What Can You Do Against Varicose Veins?

Varicose Veins primarily affect the veins close to the skin on the leg and their internal connections. Treated early can prevent complications.

Varicose veins – briefly explained

Large, crookedly twisted veins are known as Varicose Veins. Varicose veins can also be a medical issue and result in problems like venous thrombosis if they are present in addition to the tiny, superficially located spider veins. It would be best if you thus spoke with a doctor about varicose veins to see whether medical intervention is required.

Depending on the disease’s severity, a mix of other treatments may also be utilized. These include sclerotherapy, surgical removal, thermal catheter techniques (laser, radio waves), elimination using thermal catheters, and more conservative measures, including compression therapy.

What are varicose veins?

Varicose veins are chronically enlarