

These are chronically dilated pelvic veins, usually in women with multiple pregnancies. These lead to a permanent congestion of blood in the lower abdomen and can cause vulvar and vaginal varices as well as pain. However, not all women with pelvic varices have symptoms.

The exact causes of this syndrome are still the subject of research, but genetic predisposition, hormonal factors and weak venous valves are also thought to be involved.

4.4. Symptoms and complaints

Varicose veins in the genital area can cause very different symptoms – from barely noticeable to severely impairing. Typical Complaints with vulvar varices are among others:

• Visible swellings: On the labia there are swollen, tortuous veins appear on the labia usually bluish in color. When standing these are more clearly visible than when lying down (due to the influence of gravity).
• A feeling of pressure and heaviness: Many sufferers feel an unpleasant pressure in the pelvic area or a feeling of heaviness in the lower abdomen, similar to a heavy period.
• Pain: Depending on the severity pain may occur – such as pulling pain or a sore feeling in the vulva. Prolonged walking, standing or sitting can then become a pain, as the strain increases the pressure in the veins. Sometimes the pain radiates to the groin or thighs. Pain can also occur during sexual intercourse, which can be very distressing.
• Itching and burning: Enlarged veins can cause itching or burning in the genital area. The skin and mucous membrane there are sensitive, and the unusual stretching of the vessels can trigger these sensations.
• Frequent urge to urinate: Some women report increased urge to urinateas the swollen veins can press on the bladder.

Characteristically, the symptoms often worsen during the course of the day intensify – Swelling and pressure are often most noticeable in the evening, after being on your feet for a long time. The symptoms usually improve at rest, especially when lying down, as venous return is then easier.

Important: Not every varicose vein in the genital area causes pain or problems. Sometimes the visible changes are more of a cosmetic or psychological problem. Especially the Appearance can be unsettling: It is understandable that the idea of “varicose veins on the labia” is initially frightening or shameful. Those affected sometimes feel uncomfortable in their body or avoid intimacy out of shame.

It helps to realize that this is a common medical phenomenon and that there is no reason to be ashamed. If symptoms persist or increase, you should always seek medical advice instead of suffering the symptoms in silence.

4.5. Pictures or medical illustrations

Varicose veins in the genital area often occur during pregnancy. The photo shows a pregnant woman – during this time, hormonal changes and the growing belly promote the formation of vulvar varicose veins.

Typically, vulvar varicosis looks like this one or more dilated veins as soft, bluish lumps on the vulva become visible. The changes can occur on one or both sides. Sometimes the image resembles a “spider vein” or a thick, swollen strand of veins on the vulva. Doctors can often recognize pronounced varicose veins just by looking at them while standing; if necessary, a Examination in a lying and standing position as the severity can vary depending on the position.

If available, ultrasound ultrasound images of the pelvic veins to assess the extent of vein dilatation internally (e.g. in the vagina or pelvis). Such images would show congested blood flow and dilated venous plexuses, which supports the diagnosis. However, visual diagnosis and external ultrasound examination are usually sufficient to diagnose vulvar varicosis.

It is also important to differentiation from other findingsSwollen labia can also be caused by inflammation or cysts, for example – the doctor will rule out these differential diagnoses. The illustration shown here is intended to make it clear to affected women that varicose veins in the genital area are a real and treatable medical condition.

4.6. What should patients know?

Affected women are not alone with this problem. Especially during pregnancy, varicose veins in the genital area are not uncommon and in most cases no reason to panic. However, it is important to take changes seriously and have them checked by a specialist. A gynecologist can confirm whether it is actually vulvar varicose veins and not something else.

It can also be clarified whether and which treatment is necessary. The reassuring information that the varicose veins are harmless and are likely to regress after the pregnancy. This knowledge alone can help you to take a more relaxed view of the situation.

Tips for self-help: Many measures that are recommended for common varicose veins also help in the intimate area. Here is some practical advice:

• Relieve pressure: Try, prolonged standing or sitting for long periods. Take regular breaks in your daily routine, put your legs up or lie flat on your side from time to time. Lying down allows the blood to drain better, which reduces pressure and swelling. During pregnancy, lying on your left side is particularly left side is particularly recommended, as this reduces the pressure of the uterus on the great vena cava.
• Compression & support: Special compression tights for pregnant women can help to reduce congestion in the leg and pelvic veins. However, normal stockings often do not exert enough pressure in the genital area. Special supportive clothing can be useful here: there are, for example, pregnancy bodysuits or bandages that exert targeted counter-pressure on the vulva and support the veins. Such aids (sometimes as vein briefs or vulvar support cushions) can significantly alleviate the unpleasant feeling of heaviness. Ask your doctor or midwife about suitable products.
• Exercise: Stay moderately physically activeas far as your pregnancy or situation allows. Light endurance exercise such as Going for a walk or swimming promotes blood flow and can counteract blood congestion. Also Alternating showers or cool water showers in the genital area (for example, running the water over the vulva for a few seconds while showering) can be beneficial – cold causes the blood vessels to contract and reduces swelling slightly.
• Positioning & aids: If vulvar varicose veins cause pain when sitting, a soft cushion (e.g. a donut-shaped cushion or “floating ring”) can provide relief. can provide relief. If possible, do not sit directly on hard surfaces. Also wear comfortable clothing – Tight, constricting pants or briefs should be avoided, whereas supportive maternity underwear can be an advantage.

4.7. When to see a doctor?

When in doubt, rather sooner rather than later. See your gynecologist if you notice unusual swelling or pain in the genital area. This is especially true during pregnancy, but also outside of it. A medical examination (usually a visual examination and palpation, possibly supplemented by an ultrasound/Doppler) will provide clarity.

If your doctor does not take your concerns seriously, do not hesitate to seek a second opinion – you have the right to have your complaints taken seriously. As a rule, they will be able to reassure you. If varicose veins in the labia are indeed present, your doctor will discuss with you how to proceed.

Diagnosis & progression: A physical examination is often sufficient to diagnose intimate varicose veins. A Doppler ultrasound (a special ultrasound examination of the blood flow) can be used to visualize the blood congestion in the veins. In complex cases – such as suspected pelvic venous congestion syndrome – further imaging procedures such as a Phlebography (X-ray imaging of the veins with contrast medium) or MRI may be useful. However, these are usually only carried out after the pregnancy if the symptoms persist.

The treatment options depend on how severe the symptoms are and whether the woman is pregnant. During pregnancy itself is usually limited to symptomatic measures (see self-help tips above), as invasive procedures should be avoided. Sclerotherapy or surgical treatment of vulvar varicose veins is generally not recommended. not This is partly because most cases improve on their own and partly for safety reasons for mother and child.

After the birth the situation often looks much better: In many women, the protruding veins shrink significantly immediately after delivery and disappear completely within 2 to 8 months. 2 to 8 months and disappear completely. This regression process can accelerate after weaning. This means that in most cases the problem almost resolves itself as soon as the triggering factors (hormones, pressure from pregnancy) cease.

However, if the varicose veins in the genital area not disappear completely or have already existed before pregnancy, there are various treatment treatment methods analogous to common varicose veins on the legs. These include, for example Sclerotherapy (sclerotherapy by injecting a sclerosing agent into the vein) or laser therapyin which the vein is closed with a fine catheter using a laser. Such procedures can usually be performed on an outpatient basis and under local anesthesia.

Surgical procedures are also available – for example, ligation or removal of affected vein sections. In the case of underlying pelvic vein problems (e.g. leaking ovarian veins), specialized centers can perform a Embolization (closure of the defective vein from the inside) or a surgical procedure may be considered. Your attending physician will refer you accordingly, if necessary.

Outlook: The following applies to most women with vulvar varicose veins: with a little patience and supportive measures, intimate varicose veins often disappear again. It is important not to worry too much and to seek help at an early stage if symptoms occur. Compression, relief and, if necessary, modern vein treatments after family planning can help to get the problem under control.

After the pregnancy the situation often returns to normal – many sufferers are relieved that the vulvar varicose veins disappear on their own. And if not, there are gentle therapies available to help you. So don’t hesitate to ask your doctor or midwife any questions you may have. With the right care and a few targeted measures, you can continue to enjoy your pregnancy and your life as carefree as possible despite varicose veins in the genital area.

5. stages of varicosis: CEAP classification and other medical systems

The CEAP classification divides chronic venous diseases into clinical stages from C0 to C6. It is the current standard and covers all forms of chronic venous disease – in contrast to older systems that only focus on severe cases. The individual CEAP stages (Clinical Classes) mean the following in detail:

• C0: No No visible or palpable signs of venous insufficiency. Although no changes are visible to the naked eye at this stage, those affected occasionally report non-specific symptoms such as heavy, tired legs after long periods of standing.
• C1: Spider veins (medically: telangiectasias) or reticular reticular veins reticular veins. These are fine reddish-bluish veins under the skin, often on the ankles or thighs. These tiny varicose veins are usually a cosmetic problem. Possible symptoms include a slight feeling of tightness or temporary swelling after exertion, which subsides overnight.
• C2: Varicose veins (varices) – Clearly visible and palpable, dilated veins. At this stage, there are “real” varicose veins, e.g. tortuous veins on the calf or thigh. The veins are permanently dilated (diameter > 3 mm) and the venous valves no longer close properly. Patients in C2 often have symptoms such as a feeling of heaviness, pulling pain or nocturnal calf cramps, but can also be largely symptom-free. (C2* r stands for recurrent varicosisrecurrent varicose veins after treatment)
• C3: Oedema – i.e. swelling of the leg due to venous disease. Typical is a visible and palpable water retention especially around the ankle and on the lower leg. From stage C3 onwards, this is referred to as incipient chronic venous insufficiency (CVI)as the venous insufficiency now leads to functional disorders such as fluid retention in the tissue. The legs often feel heavy; shoes may no longer fit in the evening.
• C4: Skin changes due to chronic venous insufficiency. At this advanced stage, the long-standing circulatory disorders cause typical skin and tissue changes on the lower leg. A distinction is made between C4a – brownish pigmentation (iron deposits) and/or itchy congestive eczema stasis dermatitis (inflammation of the skin); C4b – hardened scar tissue of the subcutis (dermatodermatosclerosis or lipodermatosclerosis) and/or atrophy blanche (white, scarred areas of skin); C4c – Corona phlebectaticaa ring of finely dilated bluish veins around the ankle. In C4, the legs are often chronically inflamed, discolored and tender – a clear warning that without treatment, an open leg may be imminent.
• C5: Healed leg ulcer – a healed open ulcer of the lower leg, left behind as a scar. The vernacular speaks of an “open leg” (medically venous leg ulcer), which has already been closed by therapy or spontaneous healing. However, a sensitive scar remains and venous circulation is still impaired.
• C6: Active leg ulcer – A currently open, unhealed venous ulcer on the lower leg or ankle. This is the final stage of untreated varicosis. The skin has burst open and there is a poorly healing wound, usually in the ankle area. These venous ulcers can be extremely painful and severely impair quality of life. (C6* r denotes a recurrent ulcer that recurs after healing).

Note: In addition, each CEAP class can be assigned an “A” (asymptomatic) or “S” (symptomatic), depending on whether the patient has symptoms. CEAP also includes information on Cause (primary, secondary, etc.), anatomy (superficial, deep or perforating veins) and pathophysiology (reflux or outflow obstruction) – but for patients the clinical class C0-C6 is most relevant to understand the severity.

5.1. Truncal varicosis of the great saphenous vein – what does this mean?

A truncal varicosis is present when the main trunk vein of the superficial venous system is affected by varicose veins. The Saphenous vein – also great rose vein runs from the inner ankle along the inside of the leg to the groin. If this trunk vein is pathologically dilated and the valves are defective, this is referred to as varicosis of the great saphenous vein. In practical terms, this means that the largest superficial vein of the leg itself has become a varicose vein, often palpable as a string-like, protruding vein on the thigh or lower leg.

This form of varicosis belongs at least in CEAP stage C2 (visible varicose veins). It is often accompanied by symptoms such as a feeling of heaviness, pain or a tendency to swell, as the “main drainage” via the saphenous vein is impaired. If left untreated, truncal varicosis can lead to subsequent stages: the chronic backflow can cause edema (CEAP C3) and after a longer period of time skin damage such as discoloration or induration (CEAP C4). Stem varices are thus typically assigned to the classes C2-C4 to.

Important to know: Truncal varicosis of the great saphenous vein is usually the cause of other Lateral branch varices and spider veins. Due to the increase in pressure in the rose vein, more varicose veins develop on the side branches. For this reason, particular attention is paid to truncal varices during the examination, as their treatment (e.g. sclerotherapy or removal of the rose vein) is often necessary in order to successfully treat the entire varicose vein condition.

5.2. Stages 3 and 4: What happens with advanced varicosis?

In the stages C3 and C4 the consequences of prolonged venous insufficiency become very clear. From C3 fluid accumulates in the tissue due to chronic blood congestion – permanent leg permanent leg edemamostly around the ankles and on the lower legs. The swelling increases in the evening and can only partially disappear overnight.

Patients notice, for example, that sock cuffs leave deep marks or that the legs are tight. This stage of edema marks the transition to chronic venous insufficiency (CVI) in the narrower sense: the venous disease now significantly impairs blood circulation and lymphatic drainage.

From C4 it comes to trophic skin changesvisible structural changes in the skin and subcutis as a result of chronic reduced blood flow. Typical changes in Stage 4 are:

• Brown-brownish discoloration of the skin (hyperpigmentation) due to the deposition of blood breakdown products – often first appearing on the inner ankle.
• Atrophie blanchesmall white areas of scarring surrounded by dark pigmentation – signs of healed micro-ulcers.
• Stasis dermatitis or -eczemaReddened, scaly and itchy areas of skin on the lower leg caused by chronic inflammation.
• DermatoliposclerosisHardening of the subcutaneous fatty tissue to form firm connective tissue (the skin appears taut and leathery).

These changes make the skin vulnerableEven minor injuries heal poorly and can lead to an ulcer. Overall, this is referred to as signs of CVI stage II according to Widmer (see below), which are equivalent to CEAP C4 – in other words, there is severe chronic venous disease. Those affected should seek medical treatment by now at the latest in order to avoid complications.

Advanced chronic venous insufficiency (CEAP C4-C6): This image shows the inner ankle region in a patient with long-standing varicosis. Brownish skin discoloration and a shiny, hardened area of skin are clearly visible – typical signs of stage 4 CVI.

There is a lighter scar in the center of the image: This was previously an open leg (leg ulcer), which healed after intensive treatment (CEAP C5). Such skin damage and ulcers usually occur after years of untreated varicosis and should be urgently prevented by early treatment.

5.3. Early detection: recognizing varicose veins in stage 1

The earlier a vein disease is recognized, the better the progression can be stopped. Stage C1 (spider veins and reticular varicose veins) is initially perceived by many patients as a cosmetic blemish. However, these fine superficial vein markings – such as Spider veins on the inner or outer ankle or a network of blue-red veins on the thigh – can be a first indication of venous insufficiency.

Often in this initial stage there are also transient symptoms occur: Towards the evening, the legs may swell or there is a slight feeling of heaviness and tension, which improves when the legs are elevated. Such symptoms disappear completely overnight. Also occasional calf cramps or “restless legs” can be the first signs of the onset of varicosis, even before thick varicose veins are visible.

So how do you recognize Varicose veins in the early stages? Typical symptoms are visible small veins (spider veins) and Occasionally swollen ankles in the evening. The skin may show a slightly blue-red vascular pattern in the ankle area (so-called Corona phlebectaticaa ring of spider veins around the ankle).

Important: These early signs should be taken seriously, even if they are only a visual problem at first. Those affected can take simple measures (move a lot, elevate your legs, compression stockings at this stage) to counteract them – and they should observe whether the spider veins spread or symptoms increase.

Early stage C1 (spider veins): The picture shows small spider veins on a patient’s thigh. spider veins (circled in yellow). Such spider veins are fine, branched veins just below the surface of the skin. They often cause no pain, but may indicate a venous drainage disorder. If spider veins occur more frequently together with feelings of heaviness or swelling in the evening, this is a signal to consult a vein specialist at an early stage to prevent larger varicose veins from developing.

5.4. Alternative classifications: Hach, Widmer and Marshall

In addition to the CEAP classification, there are other historical classification systems for venous diseases. In Germany, the Widmer classification (or their modification according to Marshall and Wüstenberg) and the Hach classification is commonly used:

• Widmer classification: Introduced by Widmer in 1978, it divides chronic venous insufficiency (CVI) into three degrees of severity. Grade I corresponded to incipient changes (spider veins on the edge of the foot, ankle edema in the evening) – comparable to CEAP C1/C2. Grade II included pronounced edema and skin changes (pigmentation, eczema, lipodermatosclerosis), corresponding to CEAP C3/C4. Grade III denotes an open leg (venous leg ulcer).In 1994, Marshall added a subdivision of grade III intoIIIa (healed ulcer) and IIIb (active ulcer). The Widmer/Marshall classification therefore refers specifically to CVI (chronic venous insufficiency) and less on purely cosmetic varicose veins. Today, however, it is considered outdated and is no longer recommended by specialist societies. It has been replaced by CEAP, which makes a finer distinction and includes all stages (including mild varicose veins without CVI).
• Hach classification: This classification – named after a German phlebologist – describes the extent of truncal varicosis on the large veins (great saphenous vein and parva). It divides the insufficiency of the truncal veins into Stage I-IV depending on the extent of the valve damage: Hach I means an insufficient venous valve area only in the uppermost section (orifice area in the groin or popliteal fossa), Hach IV In contrast, a reflux over the entire length of the vein up to the ankle. Simply put, the Hach classification indicates, how long the diseased section of vein in the truncal vein is.Important: It saysnothing about the severity of symptoms off. A patient with Hach III (extensive truncal varicosis) may still be clinically in CEAP C2, for example, if “only” the vein is dilated but there is still no edema/skin damage. The Hach classification is mainly used by phlebologists to plan treatment (e.g. whether the truncal vein needs to be treated completely or partially). In international comparison, it plays a subordinate role; here, CEAP and duplex diagnostics are usually used directly.

In summary, Hach, Widmer and Marshall therefore serve to supplementary descriptionWidmer/Marshall focus on the severity of severity of the CVI (edema, skin, ulcer), Hach on the anatomical anatomical extent of truncal venous insufficiency. For patients, however, the CEAP classification has proven to be more comprehensible and universal, as it takes all aspects into account and is used uniformly worldwide.

5.6. Diagnosis: How is the stage determined and when to see a doctor?

The classification of varicosis into a specific stage is based on a medical examination. The most important steps are

• Medical history (interview): The doctor asks about symptoms (swelling, pain, heaviness, family history, etc.) and the course of the disease. This will reveal whether, for example, edema occurs in the evening or whether skin changes have already been noticed. Risk factors such as occupation (long periods of standing/sitting), pregnancies or a history of thrombosis are also recorded. This information provides an initial indication of the possible stage.
• Physical examination: The legs are then examined in a standing position – because varicose veins are most visible under gravity. The doctor inspects the typical areas: Are there Spider veins, nodular superficial veins (varicose veins) in the usual places (inner ankle, calf, back of the knee, inner thigh)? Are there any signs of edema (swollen ankles) or skin discoloration and eczema? He will also palpate the veins and check for pain or induration. In addition, the foot pulses are checked to rule out arterial circulatory disorders – this is important for planning the treatment (e.g. whether compression can be applied safely).
• Apparative diagnostics: For precise staging, a duplex ultrasound of the leg veins is essential. According to the guidelines, color-coded duplex sonography is the method of first choice in the diagnosis of varicose veins. It is painless and does not expose the patient to radiation. With ultrasound, the doctor can visualizewhich veins are affected and whether the venous valves are closing or show reflux. This makes it possible to determine whether varicosis of the great saphenous vein is present and how far it extends (Hach stage, if applicable).

Deep vein thromboses can also be ruled out. Based on the ultrasound findings in combination with the clinical signs, the phlebologist then determines the CEAP stage – for example C2, Ep, As, Pr for “primary saphenous varicosis of the great saphenous vein with reflux, clinically as varices (C2)”.

In special cases, additional examinations are used (e.g. light reflection rheography to assess the venous pump function or phlebographycontrast X-ray imaging, in exceptional situations). In most cases, however, ultrasound is completely sufficient to determine the exact stage of the disease.

When should you seek medical advice? Experts advise: Better early. Even at the first signs such as Regularly heavy, tired legs, a feeling of tension or pulling pain in the calves, this should be taken seriously and a vascular specialist should be consulted. Early diagnosis and treatment of varicose veins can prevent the progression of the disease and the occurrence of complications.

In concrete terms, this means that if spider veins increase, ankles swell in the evening or skin changes appear, it is better not to wait until an “open leg” develops. Also who Pronounced, visible varicose veins (C2) – even if they are not yet very painful – should have them assessed by a doctor. Modern treatment methods are gentle and effective; they can remove varicose veins before they cause damage.

The staging of varicosis according to CEAP (C0-C6) helps patients to understand how severity of their vein disease is. From the first spider veins (C1) to visible varicose veins (C2) and swollen legs (C3) up to skin changes (C4) and leg ulcers (C6) – each stage has typical characteristics and symptoms.

It is important to take early stages seriously and seek medical advice. This can often prevent a “harmless” varicose vein from becoming a serious chronic vein problem. In the next section, we present the possible therapy methods to effectively treat varicose veins at every stage and alleviate symptoms.

Having looked at the staging of varicosis (varicose vein disease) in the previous section, the question now arises as to how the diagnosis of varicosis medically. The correct diagnosis is crucial in order to determine the severity of the venous disease and, based on this, to develop suitable treatment options. therapy options in the next section.

Many sufferers initially see varicose veins as a cosmetic problem and delay seeing a doctor. However, an early examination helps to halt the progression of the disease and avoid complications. In the following you will find out which examinations a e vein specialistin – from clinical examination and ultrasound to special procedures – and when you should see a doctor for varicose veins.

6 Diagnosis: How is varicosis diagnosed?

6.1. Clinical examination by the vein specialist: medical history, inspection and palpation

The diagnosis is preceded by a detailed discussion (anamnesis), in which the doctor asks about typical symptoms such as heaviness, pain or swelling and a family history of vein problems. Risk factors (e.g. prolonged standing, previous thromboses or pregnancies) are also assessed. This is followed by a thorough Physical examination of the legs while standing and lying down. The doctor takes a close look at the legs (inspection) and recognizes dilated, tortuous veins and nodular protrusions under the skin with the naked eye – the typical varicose veins.

Fine spider veins are also documented. It is also important to look for skin changes: Are there any discolorations, thickening or eczema on the lower leg and ankle area that indicate chronic venous insufficiency? The vein specialist carefully records all of these findings – from spider veins to pronounced trunk and side branch varices.

In the next step, the doctor palpates the veins and surrounding areas (palpation). Among other things, he will check the regions where the superficial veins open into the deep veins (e.g. groin for the great saphenous vein and popliteal fossa for the subcutaneous vein). Palpation while standing allows the doctor to determine the filling status and any areas of pressure pain. When lying down, the doctor checks whether the varicose veins can be drained.

In addition, the pulses of the foot are felt on the inner ankle and back of the foot to rule out circulatory disorders of the arteries (peripheral arterial occlusive disease). If necessary, the examiner will also look for signs of superficial phlebitis, such as hardened, warm and reddened veins.

The clinical examination provides a comprehensive picture: it clarifies how pronounced the varicose veins are, whether the varicosis is primary or secondary and whether there is already any secondary damage. Of course, the doctor will also rule out other causes of leg complaints – such as heart failure, kidney disease or lymphoedema, which can also lead to leg swelling.

6.2. Doppler sonography & color-coded duplex ultrasound: visualizing venous insufficiency

To confirm the suspected diagnosis varicose veins and to determine the exact extent of the venous disease, an ultrasound examination of the leg veins is usually Ultrasound examination of the leg veins to. The color-coded duplex sonography is today considered the gold standard in the diagnosis of varicosis. This procedure combines the classic Doppler ultrasound – which converts blood flow noises into an audible and measurable signal – with a B-scan ultrasound that visualizes the vessels.

This allows the doctor and patient to see live on the ultrasound image how wide the veins are and in which direction the blood is flowing. By switching on the color scale, arterial inflow (towards the heart, usually colored red) and venous inflow (towards the veins) can be seen. reflux (back to the foot, marked in blue) can be distinguished.

In this way leaky venous valves and reflux routes can be clearly identified. Duplex sonography also shows which superficial vein sections are affected and whether the deep veins are unobstructed. The length and diameter of the varicose veins are also recorded, which is important for therapy planning.

The Doppler sonography (e.g. with a hand-held Doppler device) can provide initial indications in simple cases or if no duplex is available by making it possible to hear whether blood reflux occurs when pressure is applied to the calf. However, only the duplex examination provides a complete picture.

It is non-invasive, painless and without radiation exposure – a procedure that can be repeated as often as required. As a result, ultrasound has replaced X-ray contrast imaging of the veins (phlebography) as the standard.

The current guidelines recommend color-coded duplex sonography expressly recommended as the first instrumental procedure. In everyday practice, ultrasound of the leg veins is therefore part of routine diagnostics for varicose veins. It not only helps with the initial diagnosis, but also with the exclusion of acute thrombosis and with follow-up checks after treatment.

In some cases, duplex sonography is even directly integrated into the therapy, for example to check the correct position of catheters during an operation – but more on this in the section on therapy.

6.3. Further imaging procedures in special cases: Phlebography, MR-phlebography & LRR

In the vast majority of cases, a clinical examination and ultrasound are sufficient to diagnose varicosis with certainty. Further imaging procedures are only used in special cases. In the past, the ascending phlebography (X-ray contrast imaging of the veins) used to be the method of choice, but it has been almost completely replaced by duplex sonography.

Today, phlebography is only carried out if the ultrasound findings are unclear or if there are specific questions – for example in the case of recurrent varicose veins (recurrent varicosis) of unclear cause or if complex venous anomalies are suspected. As phlebography is an invasive examination with contrast medium and radiation exposure, it is rarely required and is no longer available everywhere.

Instead, in difficult cases it is better to use modern imaging such as magnetic resonance imaging or CT-supported phlebography. One MR-Phlebography (or CT phlebography with contrast medium) can be helpful in cases of congenital vascular malformations, pelvic vein varices or for the detection of venous thrombosis in the abdominal and pelvic area.

In pregnancy, if the ultrasound does not provide clear results, an MR examination is preferred due to the lack of X-rays. However, such procedures are reserved for special situations and are usually carried out in specialized centers.

In addition to imaging procedures, there are functional tests such as light reflection rheography (LRR) or the venous occlusion plethysmography. These non-invasive examinations measure the performance of the venous system. In the LRR, the Pump function of the veins This means how quickly the blood flows back into the skin veins after brief emptying (e.g. through foot exercises).

The vein occlusionplethysmography determines the capacity of the veins and the flow rate of the blood (drainage).

In advanced cases of varicose veins, there is typically a reduced pumping function combined with an increased filling capacity of the veins. Such measurements are mainly used as Supplementary diagnostic aids or for monitoring the course of the disease. However, they are not routinely necessary in everyday practice as long as duplex sonography provides clear results.

Your doctor will only suggest these tests if they offer added value for the assessment of your individual vein condition.

6.4. When to see a doctor? Correctly interpreting the warning signs of vein problems

Varicose veins usually develop slowly and many people go to the doctor late or not at all. But When to see a doctor for varicose veins? Experts advise starting with the first signs of venous insufficiency should be checked by a doctor.

Yourfamily doctorin can assess whether you have varicose veins that require treatment and, if necessary, refer you to a vein specialist.vein specialistin (phlebologist). Early diagnosis and treatment can slow down the progression of the disease and prevent secondary damage.

Some symptoms also indicate acute warning signs where you should not hesitate to seek medical help immediately. The following symptoms should be taken seriously and require immediate medical attention:

• Sudden one-sided leg swelling or unusually severe pain in the leg in the leg – there is a suspicion of deep vein thrombosis venous thrombosissee a doctor immediately. If you also experience acute shortness of breath or chest pain call the emergency doctor immediately (emergency number 112), as a pulmonary embolism could be present.
• Redness, overheating and pressure pain along a vein – This indicates superficial phlebitis (thrombophlebitis). Even if this is usually less dangerous, it should be examined and treated promptly by a doctor to prevent the clot from spreading. A hardened, painful strand of vein can often be felt.
• Skin changes on the lower legs such as brownish discoloration, hardened subcutaneous fatty tissue or itching – such changes indicate advanced chronic venous insufficiency. A visit to the doctor is important now at the latest to prevent an open leg (leg ulcer).
• Open wounds on the lower leg (poorly healing ulcers) – a leg ulcer often arise from untreated varicose veins. Please seek medical help immediately, as these skin defects are at risk of infection.
• Bleeding from a varicose vein – In rare cases, a varicose vein can rupture and lead to considerable blood loss. A visible sign of this is the sudden onset of severe venous bleeding in the lower leg. This is an emergencyin which the leg must be elevated immediately and pressure applied to the bleeding site. In this case, call an emergency doctor immediately, as rapid wound care and hemostasis are required.

The basic rule is: take your leg complaints seriously. It is better to go to the doctor once more and get the all-clear than to overlook a serious development. If you are unsure – for example, whether swelling is a “normal” varicose vein symptom or a thrombosis – it is always advisable to seek medical advice at short notice.

6.5. Important questions you should ask at your doctor’s appointment

Good preparation for the consultation helps to clarify all the important points. Make a note of any questions that are on your mind in advance. Here are a few specific questionsthat you can ask your doctor when diagnosing varicose veins:

• How pronounced is my varicosis? Are my veins in the early stages or already at an advanced stage?
• Are my complaints actually caused by varicose veinsor could there be other causes?
• What treatment options are there in my case – from compression stockings to surgical procedures – and which do you recommend?
• What happens if I don’t get treatment? Is there a risk of my varicose veins getting worse or complications occurring (e.g. thrombosis, “open leg”)?
• Is there anything I can do myself to alleviate the symptoms or slow down the progression? (Exercise, elevation, weight control, etc.)
• Do I have to wear compression stockings? If so, what strength and how often?
• Would an operation or sclerotherapy make sense in my caseand what are the advantages and disadvantages of the procedure?
• How high is my personal risk of thrombosis and how can I recognize warning signs in time?

These questions serve as a guide. Depending on your individual situation, you may need to add further points – for example, if you are planning a pregnancy or have already undergone preliminary treatment. Do not hesitate, to ask openly. A good doctor will take the time to explain the findings and next steps to you in an understandable way.

6.6. GP, phlebologist or vascular surgeon – who is the right person to contact?

The question often arises with vein complaints, which doctor is responsible for varicose veins is. In the German healthcare system, you can first contact your n General practitioner contact. GPs know your medical history and can make an initial assessment. They will refer you to a specialist if necessary. Specialized Vein therapists carry the designation phlebologist (vein doctor).

In Germany, phlebology is an additional advanced training course that can be acquired by doctors from various specialties, often by dermatologists, vascular surgeons or angiologists. Therefore, a phlebologist may originally be a dermatologist, surgeon or internist – the decisive factor is their experience in diagnosing and treating veins.

Purely trained angiologists (specialists in vascular medicine, a branch of internal medicine) also deal with venous disorders and can diagnose and treat varicose veins.

In many cases, your GP will refer you to a phlebologist if varicose veins become noticeable. However, you can also consult a vein specialist directly; many cities have specialized vein clinics or phlebology practices. It is important that the practitioner has experience with modern methods of vein diagnostics (especially duplex ultrasound).

For surgical treatment options – if, for example, vein stripping or endovenous procedures are necessary vascular surgeons come into play, often in close collaboration with phlebologists.

Angiologists and phlebologists are more concerned with diagnostics, conservative therapy (such as compression, sclerotherapy) and minimally invasive measures; Vascular surgeons perform classic operations on the veins. Ultimately, these specialties work hand in hand. If you are unsure which doctor you should see, a recommendation from your family doctor can help.

Also the doctor search The German Society for Phlebology, for example, can provide further information – certified vein specialists are listed here. It is important that you see a doctor if you have persistent vein problems – whether you see a GP or a specialist, the main thing is to get your symptoms checked out.

6.7. Tips for preparing for a visit to the doctor for vein problems

Good preparation will help you to make the most of your visit to the doctor and not to forget any important information. Here are some useful tips on how to prepare for your varicose vein examination:

• Keep a symptom diary: Note down over a few days which symptoms (e.g. swelling in the evening, pain after standing for a long time) and what brings relief. This will help the doctor to better classify your symptoms.
• List previous findings and pre-existing conditions: Provide all relevant information previous venous thromboses or operations, known chronic illnesses (e.g. diabetes), medication you are taking and allergies. Bring any existing medical reports or findings (e.g. old ultrasound examinations) with you.
• Note down questions: Think in advance about what you would like to ask the doctor (see above). Write down these questions and take the note with you so that nothing falls by the wayside during the consultation.
• Documentation through photos: If your varicose veins are particularly prominent at certain times of day or under certain circumstances (such as in the evening or after standing for a long time), it can be helpful to record this with photos. This allows the doctor to get an idea of the extent of the varicose veins, even if your legs are relaxed at the start of the appointment.
• Choose practical clothing: On the day of the examination, wear comfortable clothingthat is easy to put on and take off. For example, shorts or loose training pants are ideal for the leg examination. Avoid applying very greasy creams to your legs immediately before the appointment, as this could interfere with the ultrasound examination.

With these preparations you can help to ensure that the diagnosis of your varicosis runs smoothly and effectively. Your doctor can get a comprehensive picture and help you in a targeted manner. Remember: as a patient, you can and should play an active role – ask questions, tell us openly about your symptoms and feel free to express your concerns. This will help you find the right treatment for your varicose veins together.

7. treatment options for varicosis (varicose veins)

Now that expression and diagnosis of your varicosis have been determined, the next step is to determine the appropriate treatment options. Depending on the severity, there are conservative measures for relief, modern minimally invasive procedures for Treat varicose veins and classic surgical procedures.

Below you will find a clear overview of conservative, minimally invasive and surgical treatment options – and when which method is suitable. (An outlook: After treatment, the next section deals with what you can do yourself to support the success of the treatment).

7.1. Conservative measures

Conservative therapies are primarily aimed at alleviating symptoms and preventing the progression of varicosis. It is important to know: Conservative treatments cannot eliminate the cause of varicose veinsbut temporarily improve symptoms. They are often used when surgery is not (yet) necessary or not possible.

Example: Medical compression stockings up to the thigh. They exert pressure on the legs and support the return flow of blood in the veins.

Compression stockings and bandages:

Wearing compression stockings is a basic conservative therapy. The controlled pressure on the leg causes the veins to constrict and the Muscle pump so that the blood can flow back to the heart more easily. There are four medical compression classes (I-IV), which differ in terms of pressure intensity. Depending on the severity of the varicosis, a class II or higher stocking is usually fitted.

It is important to wear the stockings consistently during the day – especially when sitting or standing for long periods. They can be unfamiliar or uncomfortable at first, especially in warm weather. However, modern compression stockings are available in different materials and colors and can also be made to measure, which makes them more comfortable to wear. Compression bandages are mainly used for pronounced oedema (swelling), for example initially for decongestion, and are often applied in specialist practices.

Exercise, venous gymnastics and elevation

Regular exercise is one of the best ways to support vein function. Through Vein gymnastics (such as rocking with your feet or standing on tiptoe) activates the calf muscles and improves venous return. In everyday life: avoid standing and sitting for long periods at a time. Stand up from time to time or walk a few steps to stimulate the blood flow.

If you have to stand a lot due to your job, compression stockings and small exercises in between can reduce the strain. You should also elevate your legs on occasion – just 20-30 cm above heart level is enough to facilitate the return flow of blood. Elevating your legs at night (e.g. using a pillow) can also reduce swelling.

Diet, weight control and risk factors

Obesity is considered a risk factor for varicose veins, so normalizing weight helps to reduce venous pressure in the legs. A healthy, high-fiber diet also supports vascular health (and prevents constipation, which can increase venous pressure). Adequate fluid intake keeps the blood “fluid”. Quitting smoking is also recommended, as nicotine can damage blood vessels.

In addition, known trigger factors should be avoided: Hot baths or saunas can dilate the veins – cool your legs with cold water afterwards if necessary.

Tight clothing and high heels should be avoided as they impede blood flow. Sitting or standing for long periods as far as possible or take regular breaks with exercise. All of these measures can help to reduce the feeling of heaviness, swelling or nocturnal calf cramps. However, they are no substitute for causal treatment of varicose veins.

Limits of conservative therapy

Conservative measures can often only improve symptoms temporarily. Studies show that compression stockings only alleviate symptoms such as pain and swelling slightly at best. They must also be worn permanently for as long as the varicosis persists, as the veins will give way again without compression.

It is also important to know that Compression treatment alone does not make varicose veins “disappear” – the dilated veins remain despite relief. Guidelines therefore recommend compression primarily as an accompanying measure or if surgery is not an option. If general measures are not sufficient, minimally invasive or surgical procedures are available.

7.2. Minimally invasive procedures

Minimally invasive procedures are understood to mean gentle interventionsthat do not require a large incision. In most cases, the affected veins are not surgically removed but Locked from the inside – either using special adhesives, heat or sclerosing agents. These methods have made enormous progress in recent decades and are now considered effective alternatives to traditional surgery.

In many cases, they are even the treatment of choice, as they are similarly successful but are associated with fewer risks and faster recovery. Here is an overview:

VenaSeal™ (vein glue)

One of the newer methods for the treatment of varicose veins is therapy with a medical vein adhesive (trade name VenaSeal™). This is a Tissue adhesive (cyanoacrylate), which is inserted into the diseased vein via a thin catheter.

Under ultrasound guidance, the doctor places the catheter in the vein and applies a small amount of adhesive while slowly withdrawing the catheter. The adhesive seals the vein durable from the insideso that blood can no longer flow back. The body breaks down the clogged vein over time.

Advantages: The vein is glued without heat without heat and without tumescent local anesthesia out. This means that there is no need for many anesthetic injections along the vein, as is usual with laser or radiofrequency. This often makes the treatment more comfortable for patients.

In studies, the adhesive technique showed success rates (vein closure) of over 90 % after 1-3 years, comparable to radiofrequency ablation. The complication rate is also low: there is even a tendency for less bruising or pain than with than with heat treatments.

Another advantage is that after VenaSeal there is usually no compression stockings or only for a short time, as the vein is closed immediately. The procedure is performed on an outpatient basis; you can usually walk normally and resume everyday activities immediately afterwards.

Risks/side effects: Overall, the vein glue is very safe. In the first few weeks after the procedure, about 1 in 4 cases may experience a mild phlebitis This can lead to local irritation in the treated area, which is known as a “phlebitis-like reaction”. This manifests itself as redness, hardening or a feeling of tightness over the adhered vein, but usually subsides on its own or with anti-inflammatory ointment. Rarely (<1 %) can a allergic reaction to the adhesive may occur.

Serious complications such as deep thromboses or embolisms are extremely rare and practically did not occur in studies up to 5 years of follow-up. Overall, the vein glue is considered Gentle and safe methodespecially for patients who value rapid recovery and minimal intervention.

Radiofrequency ablation (RFA) and endovenous laser (EVL)

The radiofrequency ablation and the endovenous laser therapy are established catheter procedures in which the varicose veins are heat to “obliterate” the varicose vein from the inside will be. Both belong to the endovenous (acting inside the vein) procedure. The procedure: After local anesthesia, the doctor inserts a fine catheter into the affected truncal vein (e.g. the great saphenous vein).

Either a radio wave probe (for RFA) or a laser fiber optic cable (for EVL) is inserted via the catheter. Then, along the vein, a Tumescent solution is injected – a diluted anesthetic solution that surrounds the vein and protects the surrounding tissue from heat. The probe is then activated and slowly withdrawn.

The heat (approx. 100 °C for laser, 120 °C for RFA) causes the inner walls of the veins to the inner walls of the veins are specifically scorched and sealed. The vein shrinks and remains as a strand of connective tissue, which the body gradually breaks down.

Radiofrequency and laser therapy differ technically in the energy source (radio waves vs. laser light), but clinically their results are comparable. Both achieve very high closure rates: Immediately after the procedure >95%, and even after 5 years ~80-90% of treated veins are permanently closed, depending on the study.

RFA can heat somewhat more evenly with special segment catheters, while modern laser systems work with radially emitting fibers – both of which improve effectiveness and reduce side effects compared to older techniques.

For whom suitable: Endovenous thermal procedures are used for larger truncal varicose veins (especially insufficiency of the great saphenous vein or parva) as the first choice therapy of first choice is considered to be the best option. The European guidelines recommend them, if anatomically feasible, before open surgery. They are suitable for almost all patient groups and age groups, as they can be performed under local anesthesia on an outpatient basis.

In the case of very tortuous (“curvy”) veins, however, it can be technically difficult to advance the catheter completely – in such cases, foam sclerotherapy or a surgical procedure could be considered as an alternative. Even if there is already severe scarring or vascular changes (e.g. following previous thromboses), an individual decision must be made as to whether endovenous access is possible.

In most cases, however, RFA/EVL can be performed, even at an advanced age or with concomitant diseases, as no general anesthesia is required.

Risks/side effects: The complication rate is lower than with conventional surgery. Temporary local discomfort is typical: A pulling sensation during the course of treatment, slight pain, bruising or hardening under the skin. These usually subside within a few weeks.

Occasionally, a feeling of numbness occurs in small areas of skin if a cutaneous nerve has been irritated by the heat – this is rare and usually disappears. More serious complications (infections, deep vein thrombosis, injury to deeper vessels or nerves) are very rare.

In studies, for example, thromboses occurred in significantly less than 1% of cases. After the procedure, it is often recommended to wear compression stockings for a few days to two weeks and to walk regularly to promote healing. However, most patients are able to return to work or go about their daily lives the following day.

Healing process and success: The recovery time after RFA or EVL is short – you often hardly feel any discomfort after just a few days. As no large incisions are necessary, only punctiform scars are created. Long-term studies show that the results are comparable to those of surgery.

It is important to know that – as with any varicose vein treatment – new varicose veins can occur over the years. After a few years, approx. 20-30% of those treated will have new varicose veins. new varicose veins become visible, either by reopening the treated vein or by widening other veins.

This corresponds approximately to the recurrence rate after a classic operation. If necessary, a minimally invasive procedure can then be performed again. Overall, however, RFA and laser have a very high initial chance of success and enable many patients to achieve a significant improvement in symptoms and leg aesthetics with minimal downtime.

7.3. Foam sclerotherapy (sclerotherapy)

The sclerotherapy (sclerotherapy) is an injectable procedure in which a sclerosing agent is injected into the dilated vein to sclerose and scar it. Sclerotherapy and scarring to bring. A distinction is made between liquid and foam sclerotherapy. Particularly for larger varicose veins (side branch or trunk veins), a Sclerosing foam is used, as this is better distributed in the vein. The doctor injects a fine bubble foam (a mixture of sclerosing agent and air/CO₂) into the vein under ultrasound guidance.

The active ingredient – often polidocanol or cautery thorn – damages the inner wall of the vein, causing the vein to contract and transform into a strand of connective tissue. This method also does not physically remove the veinbut closes them from the inside. Smaller varicose veins (e.g. reticular veins and spider veins) can often be sclerosed using liquid injections, while larger veins are treated with foam.

Typical indications: Foam sclerotherapy is very versatile. It is often used for Lateral branch varicose veins are used, i.e. medium-sized varicose veins that remain after treatment of the main vein, for example. Also recurrent varicose veins (varicose veins that have recurred after previous surgery) can also be treated well with foam if the anatomy does not allow a catheter.

In some cases, an insufficient trunk vein (saphenous vein) can even be closed with foam instead of surgery – especially if patients do not want a more invasive procedure or if health risks prohibit surgery.

However, the success rate for very large truncal veins is limited; guidelines see foam sclerotherapy primarily as an option if laser/RFA unsuitable or for smaller veins. Sclerotherapy is also often in addition to other procedures (e.g. sclerotherapy of small residual branches after RFA, or combination of foam and compression therapy).

Procedure: Treatment is carried out on an outpatient basis. Usually several sessions depending on how many vein sections need to be sclerosed. Only a certain amount of sclerosing agent can be used per session. After the injection, the vein is treated with a compression bandage or stocking, which must be worn for a few days to weeks to ensure that the vein walls stick together and inflammation is kept to a minimum.

Shortly after the injection, patients should walk around for 30-60 minutes to promote blood flow in deep veins. Otherwise, there are hardly any restrictions on everyday activities – a major advantage over surgery.

Risks/side effects: Local irritation is relatively common, but usually harmless. There may be redness, itching or a brief burning sensation at the injection site. Known adverse effects are Skin discolorationIn approx. 10-30 % of those treated, a brownish pigmentation develops along the sclerosed vein.

These discolored areas often disappear within months, but in some cases they can remain permanently visible. In addition, a small vein branch inflamed (superficial thrombophlebitis), which appears as a painful, hardened “nodule” – this is punctured if necessary or treated with heparin ointment and is not dangerous. Complications such as nerve damage or major bruising occur less frequently than with surgery.

Serious complications (deep thromboses, allergic reactions, visual disturbances or – extremely rarely – strokes) are described in the literature, but only occur in exceptional cases if the technique is correct and ultrasound monitoring is used. Overall, foam sclerotherapy is considered Relatively safe procedure. Nevertheless, it is mainly used for small and moderate varicose veins, where the risk-benefit profile is favorable.

Success and recurrence rate: Sclerotherapy can treat many varicose veins effectively. It is the treatment of choice for side branches and spider veins in particular. Although the initial success rate is high for larger truncal veins, the probability of reopening or new formation is higher than with laser or stripping.

A comparative study showed recurrence-free rates of only ~51% after foam sclerotherapy after 4 years, compared to ~81% after stripping surgery. This means that approximately one in two obliterated large veins can become patent again in the medium term or collaterals can form. Therefore Follow-up treatments are necessary – either renewed sclerotherapy or a change to another method.

Nevertheless, foam sclerotherapy also has advantages: it is less expensive, does not require anesthesia and allows a quick return to everyday life. In the hands of experienced phlebologists and for suitable vein sections, it is a valuable procedure for eliminating varicose veins without surgery.

Current developments and combination therapies

Phlebology is constantly evolving. Microfoam-Sclerotherapy is a refined form of foam sclerotherapy: a special mixing process produces a particularly homogeneous, stable foam with very small bubbles. This Microfoam (e.g. the polidocanol microfoam approved in the USA) is optimally distributed in the vein and can potentially achieve even better closure rates.

Studies are underway to assess whether microfoam is superior to classic foam sclerotherapy. Also under development are new Sclerosing agents and adhesive materialsthat are more compatible and more efficient. For example, research is being conducted into alternative medical adhesives that could be used alongside VenaSeal, as well as into combined processes.

One example of the latter is mechanochemical ablation (MOCA, e.g. “ClariVein®”): Here, a rotating catheter mechanically causes damage to the vein wall and a sclerosing agent is introduced at the same time – this combination is intended to utilize the advantages of both principles, completely without heat. Initial results show good success rates with minimal side effects, although long-term data is still lacking.

In addition, often therapy combinations are often used to achieve optimal results. In the practice, for example, a large trunk vein is treated with laser or RFA and then smaller side branches are sclerosed with foam or removed using miniphlebectomy. The combination with compression has also proved successful: Temporary compression therapy is recommended after practically every endovenous or surgical procedure, as studies indicate that this promotes healing and reduces complications.

Medication supplements, on the other hand, play a subordinate role. vein toning agents (such as red vine leaves or horse chestnut extract) alleviate subjective symptoms, but are no substitute for interventional therapy. Overall, the A mix of different procedures Individualized treatment – depending on the findings, several methods are often used to achieve the best possible treatment result.

7.4. Operative procedures

Surgical interventions on the veins have a long tradition and were long considered the gold standard in varicose vein treatment. Even today, they are still necessary or useful in certain cases – for example in the case of very pronounced varicose veins, if minimally invasive methods are not feasible or if there is a high level of recurrence.

Modern surgical techniques have become gentler; many procedures are performed on an outpatient basis. The classic surgical methods for varicosis are Vein stripping and the crossectomy (ligation at the mouth of the vein), often in combination with the removal of side branches. The varicose vein is actually removed from the body.

The advantage is that the diseased vein is completely removed, which may result in slightly lower recurrence rates in the long term. The disadvantages are, of course, the more invasive nature and possible wound healing problems. The most important surgical procedures are listed below:

Vein stripping (according to Babcock)

The stripping (“pulling”) of the vein is the best-known varicose vein operation. A typical example is Babcock stripping of the great saphenous vein. Two small incisions are made: one in the groin (or popliteal fossa in the case of the small trunk vein) and a second further down the lower leg or ankle.

First, the dilated truncal vein is separated from the deep vein at the groin (crossectomy: Ligation of the saphenous vein at the crosse). The surgeon then inserts a flexible probe into the vein from the lower incision and pushes it up to the groin. The vein is then fixed to the probe – classically with an “olive head” attachment – and the vein is removed via the inguinal stitch. pulled out.

In this way, the entire diseased section of vein is removed. In addition, often visible Side branch varicose veins removed by miniphlebectomy: Using tiny, punctiform skin incisions (<5 mm), the secondary branches are hooked out with special hooks and pulled out piece by piece. This method leaves only minimal scars. The removed vein material no longer plays a role in the blood circulation – the blood flows back through deep and other superficial veins, which is not affected by the operation.

Indication: Stripping is mainly used for extensive truncal varicosis is performed if the large or small truncal vein is insufficient along its entire length. Also with Recurrent varicosis (recurrence of varicose veins after previous treatment), stripping can be useful to completely remove remaining or newly formed vein sections.

In certain stages (e.g. C2-C5 according to CEAP with symptoms), surgical removal may be considered, especially if minimally invasive procedures are not suitable (e.g. due to extremely tortuous veins or very large vein diameters >2 cm). In very young patients with a long expected lifespan, some phlebologists also argue for a more radical removal to prevent recurrences – although this is controversial, as recurrences can also occur after stripping, e.g. due to neovascularization.

Risks/side effects: As with any operation Wound pain, bruising and swelling occur in the days following the operation. Stripping in particular can lead to extensive bruising along the removed vein. The incisions result in scars – a few centimetres in the groin, often <1 cm on the lower leg, and numerous mini-scars from the phlebectomy. Around 15 % of patients who have undergone the operation develop a Side effects such as wound infection, post-operative bleeding, persistent swelling or noticeable scarring.

Serious complications are rare but possible: these include injuries to neighboring structures (e.g. nerve injurieswhich can lead to areas of numbness) or deep vein thrombosis due to injury to a deep vein branch. A special, rare complication of small trunk vein stripping is damage to the calf nerve (sural nerve), which runs along the lower leg next to the vein – this can lead to persistent numbness in the lateral foot.

Overall, however, the risk of serious complications is very low (serious problems occur in well under 1% of cases). Thanks to modern surgical technology and experienced surgeons, stripping is now a safe procedure.

Healing time: After a vein stripping, you can often go home on the same day or the following day. You should rest your legs for the first few days, but Mobilize early – Walking with a compression bandage is often recommended on the day of the operation to promote blood circulation. The stitches (if not self-dissolving) are removed after approx. 7-10 days.

Swelling and bruising usually subside within 2-3 weeks. Depending on the occupation, a sick leave of about 1-3 weeks may be necessary, especially if physical work or long periods of standing are involved. Sporting activities (except swimming, as long as the wounds have not healed) are possible again after about 2 weeks, as soon as there is no more pain. Overall, the Recovery time after stripping is somewhat longer than with minimally invasive procedures, but still manageable.

Success and relapses: In over 80% of patients, stripping significantly alleviates the symptoms or makes them disappear completely. The aesthetic result is also usually good – the crooked, protruding veins are removed and the leg looks smoother again. However, there can also be new varicose veins form after an operation.

In studies, varicose veins recurred within 2 years in around 30% of those who had surgery. In the long term (after many years), up to 50% can be affected again, especially if there is a hereditary predisposition. The cause of such recurrences is often New connecting veins at the crosse (neovascularization) or unnoticed remaining vein sections that dilate. It is interesting to note that radical stripping has been shown to fewer If, for example, only the crosse is ligated without pulling the vein, the recurrence rate is significantly higher. Stripping also performs better than foam sclerotherapy in terms of durability.

Nevertheless, a residual risk remains. If varicose veins reappear, treatment can be carried out again years later – be it a new stripping of residual sections, re-sclerotherapy or an endovenous procedure. Overall, however, vein stripping offers very good chances of success with a relatively low recurrence rate with suitable indications.

Crossectomy and perforating vein ligation

Under crossectomy is the surgical ligation of the point where a superficial vein joins the deep venous system. In practice, this means, for example, that the great saphenous vein is cut and ligated in the groin where it joins the deep femoral vein (this area is called the crossectomy). crosse). A crossectomy is often Part of the stripping process (the first step). In rare cases, it can also be performed as a stand-alone procedure – for example in older patients who no longer want to undergo a complete stripping procedure or if the truncal vein is only insufficient in the upper section.

However, without the subsequent removal of the vein, the recurrence rate is higher. Studies show that varicose veins recur much more frequently or reoperations are necessary after crossectomy alone, compared with crossectomy plus Stripping. For this reason, an isolated crossectomy is rarely performed today, unless there are special reasons not to remove the vein.

If a sole crossectomy is performed, this is a relatively minor procedure (in principle, only the groin incision as for stripping, but without the long “pulling” of the vein). The risks are similar to those of stripping, but are lower overall as less tissue is traumatized. Nevertheless, there is also an (even higher) risk of recurrence, which is why this procedure is rarely used in isolation.

The perforating vein ligation is another surgical procedure that is only necessary in special situations. Perforating veins are connecting veins between the superficial and deep venous system. In the case of advanced chronic venous insufficiency (CVI), especially if there is already a Ulcus cruris venosum (open leg), certain perforating veins are often insufficient. This means that blood flows from the deep system back into superficial areas and accumulates in the tissue – which impedes the healing of an ulcer.

In such cases, the prevention of these misdirected perforating veins may be necessary to reduce the pressure in the tissue and enable healing. This is done either by open surgery through a skin incision over the corresponding vein or by an endoscopic procedure (SEPS – subfascial endoscopic perforating vein ligation). However, due to the additional surgical effort and not inconsiderable risk (wound healing disorders etc.), SEPS is not recommended. very cautiously indicated and practically only carried out in the case of therapy-resistant ulcers.

Perforator ligation is usually combined with other procedures (e.g. as part of a stripping procedure if insufficient perforating veins have been identified on the lower leg). For most ordinary varicose vein patients without an ulcer, this procedure is not necessary. not relevant. If it is necessary, your vascular surgeon will discuss this with you specifically.

7.5. Which method for whom – patient perspective

In view of the wide range of treatment options, the question arises: Which treatment is the right one in my case? The answer depends on several factors, in particular the stage of varicose veins, your symptoms, your general state of health and also your personal preferences. Basically applies:

• General measures first: Mild findings (e.g. few varicose veins without symptoms) or early stages are often treated conservatively first. Compression, exercise and risk factor management can be tried.

If this achieves freedom from symptoms, it is not necessarily necessary to intervene immediately. However, existing varicose veins will not disappear. As soon as symptoms appear or the varicose veins progress, further steps should be considered.

• Minimally invasive before surgery: According to current guidelines, patients with varicose veins requiring treatment should preferably undergo an endovenous procedure should be offered an endovenous procedure – the first choice here is increasingly the VenaSeal™ (vein glue)followed by proven techniques such as radiofrequency ablation or the endovenous laser therapy. These methods are suitable for most people, as they are performed on an outpatient basis, under local anesthesia and require little downtime. From a medical point of view, they are also considered to be the best treatment for truncal vein insufficiency. standard of care (recommendation grade I).
  Exceptions are special anatomical conditions that rule out an endovenous procedure. If a thermal procedure is not possible (e.g. very tortuous vein or contraindications for the required anaesthetic), the next step is the Ultrasound-guided foam sclerotherapy can be considered. This is well suited for slightly smaller main veins or pronounced side branch varices.

It can also be an alternative if someone does not wish to undergo surgery. Only if neither laser/RFA nor sclerotherapy are an option (or were unsuccessful) should a Operation (stripping) should be considered. Of course, there are also situations in which surgery is performed directly – for example in the case of very large varicose veins with complications, or if other venous problems need to be surgically repaired at the same time.

• Severity of varicose veins and symptoms: In the case of advanced chronic venous insufficiency (C3 with severe oedema, C4 skin changes, C5 healed ulcers, C6 open ulcers), interventional therapy should not be delayed too long. The risk of complications (ulcers, thrombophlebitis, etc.) is increased here and treatment can halt progression.

For example, in the case of an open leg The underlying venous hypertension should always be treated – often by a combination of stripping/RFA and perforator ligation in order to heal the ulcer. Conversely, in the case of purely cosmetic varicose veins without symptoms, there is no medical obligation for immediate treatment. Patients can decide in consultation with their doctor whether they want sclerotherapy or laser therapy for aesthetic reasons. However, health insurance usually does not cover the costs in such purely cosmetic cases.

• Age and concomitant diseases: Patient age alone is not a strict exclusion for any method. Even senior citizens over 70 or 80 can also benefit from varicose vein treatment, especially if they have symptoms. Minimally invasive methods are particularly advantageous here due to the lack of general anesthesia.

However, if life expectancy is limited or serious illnesses are present, the benefits and risks will be weighed up carefully – sometimes purely conservative treatment is the only option. Younger patients tend to benefit longer from definitive removal (fewer recurrences in the near future), but they too must expect possible relapses.

Important to know: New varicose veins can form after any method. No procedure can guarantee that new varicose veins will not appear in a few years. Therefore, all patients – whether they have had surgery or not – should support their veins in the long term with a healthy lifestyle (exercise, normal weight, compression if necessary, etc.).

• Patient preference: Your personal wishes play a major role. Do you attach importance to making the varicose veins visibly visibly? Then surgical removal or endovenous ablation could provide a quick cosmetic result. Do you shy away from surgery and want a particularly gentle approach? Then the adhesive technique or foam sclerotherapy may be attractive.

Some patients want to “play it safe” and prefer to opt for classic stripping, assuming that this will “take everything out” – in fact, stripping has very good long-term results in suitable cases, but minimally invasive methods are hardly inferior and are more gentle.

Others want to avoid a general anesthetic at all costs or be fit again as quickly as possible – in this case, laser/RFA or VenaSeal would be ideal. Seek advice from your vein specialist: In many cases, there are several equivalent optionsand the decision can be made on an individual basis.

In summary, it can be said that the treatment of varicosis today is very individualized can be shaped. Thanks to conservative measures, many sufferers can contribute to relief themselves. Modern minimally invasive procedures (laser, radiofrequency, vein glue, foam) enable effective treatment with minimal stress – they are therefore suitable and recommended for most patients with varicose veins requiring treatment.

The surgical therapy (stripping, crossectomy) remains an important component, especially in complex or severe cases, and continues to offer excellent results. Ultimately, you should decide together with your doctor which method best meets your medical requirements and personal expectations.

It is important that you understand: no matter which therapy you choose, your health is the focus – and after the treatment, you can do a lot yourself to maintain the result. You can find out how you can support your veins through lifestyle and personal measures in the next section.

8. prevention of varicose veins: Effective measures for healthy veins

Varicose veins (varicosis) are usually caused by a combination of predisposition and lifestyle. About 20 % of adults develop varicose veins in the course of their lives – women more frequently than men. The main contributing factors are genetic predisposition, increasing age, obesity and occupational activities with long periods of standing (e.g. care, sales).

Also Lack of exercise and prolonged sitting also make it more difficult for blood to return to the leg veins and promote the formation of varicose veins in the long term. Pregnancies can also temporarily cause varicose veins, as hormonal changes and the weight of the child make it more difficult for blood to drain from the legs.

Especially if there is a family history of venous insufficiency or if you are in a phase of life with an increased risk (pregnancy, standing job), active prevention is worthwhile. This can often delay or alleviate symptoms – even if an inherited Connective tissue weakness cannot, of course, be completely prevented. In the following you will learn how to maintain your vein health and prevent varicose veins – with the right exercise, posture, clothing, diet and other preventive measures.

8.1. Why prevention is so important

Early prevention instead of later surgery: Varicose veins are not just a cosmetic problem, they can cause heavy legs, swelling and pain. If left untreated, there is even a risk of complications such as thrombosis or leg ulcers in rare cases. It therefore makes sense, strengthen the veins before permanently dilated veins develop.

Especially people with risk factors – such as a family history of genetic predisposition, pregnancies or long periods of standing/sitting at work – should emphasize vein-healthy habits. The better the venous valves and vascular walls are kept in shape through exercise and a healthy lifestyle, the more likely it is that varicose veins can be avoided or at least delayed.

In addition, many of the following measures can also alleviate complaintsif you already have mild venous insufficiency. All in all, it is not always possible to completely prevent varicose veins, but Preventive measures reduce the risk of and vein problems occur later or are milder.

8.2. Exercise in everyday life: keep your veins going

Regular exercise is the best vein therapy – and also the best prevention. Especially sports that strain the leg musclessupport the venous system in its main task, namely the transporting blood back to the heart. Every step activates the calf muscle pump, which pushes the blood upwards from the leg veins. Therefore Run away from varicose veins in the truest sense of the word. Exercise also improves blood circulation and helps to maintain a normal body weight – important because Obesity promotes the development and worsening of venous disorders.

Recommended vein-friendly activities: Optimal are Endurance sports with even leg movement. Especially Go, brisk walking, light jogging, cycling and dancing get your calves going. Your veins are also in their element in the water: Swimming, aqua gymnastics or aqua jogging relieve the legs twice – through movement and water pressure.

Water pressure and cooler water temperatures act like a natural compression massagecontract the vessel walls and support the outflow of blood. Already 10-15 minutes in the pool promote the removal of stored fluid; many people notice that they have to go to the toilet more often afterwards. Outside of the water Hiking, Nordic walking, moderate inline skating or training on the cross trainer/stepper as “vein-friendly”.

Their common feature is a uniform, rhythmic contraction of the leg and calf muscles. Cycling is also excellent, if the seating position is right: An upright posture (Dutch bike instead of racing bike) prevents the veins in the groin and abdomen from kinking. In winter, there are alternatives such as Cross-country skiing or snowshoe hiking the main thing is to keep your legs moving. Important: Exercise is good at any ageOlder people also benefit from regular walks or gymnastic exercises to support venous return.

Vein exercises for in between: In addition to sports units, you can also do a lot for vein health in everyday life. vein health do. Special Vein exercises can be done at home, in the office or on the go without any aids. Just a few minutes a day can work wonders and even help people with healthy veins to get through a long working day sitting or standing without swollen and heavy legs. For example, try the following exercises (several times a day, e.g. in the morning and evening or during breaks):

• Foot rocker: When sitting place both feet flat on the floor next to each other. Then alternately raise and lift and lower your heelsso that your toes remain on the floor and, conversely, raise your toes (heels on the floor). This rocking activates the calf pump. Variations: While standing again and again toes and back onto your heels to stimulate the venous returnto stimulate the venous return flow.
• Foot circles: Sit down and place your toes on the floor. Now alternate between lifting your feet slightly and circle your feet in the ankle jointsometimes inwards, sometimes outwards. This also works under a desk or even on an airplane.
• Stretch the tips of your toes: In a seated position, stretch one leg forward and pull the tip of your foot towards your knee (as if you were pulling your toes towards your shin). Then extend the foot forwards. Repeat this several times for each leg. This exercise trains the alternation between tensing and relaxing the calf muscles – ideal for “office legs”.

Tips for working people: Many professions force us to sit for long periods (office work, driving) or to stand (nursing, sales). It is important to find a balance: Take every opportunity to exerciseto relieve the veins. Like this:

• Active commute: If possible, take the stairs stairs instead of the elevator. Leave the car behind for short distances and go on foot or by bike.
• Take exercise breaks: Stand up regularly in the office, stretch your legs or walk a few steps. Don’t always pick up the phone, but visit colleagues in person – this will automatically add up to a few steps. In nursing or sales, micro-breaks can be used, for example, to bounce your feet briefly or shift your weight from one leg to the other.
• Relieve strain while standing: If you have to stand for a long time, walk on the spot in between. You can also alternately lifting the tips of your toes and heels (see foot rocker) also works discreetly and helps to pump the blood upwards out of the legs.
• Take the strain sitting down: Do not sit not sit rigidly for hours in the same position for hours. It is better to dynamic sitting: frequent changes of positionstand up from time to time and do small exercises (circling your feet, rocking your toes) in place. This keeps the muscle pump active instead of “switching off” completely.

Conclusion: Movement, movement, movement! Anything that calf muscles work regularlyhelps to prevent varicose veins. A mixture of everyday activities (climbing stairs, walking) and targeted training (sport and vein exercises) is ideal. Even small changes – e.g. walking around the block at lunchtime instead of staying seated – have an effect. Incorporate exercise into your daily routine to keep your veins in good shape in the long term.

8.3. Sitting and standing correctly: Dynamics instead of continuous strain

“It’s better to lie down and walk than sit and stand” – this saying from vein specialists sums it up perfectly. Long uninterrupted sitting or standing puts enormous strain on the leg veins: the blood must constantly against the force of gravity pumped upwards against gravity, but the necessary muscle pump is hardly active in these postures.

As a result, blood accumulates more easily in the leg veins, fluid can leak into the tissue (swelling) and the vein walls become overstretched in the long term. You should therefore Avoid sitting and standing for long periods or interrupt them frequently. Of course, this can’t always be arranged – but it can be achieved by Correct behavior when sitting/standing relieves the veins:

Dynamic sitting: How to keep your veins moving

Movement despite sitting:
Anyone who sits a lot – whether in the office, when driving or at home – should make sure they have an active sitting posture.
This means:

• Change sitting position regularly

• Stand up from time to time

• Move your feet regularly (e.g. vein exercises)

Important: Do not cross your legs permanently.
This squeezes the veins in the back of the knee.
Better: Place both feet next to each other.

Correct seat height and choice of chair:

• Your feet should be flat on the floor – not dangling.

• Alternatively, a footrest can help.

• The front edge of the seat must not press against the thighs – otherwise the veins in the legs will be constricted.

• Ergonomic chairs with adjustable height and seat tilt are ideal.

Tip:
A small footrest can help to keep your legs slightly elevated and relieved.

Also important in the car:

• Take a break every 1-2 hours.

• Walk a few steps or do foot exercises to stimulate blood circulation and avoid “sitting stiffness”.

Stand correctly: If your everyday life or job requires you to stand for long periods, try to do this too, incorporate movement. Shift your weight regularly from one leg to the other, take a few steps in between. It is very effective to stand for long periods of time walking on tiptoe and rolling off again – virtually Calf raises on the spot.

This activates the muscle pump and prevents the blood from pooling in the lower legs. If possible, place one foot slightly elevated for a short time in between (e.g. on a low footrest or a landing); this also relieves the leg veins in the short term. Take breaks to shake out your legs or put them up.

Elevate your legs – when, how often, how long? Elevating your legs is the easiest vein therapybecause it uses gravity to your advantage. As soon as you have the opportunity, put your legs up – yourself 2-3 minutes in between on a stool, a shelf or (in the office) e.g. the wastepaper basket under your desk will already help. By elevating your legs, the blood can flow back to the heart more easily and does not build up in the legs. Especially after long periods of standing or sitting elevating your legs is ideal for draining accumulated fluid and reducing swelling in your ankles. Give your legs a longer break in an elevated position, especially at home in the evening – for example on the sofa with a cushion under your feet.

After an exhausting day you can put your legs up for half an hour. It can also be useful to elevate your legs slightly at night if you are prone to swelling or heavy legs. It is sufficient if your feet are about 5-10 cm higher than the heart – for example with an adjustable slatted frame or a wooden board under the bedposts at the foot end. This small incline supports venous return for hours. Alternatively, you can place a pillow under the mattress at the foot end. However, make sure that it is not too high so that the sleeping position remains comfortable.

Additional everyday tips for sitting/standing: Pay attention in everyday life to vein-friendly habits. For example, avoid sleeping for long periods with your legs bent legs for long periods of time (e.g. sitting on an airplane), as this pinches the veins. If possible, get up regularly and move around instead of staying in one position for hours on end.

If you sleeping pills or tranquilizers be careful if you take a lot of sedatives (e.g. on long journeys) – these encourage a rigid sitting posture; it is better to stay awake and move your legs from time to time. Overall: Dynamics is the trump card. Alternating between stress and relief, movement and elevation keeps the venous circulation going. This effectively prevents congestion.

8.4. Shoes, clothing and temperature: what you should look out for

Vein-friendly shoes

The right footwear relieves the veins with every step. The best shoes are comfortable, flat shoes with a flexible sole and plenty of room for your toes. This allows you to keep your foot roll well and move the toeswhich activates the muscle-joint pump. High heels on the other hand may look stylish, but make it more difficult to roll the foot and move the ankle joint – the calf pump remains largely inactive. As a result, blood tends to build up in the leg veins. You don’t have to do without heels completely, but wear High heels only for special occasions.

In everyday life, flat shoes or shoes with a maximum of a small heel (3-4 cm) are the better choice for your vein health. Tip: If you have been wearing high heels for a long time, walk for a few minutes afterwards barefoot or in flat shoesto relax the feet and stimulate circulation. Also Walking barefoot itself is healthy for the veins – it trains the foot muscles and promotes a natural rolling motion.

Not too tight: clothing that does not constrict the veins

Tight clothing can impede the blood flow in the leg veins. You should therefore avoid constricting clothing in the pelvic and groin area – For example, pants that are too tight, girdles or shaping underwear (shapewear). Such items can slow down the return flow of blood from the leg veins to the heart and also impair lymph drainage. Very tight-fitting jeans or leggings that leave no wiggle room are also unfavorable for venous circulation.

Also make sure you wear matching socks and stockings: these should not cut in. If stockings are wrinkled or have a tight elastic waistband, they can cut into the calf and disrupt blood and lymph flow. Better: Stockings in the right size that fit snugly and do not leave any pressure marks. If in doubt, opt for special support stockings or seek advice from a medical supply store to ensure that nothing pinches.

Loose, breathable clothing is particularly important on warm days. Heat causes the blood vessels to dilate anyway – if tight clothing is then worn, the heat also “builds up” on the body. Wide, airy outfits (e.g. summer dresses, loose pants) prevent heat build-up and are therefore more comfortable for the leg veins. If you are already wearing compression stockings (see below), this applies even more: in summer, loose garments support the veins. body climate and the comfort of the stockings.

Heat, cold, showers and baths

Extreme temperatures have a noticeable effect on the veins: Heat dilates the vesselscold contracts them. Many people with vein problems notice this clearly: Hot summer days or a very warm bathtub often increase swelling and heaviness in the legs. Cold on the other hand, is good – cold water, for example, quickly provides relief for “tired” legs. This leads to some practical recommendations:

• Hot baths only in moderation: A warm bath is relaxing, but if you have pronounced varicose veins or chronic venous insufficiency, you should do not bathe too long and not too hot. The heat causes the veins to dilate considerably; if the skin is already damaged (brown discoloration, thin areas of skin over varicose veins), extended bathing can also soften the skin and, in extreme cases, increase the risk of venous bleeding.

Experts advise against hot baths immediately after vein surgery or in the case of acute thrombosis, for example. However, there is nothing wrong with a short, moderately warm bath: Make sure that the water temperature is about below body temperature (max. ~37 °C) lies. This allows you to relax safely, even if you have veins. Afterwards, it is advisable to shower your legs with cold water to constrict the blood vessels again.

• Sauna – yes or no? Sauna means first of all very high heat (80-100 °C) and is prohibited for acute venous disorders (thrombosis), as heat promotes clot formation and can increase swelling. For otherwise healthy veins, the same applies as for bathing: There is no clear scientific evidence that saunas have a positive or negative effect on vein health.

The fact is: In the sauna the walls of the blood vessels expand due to the heatbut the cold water afterwards causes them to contract again. This alternation of dilation and constriction acts like vascular training for the veins – similar to Kneipp’s treatments. If you are a sauna user and have no acute vein problems, you can enjoy the sauna in moderation.

However, observe how your legs react to this. We recommend short sauna sessions (one to two passes) and always a Cold water splash of the legs. Put your legs up in the sauna to facilitate reflux and cool them down thoroughly afterwards. Many vein patients report that this approach works for them – try it out to see if it works for you.

• Cold water applications (contrast showers): Cold showers or alternating showers are among the best-known tips against venous insufficiency – and they are indeed highly recommended. Cold water applications cause the veins to contract, which significantly reduces swelling and the feeling of heaviness.

Especially on hot days or after long periods of standing, cold cold showers for the legs are a blessing. They promote venous return and can prevent complaints from arising in the first place. The cold stimulus works best when it is applied after the classic Kneipp method is carried out. Each Leg section specifically cooledStart with the outside of the right foot, run the cold water jet up the outside of the right leg to the groin, then down the inside of the leg to the foot. Repeat this on the inside. Do the same with the left leg. Finally, briefly rinse the soles of your feet with cold water. This procedure – known as Kneipp irrigation – stimulates blood circulation and tightens the blood vessel walls.

Important: The body should be well warmed up before the cold shower (e.g. after getting up or exercising). Alternatively, you can take alternating showers (alternating hot and cold showers, always ending with a cold shower). This is also a vein workout and also strengthens the immune system. Make sure you keep warm afterwards so that your body returns to a normal temperature.

To summarize: Heat as briefly as possible, cold more often. Anything that avoids excessive heat stress on the legs (no extremely hot baths, sun in moderation, no hot water bottle on varicose veins) is positive. Cooling down, on the other hand – in the form of cold water or cool air – is good for the veins.

Many vein patients keep a spray bottle of water in the fridge in summer, for example, and spray their legs with it from time to time. This provides immediate relief for heavy legs. So don’t hesitate to use the power of water: alternating showers and cold leg showers are simple but effective methods of keeping your veins fit.

8.5. Vein-friendly nutrition: prevention from the inside

A healthy diet can contribute to vein healthby reducing overload and strengthening the vascular walls. Here are the most important aspects:

• Keeping your weight under control: Being overweight puts considerable strain on the leg veins. Every extra kilo increases the pressure on the leg veins and makes it more difficult for the blood to return. In addition, overweight people often move less, which combines two factors that are harmful to the veins. The following therefore applies: keep your weight as close to normal as possible. If you are overweight, try to lose weight gradually – even a few kilos less will relieve the pressure on the venous system.

Tip: A balanced, calorie-conscious diet with plenty of fruit and vegetables helps you lose weight and at the same time provides important nutrients for the blood vessels.

• Eat a high-fiber diet: Constipation is an often underestimated enemy of the veins. Pushing hard during bowel movements increases the pressure in the abdomen and therefore also in the leg veins, which can damage the vein walls in the long term. Prevent this by plenty of fiber into your diet: Wholemeal products, vegetables, fruit and pulses keep your digestion going and your stools soft. This will help you avoid straining.

Note: There is some discussion that a low-fiber diet and the resulting chronic constipation could be a risk factor for varicose veins – however, there is no clear scientific evidence of this connection. However, it is undisputed that good digestion is good for the whole body and that abdominal pressure puts pressure on the veins. So do your veins a favor and eat enough fibre.

• Drink enough: Hydration is crucial for blood circulation. Drink at least ~2 liters of liquid per day (more if it is hot) – preferably water or unsweetened tea. Sufficient fluids keep the stool soft and the blood is thinwhich reduces the risk of thrombosis. If you drink too little, you run the risk of your blood becoming thicker and more prone to clots. Drinking is particularly important when traveling by plane or in summer, as otherwise the body becomes dehydrated (the air is very dry on planes, for example, which causes the body to lose fluids).

Experts recommend on long-haul flights about 0.25 liters of water per hour of flight to drink. Avoid excessive salt consumption: A low-salt diet helps to reduce water retention in the tissue. Too much salt causes the body to retain water, which can contribute to swollen legs. It is therefore better to cook fresh and limit ready-made products, which are often very high in salt. Tip: Season more with herbs instead of salt. (This will also reduce your risk of high blood pressure).

• Vitamins and vascular protection: Certain vitamins and antioxidants play a role in healthy blood vessels. Above all Vitamin C is important for collagen formation and therefore for stable vein walls. Therefore, eat plenty of fruit and vegetables containing vitamin C (e.g. citrus fruits, berries, peppers). Bioflavonoids – secondary plant substances that often occur together with vitamin C – are also considered to protect the blood vessels. They are found, for example, in red grapes, berries, citrus fruits (white skin of the orange), buckwheat and green tea.

Also Vitamin E and beta-carotene (carrots, sweet potatoes, spinach, nuts) act as antioxidants and can help protect blood vessel walls from free radicals. Overall, a varied diet rich in fruit and vegetables is ideal for supplying the veins with micronutrients. Note: Isolated vitamin supplements are generally not necessary if you eat a balanced diet. Natural foods provide a whole package of protective substances.

• Salt and alcohol in moderation: As mentioned, salt promotes water retention, which is unfavorable for veins. Alcohol dilates the blood vessels and also has a dehydrating effect (the body loses fluid and the blood “thickens”). Both of these have a negative effect on vein function. You should therefore only indulge in alcohol occasionally and in moderate quantities.

Smoking damages the arteries in particular, but the veins also benefit from quitting smoking: studies show that risk factors such as smoking, high blood pressure and diabetes can damage not only the heart, but also the veins. Smoking also promotes the formation of blood clots. In short: A vein-friendly lifestyle includes abstaining from nicotine and moderate use of alcohol in. In contrast, you can use stimulants such as comfrey or marigold flowerse, which are traditionally recommended for venous insufficiency – even if their benefits have not been scientifically proven, they do no harm and promote fluid absorption.

Food supplements – helpful or just a placebo?

The market offers numerous herbal vein remedies and dietary supplementsthat promise relief – from horse chestnut extract to red vine leaves through to combination preparations with vitamins and bioflavonoids. But what should we make of them? Important to know: Creams, tablets and remedies cannot “conjure away” damaged venous valves or pronounced varicose veins. Cure This does not prevent varicosis. However, studies show that some herbal veno-therapeutics definitely alleviate complaints can alleviate complaints.

For example, a review by the Cochrane Collaboration found that Horse chestnut seed extract can reduce swelling and pain in chronic venous insufficiency in the short term. Red vine leaves are also said to have a similar effect (decongestant, anti-inflammatory). The following applies: Such remedies can at best complementary be used – instead of measures (exercise, compression, etc.) they should not be used as a not be used.

The scientific evidence on dietary supplements is generally poor. The German Society for Phlebology emphasizes that the Effectiveness of advertised vein products is not clearly proven. In studies, many preparations have shown at best a Placebo effect or very small benefits shown. Anyone taking them should not expect miracles. Nevertheless, reputable products in the Subjective help in individual cases (e.g. feeling of lighter legs).

If you want to try such remedies, talk to your doctor beforehand, especially if you are taking other medication (there may be interactions). Make sure you choose high-quality products especially in the case of herbal extracts, there are cheap preparations with few active ingredients that are useless. If in doubt in the pharmacy for advice.

Conclusion: Dietary supplements are no substitute for lifestyle measures or medical therapy. They can have a supportive effect (e.g. reduce slight swelling), but are not a not a miracle cure for varicose veins. Invest your money in healthy nutrition and compression stockingsyour veins will benefit far more.

8.6. Compression stockings as prevention

Compression stockings exert pressure on the leg veins and thus support the blood flow to the heart. They are a cornerstone in the treatment of venous disorders – but they can also be used preventive preventive? YesIn certain situations, this makes perfect sense:

• During pregnancy: Many women develop varicose veins for the first time during pregnancy. Wearing compression stockings from the early stages of pregnancy can have a preventative effect. The external pressure of the stockings prevents blood from pooling in the leg veins and can therefore Reduce swelling and pain.

Experts often advise pregnant women with vein problems or a family history to put on compression stockings at an early stage – at the latest as soon as the first signs such as a feeling of heaviness or spider veins appear. Usually Compression class II (medium) as a pregnancy stocking, as this provides good pressure but is still relatively comfortable. Ask your gynecologist or phlebologist about this; compression stockings during pregnancy are usually prescribed by your doctor and covered by your health insurance.

• For standing or sedentary occupations: People who spend many hours a day standing (e.g. sales staff, nursing staff) or sitting (office workers, professional drivers) can benefit from wearing support or compression stockings as a preventative measure. Special support stockings (compression class I) provide relief, especially if your legs are often swollen in the evening. They are thinner and more elastic than medical compression stockings in higher classes, but still exert sufficient pressure to prevent the legs from swelling. Prevent the development of edema.

By constricting the veins, they support the return flow of blood in a similar way to a continuous gentle massage. Many sufferers report that wearing them makes their legs feel less tired and heavy in everyday life. When standing, it can therefore make sense to wear compression knee-highs as a preventative measure before serious vein problems occur. They also help to prevent swelling when sitting (office), especially if you cannot stand up all the time.

• When traveling and on long journeys: Support stockings are especially on air travel or long bus/car journeys. Sitting for hours on end with little legroom increases the risk of venous thrombosis. Studies have shown that knee-length compression stockings significantly reduce the likelihood of deep vein thrombosis on long-haul flights. Even for travelers without a known high risk, wearing such stockings significantly reduces the risk of thrombosis.

Therefore applies: On flights from ~4 hours You should consider wearing compression stockings for the entire duration of your journey – it is a simple measure that allows you to “play it safe”. The same applies to long bus journeys or car journeys, especially if you are prone to thrombosis or already have varicose veins. In addition to the stockings, you should of course still take regular breaks and do exercises (see above). With the combination of Movement and compression your legs reach their destination more safely.

The right choice of stockings: Not all compression stockings are the same. There are four compression classes (I = mild, II = moderate, III = severe, IV = very severe) with increasing pressure. As a preventative measure and for mild complaints Class I or II prescribed. It is important that the stocking is worn regularly so that it works – it is better to consistently wear a slightly lighter stocking than to leave one that is too thick in the cupboard out of discomfort. Often, for example, a knee-high stocking This is because it is more comfortable and easier to put on in everyday life than a thigh-high stocking – and a knee-high stocking on is better than a thigh-high stocking in the wardrobe. Knee compression stockings are usually sufficient for incipient venous insufficiency or for prevention, as the important venous valves in the lower legs are supported.

Fitting and use of compression stockings

The right size is crucial:
Make sure you are measured by a specialist to get the right size and length.
Compression stockings must fit well – they must not slip or constrict.

When and where should you have your legs measured?
It is best to go to the medical supply store or pharmacy in the morning when your legs are still slightly swollen.
There, trained staff will measure several parts of your leg – for example:

• Ankle

• calf

• Thigh if necessary

Selection and prescription:
The specialist staff will help you with the selection of:

• Material (e.g. fine or robust)

• Model (e.g. knee-high or thigh-high stocking)

In Germany, all statutory health insurance physicians can prescribe compression stockings on prescription if medically necessary.
The health insurance company then covers the costs – you only pay the statutory co-payment of €5 to €10.

Process in the specialist store:
Take your prescription to a medical supply store or a suitable pharmacy.
They will order your custom-made pair.

Fitting and instructions:
As soon as the stockings arrive:

• Try them on directly on site.

• Let us show you how to put them on correctly.

Important for the fit:
A good stocking:

• must not wrinkle

• must not cut in

• should ideally hardly be noticeable

Some practice required:
Putting them on requires a little patience at first – but there are also practical donning aids.
After a few days, the material adapts and putting them on becomes much easier.

When to wear them? Compression stockings are most effective if you wear them in the morning immediately after getting up and wear them until the evening. This prevents the legs from swelling too much in the first place. Especially on days when you will be standing/sitting for long periods (work, traveling), you should wear the stockings. You can also take a break in less stressful situations. Listen to your body: if you have no complaints without stockings, you don’t have to wear them all the time. During pregnancy daily wearing is usually recommended in order to provide the best possible prevention. When traveling by plane the stockings should also be worn consistently throughout the entire journey.

Note: Compression stockings are primarily used to prevent discomfort and complications (swelling, thrombosis). Varicose veins do not disappear as a result, but smaller veins often shrink slightly under the pressure. According to experts, it is still unclear whether regular wearing actually slows down the progression of varicose veins. Nevertheless, many phlebologists advocate early wearing because it is low-risk and at least the Symptoms significantly improved. The correct application is important – only then will the stockings be fully effective. If you are unsure or have problems wearing them (e.g. slipping, pressure points), consult your doctor or orthopaedic technician. Small adjustments or a different model can often help. When used correctly, compression stockings are a simple and effective way of preventing venous disorders or halting their progression.

8.7. Prevention in various life situations

During pregnancy

The veins work hard during pregnancy: hormonal changes cause the connective tissue to slacken and the vein walls also become more elastic. At the same time, the blood volume increases and the growing baby puts pressure on the pelvic veins. No wonder that Varicose veins often appear for the first time during pregnancy. The good news is that these “pregnancy varicose veins” often disappear again in the months following the birth. Nevertheless, you should not simply accept discomfort, because even temporary varicose veins can promote thrombosis, for example. Prevention and relief are therefore paramount – surgical interventions are generally avoided until after pregnancy.

Tips for expectant mothers: Exercise regularly, as far as your condition allows – swimming or walking are ideal to relieve the veins (and also reduce swollen legs). Avoid standing for long periods; put your feet up from time to time in everyday life.

Many pregnant women swear by Alternating leg showers in the morningto start the day fresh and light. Pay attention to a weight-conscious diet – excessive weight gain is an additional burden. And as mentioned above: use compression stockings early! Don’t be afraid to ask your doctor for them in the first trimester, especially if you have a family history of venous insufficiency or have already noticed spider veins.

It is better to take preventative measures than to struggle with varicose veins for months afterwards. After the birth, many varicose veins recede; remaining varicose veins can still be treated (e.g. sclerotherapy or removal). During breastfeeding, invasive treatments should also only be carried out after consultation. Overall, the following applies: Enjoy your pregnancy and support your veins with healthy habits – your legs will thank you for it.

In old age

The frequency of vein problems increases with age. The tissue naturally becomes less elastic and many people move less as they get older. But this is precisely when exercise is important! Seniors can also prevent varicose veinsby staying active. Regular walking – even if it’s just a leisurely stroll around the block – keeps the calf muscles fit. Exercises can be adapted to individual performance levels; there are vein exercises especially for older people (e.g. can be done sitting on a chair). Swimming is also easy on the joints and good for the veins, if you are in good health.

Older people are sometimes prone to Water in the legs (edema), especially on hot days or in the case of cardiac insufficiency. The same measures help here: Raise your legs, drink a lot (as paradoxical as it sounds – but dehydration leads to water retention because the body retains salt/water), eat little salt and if necessary compression stockings wear compression stockings.

Especially if you already have small varicose veins or your legs are heavy and swollen in the evening, you should not hesitate to use compression stockings regularly as you get older. They prevent consequential damage such as skin discoloration or poorly healing wounds. Important: Get medical treatment for underlying diseases that can contribute to oedema (heart failure, kidney weakness). Well-regulated cardiovascular function also benefits the leg veins.

If the walking ability is limited try to at least sitting exercises to do: Rocking your feet, circling, tensing and relaxing your leg muscles – every movement counts. Some seniors benefit from medical gymnastics or physiotherapyto promote blood circulation. Do not overexert yourselfbut stay as active as possible. And allow yourself breaks with your legs up, especially if you have been standing or sitting for a long time.

In addition, as you get older you should pay more attention to skin care should be taken into account: Dry skin on legs with varicose veins is prone to itching and eczema. Gentle creams keep the skin supple and resistant.

Avoid injuries to the lower legs, as wound healing can be worse, and wear comfortable, non-restrictive clothing. Short: Even in old age, there is a lot you can do to “keep your veins happy”. Exercise, compression, elevation and a healthy lifestyle are effective at every stage of life – it is never too lateto start.

Adolescents and young adults with a predisposition

Varicose veins are often seen as a problem for older people, but in fact – with the appropriate hereditary predisposition – varicose veins can occur at a young age. If congenital vein walls or valves are particularly weak, varicose veins or at least spider veins can sometimes appear as early as the teenage or tween years. This typically happens after the age of 25, but there are exceptions. The first warning signs can be Visible blue veins on the legs, frequent swelling or an early feeling of heaviness in the legs (e.g. after standing for a long time).

Young people with a family history of varicose veins – e.g. if their mother or father is severely affected by varicose veins – should therefore pay attention to their vein health at an early stage. The preventative strategies are no different to those for older people: plenty of exercise (young people in particular tend to lead sedentary lifestyles these days – it is important to balance this out with sport! For example, if you spend the whole day standing during your training, you should make sure you balance this out in your free time (legs up, exercise).

Heavy physical strain such as intensive strength training with very high weights could be unfavorable if you are predisposed to this, as the pressure in the abdominal and leg veins increases significantly. This does not mean that young people should not do any sport – on the contrary, moderate muscle building also stabilizes the blood vessels. But extremely heavy lifting (such as powerlifting) should be approached with caution if there is a family history of venous insufficiency. If in doubt, it is better to do more repetitions with moderate weight than maximum pressure with a single heavy attempt.

If already the first varicose veins are are already visible, a specialist clarification advisable. A phlebologist can use ultrasound to check whether there is a valve weakness that requires treatment. Small varicose veins in young people are usually not operated on immediately, but they are monitored. If necessary, early Sclerotherapy (sclerotherapy) can be useful to slow down the progression of small varicose veins – this is decided by the doctor on an individual basis.

It is important that young patients are educatedhow they themselves can contribute to vein health. Many are surprised to learn, for example, that playing computer games for long periods without exercise can have negative effects on the leg veins. Education can help here: Young people should also get up from time to time, walk around, move their feet while studying and not sit motionless for hours on end.

Summarized: Young people with venous insufficiency in the family would do well to early preventive measures implement. By leading an active, healthy lifestyle, you may be able to delay or reduce the appearance of varicose veins. And if symptoms do appear early on, please don’t be ashamed or ignore them – a check-up with a vein specialist will provide clarity and appropriate steps can be taken immediately (e.g. compression stockings in special situations, vein exercises). This way, varicose veins have less chance of spreading, even at a young age.

8.8. Myths about prevention

On the topic “Preventing varicose veins” There are many tips circulating on how to get rid of fat – but not all of them stand up to scientific scrutiny. We clarify three common myths:

• Myth: Cold showers prevent varicose veins.

Fact: Cold water showers (alternating showers) strengthen vein function in the short termas the blood vessels contract – this relieves swelling and heavy legs. In this respect Helps Cold showers can certainly help to improve symptoms and increase the well-being of the legs. It is also a good workout for the blood vessels (the cold stimulus causes them to contract and later expand again).

However, cold showers alone cannot “shrink away” existing varicose veins or eliminate a strong genetic predisposition. It is a supportive measure that makes sense in combination with exercise, compression and the like – but it is not the only protection. Nevertheless: Kneipp treatments are by no means overrated, they should just be used realistically. Use cold water regularly – your veins will thank you for it (discomfort can actually be reduced this way), but don’t rely on it only on it.

• Myth: Dietary supplements make varicose veins disappear.

Fact: Unfortunately no. Neither vitamin pills nor herbal preparations can dissolve or make existing varicose veins disappear. Horse chestnut extract, red vine leaves & co. can at best alleviate symptomse.g. reduce swelling somewhat. However, they do not heal defective venous valves. The effectiveness of many over-the-counter vein remedies has also not been clearly scientifically proven – some studies have shown that they have little more effect than a placebo. This does not mean that all of these products are ineffective; some, when used correctly, can provide a slight benefit (see Horse chestnut for venous insufficiency). But you should not have false expectations: Varicose veins cannot be “swallowed away”. Any claims to the contrary should be treated with skepticism.

Tip: Use food supplements at most as a supplement (after consulting a doctor), but continue to rely on proven measures such as exercise and compression to achieve real effects.

• Myth: Plenty of exercise alone protects against varicose veins.

Fact: Exercise is the most important factor – but not the only one.

Someone with a high genetic risk can develop varicose veins even if they lead an active lifestyle.
However, varicose veins usually develop later and are less pronounced than without exercise.

Several factors play together:

• Predisposition

• Hormones

• Lifestyle

What exercise can do:
Regular exercise can delay the development of varicose veins and reduce their severity.
But: It is not a guarantee.

Other influences:

• Standing for long periods is also harmful to athletes if they don’t pay attention during the day.

• Extreme heat can also lead to vein problems – despite exercise.

Optimal prevention means:
Pursue a holistic approach:

• Plenty of exercise

• Avoid risky activities (such as standing for long periods)

• Eat healthily

• Prevent obesity

• Use compression if necessary

Exercise alone is not always enough – especially if you have a high preload.
But it is the basis of all effective vein care.
All other measures build on this.
The best protection is achieved in combination.

Finally, an important tip: Listen to your body’s signals. If you notice signs of vein problems despite all preventative measures – e.g. persistently heavy, swollen legs, visible crooked veins or skin changes – see a doctor early on. The sooner you intervene, the easier it is to treat varicose veins. Prevention does not replace medical treatment, but it can postpone or support the need for it.

With the tips presented here, you can actively maintain your vein health and effectively prevent varicose veins. Your legs carry you through life – give them the attention and care they deserve!

9 Early diagnosis is crucial

Early diagnosis and treatment of varicose veins can significantly slow down the progression of the disease and prevent the occurrence of serious complications. In other words: varicose veins should be treated as early as possible. treated early as they can cause serious consequences such as leg ulcers in advanced stages.

Timely, complete treatment also reduces the risk of recurrence – all diseased vein sections must be treated to prevent recurrence. Early treatment is often also gentler: in the early stages, it is usually sufficient to less invasive therapies while more extensive interventions are often necessary later on.

9.1. Treating varicose veins: Therapy depending on the stage

Depending on the severity of the varicose veins (varicosis), the appropriate forms of treatment differ. In early stages conservative measures (e.g. exercise, venous gymnastics, compression stockings) are often sufficient, possibly supplemented by minor interventions such as sclerotherapy. With advanced stages with more severe symptoms, however, invasive procedures are increasingly used – at the latest when general measures no longer help or complications such as a leg ulcer occur.

In principle, conservative therapy can be conservative therapy (especially compression) can be helpful to relieve the pressure on the veins. The following table provides an overview of typical symptoms and recommended treatment measures depending on the stage of varicose veins:

9.1.1. Stage I – initial stage: slightly pronounced varicosis

Typical symptoms:

• Visible spider veins or small superficial varicose veins

• Usually not painful – mainly a cosmetic problem

Recommended measures:

• A vein-healthy lifestyle:

  • Regular exercise

  • Keep your legs elevated

  • Avoid sitting or standing for long periods

• Compression stockings if required

• Sclerotherapy is possible for small varicose veins for cosmetic correction

9.1.2. Stage II – Moderate stage: varicose veins with symptoms

Typical symptoms:

• Heavy, tired legs

• Feeling of tightness and ankle swelling in the evening

• Calf cramps, leg pain (especially at night or when standing for long periods)

• Itching, symptoms often increase in summer

Recommended measures:

• Conservative therapy:

  • Exercise and elevation

  • Weight control

  • Compression therapy

• For persistent symptoms:

  • Sclerotherapy (sclerotherapy)

  • Endovenous procedures (laser or radio wave therapy)

• In some cases, surgical therapy (depending on the findings)

9.1.3. Stage III – Severe stage: Chronic venous insufficiency

Typical symptoms:

• Significant swelling (edema), especially in the ankles

• Skin changes:

  • Brownish discoloration

  • Stasis dermatitis (reddish, itchy)

  • Parchment skin in older patients

• Poor wound healing, increased risk of open sores

Recommended measures:

• Specialist clarification urgently required

• Consistent compression in everyday life

• Depending on the findings:

  • Endovenous procedures (laser, radio wave)

  • Surgical removal of defective truncal veins (e.g. stripping)

• Skin care to prevent eczema

• Treatment of small wounds if required

9.1.4. Stage IV – Complicated stage: Open leg (leg ulcer)

Typical symptoms:

• Poorly healing, open wounds on the lower leg or ankle

• Often with an inflammatory skin environment

• Late consequence of long untreated varicosis

Recommended measures:

• Professional wound care by specialist medical staff

• Treatment of the underlying venous insufficiency:

  • Surgery or endovenous intervention to redirect the blood flow

• Supplementary measures:

  • Pressure bandage or compression

  • Close follow-up care to support healing

9.2. Individual help at the VenaZiel vein center

VenaZiel is available to you as a certified Vein Competence Center with specialized medical specialists. We offer individual diagnostics using state-of-the-art technology: using color-coded Duplex sonography (Doppler ultrasound) – the standard for assessing vein flow and valve function – we precisely analyze the condition of your veins. On the basis of this thorough examination, you will receive a Therapy recommendationwhich is tailored to your findings, your life situation and your personal wishes.

We therefore plan the treatment together with you in order to find the best solution, both medically and personally.

9.3. Consultation and initial examination – we are here for you

Please do not hesitate to contact us if you have any questions or uncertainties. In the VenaZiel Vein Center you can easily make an appointment for an initial examination with our vein specialists at any time – by phone or online. Our friendly team will advise you in detail and sensitively about your options.

If you are unsure whether your complaints require treatment, we will be happy to clarify this together. We want you to feel that you are in good hands and find the best way for you to treat your varicose veins to have your varicose veins treated.

10 Frequently asked questions about varicose veins (FAQ)

Basics & causes

1. What are varicose veins – and how do they develop?
   Varicose veins are permanently enlarged, tortuous veins. The cause is usually a defect in the venous valves. The blood accumulates in the legs instead of flowing back to the heart.
   
2. How do you recognize the onset of varicose veins?
   Fine, visible veins, a feeling of heaviness or swelling in the evening can be the first signs.

• First symptoms: tired legs, feeling of tension, calf cramps
  
• Early diagnosis possible using ultrasound even without visible signs
  

3. What types of varicose veins are there (e.g. labia, testicles, oesophagus)?
   Varicose veins can also occur outside the legs – for example in the pelvis, genitals or internal organs.

• Leg varices: truncal veins, lateral branches, spider veins
  
• Genital area: vulvar varices, varicocele (testicles)
  
• Internal organs: oesophageal varices, anorectal varices
  

4. Can varicose veins disappear by themselves?
   No – they do not disappear spontaneously, but usually progress if left untreated.
5. What role do genes, hormones, obesity and lack of exercise play?
   A central one – there is usually a combination of these factors.

• Genetics: often familial predisposition
  
• Hormones (e.g. pregnancy) → vein walls become softer
  
• Obesity & lack of exercise → promote venous congestion
  

6. Why do varicose veins often only occur on one leg?
   The strain or previous damage to the veins is not always symmetrical.

• Causes: previous thromboses, anatomical features
  

7. What does the body lack in varicose veins (e.g. vitamins)?
   As a rule, it is not a lack of nutrients, but a structural weakness of the vein walls.

Symptoms & complaints

8. How do varicose veins feel?
   Typical symptoms are pulling, pressure or a dull, tight feeling – especially in the evening.

• Complaints often increase during the course of the day or in warm weather
  
• Itching, cramps or skin changes possible

9. What symptoms can occur suddenly?
   Sudden swelling, pain or redness can indicate inflammation or thrombosis.

10. How do you notice that a vein is blocked?
    A painful, one-sided swelling with a feeling of tightness can be a warning sign of deep vein thrombosis.

11. Can swollen legs be caused by varicose veins?
    Yes – fluid builds up in the tissue due to impaired blood flow, especially in the evening or when it is warm.

12. What do throbbing or hardening of the veins mean?
    This may indicate superficial phlebitis or thrombosis – please seek medical advice.

Risks & dangers

13. When are varicose veins dangerous?
    Medical treatment becomes important in the event of pain, inflammation or skin changes.

14. Do varicose veins increase the risk of thrombosis or heart problems?
    The risk of thrombosis increases – the heart itself is not usually directly affected.

When & to whom?

15. When should you see a doctor if you have varicose veins?
    An examination is advisable if you have symptoms, visible vein changes or a family history of varicose veins.

16. Which doctors treat varicose veins – and which specialty?
    Phlebologistsand vascular surgeonsare specialized in vein diseases.
    → With us: VenaZiel – certified vein competence center

17. How is a diagnosis made?
    A painless ultrasound (duplex sonography) is usually sufficient. If necessary, additional procedures are carried out.

Treatment options

18. What treatments are available for varicose veins?

• Compression stockings
  
• Sclerotherapy (sclerotherapy)
  
• Laser or radio frequency procedure
  
• Microfoam treatment
  
• Surgical removal (stripping)
  
• VenaSeal™ (medical adhesive)
  

19. Do I need an operation?
    Only in severe cases. In many cases, minimally invasive procedures are sufficient.

20. Which is better: laser treatment, sclerotherapy or surgery?
    Depends on the findings – laser and sclerotherapy are usually the first choice today.

21. How effective are the individual procedures?
    All common methods achieve good long-term results – if they are selected correctly.

22. How painful is the removal of varicose veins?
    Modern procedures are usually virtually painless and only require local anesthesia.

23. What are the disadvantages of vein stripping?

• Longer recovery time
  
• More frequent bruising
  
• Higher risk of nerve irritation
  

24. What is the success rate of laser treatment?
    Over 90 % – with the right indication and technique.

25. What are the risks or disadvantages of laser therapy?

• Occasional skin discoloration or numbness
  
• Very good aesthetic results, hardly any scarring

VenaSeal™ – modern bonding technology

26. What is VenaSeal™ and how does it work?
    A medical adhesive closes the vein – without heat or incisions. Often no compression is necessary.

27. What advantages does VenaSeal™ offer over laser or stripping?

• No thermal stress
  
• Less bruising
  
• Usually no anesthesia along the vein
  
• Quick recovery
• In rare cases, local anesthesia may still be necessary along individual sections.

28. Who is VenaSeal™ suitable for?
    Ideal for truncal vein insufficiency – e.g. large rose vein. Suitability is checked by ultrasound.

29. Are there contraindications?
    Yes, e.g. allergy to the adhesive, acute thrombosis or severely tortuous veins.

30. How does the treatment work?

• Local anesthesia
  
• Insertion of the adhesive via catheter
  
• Duration: approx. 30-60 minutes
  
• No or short compression necessary
  

31. What are the risks?
    Rare: slight inflammation, swelling, allergic reactions.

Costs & reimbursement

32. How much does the VenaSeal™ treatment cost?
    Between €1,500 and €3,000 per leg – depending on the complexity.

33. Does health insurance cover the costs?
    In medically justified cases yes – cosmetic treatments usually not.

34. Are there alternatives that are covered by health insurance?
    Yes – e.g. laser, radiofrequency or stripping if medically indicated.

Long-term results & risk of relapse

35. Can varicose veins come back?
    Yes – new sections of veins can change pathologically.

36. How can I prevent recurrences?

• Regular exercise
  
• Weight control
  
• Compression stockings if required
  
• Annual check-up with a vein specialist
  

Lifestyle & self-help

37. Is exercise helpful or harmful?
    Light exercise is beneficial – excessive exercise can exacerbate symptoms.

38. When and for how long should I wear compression stockings?
    After therapy – depending on the procedure. Your doctor will advise you individually.

39. What role does diet play?

• High in fiber
  
• Little salt, sugar, saturated fats
  
• Drink a lot
  

40. Is sitting or standing for long periods problematic?
    Yes – regular exercise breaks are important.

41. Which exercises are suitable for varicose veins?

• Walking, cycling, swimming
  
• Vein gymnastics, e.g. standing on tiptoe
  

42. What should you not do with varicose veins?

• Sitting/standing for long periods without movement
  
• Sauna and hot baths
  
• Tight clothing and crossed legs
  

43. Which ointments, oils or household remedies can help?

• Horse chestnut, red vine leaves – symptom-relieving
  
• Cooling gels – refreshing, but not causally effective
  

Any questions?

We will be happy to advise you personally.
Make an appointment now – VenaZiel Vein Center Berlin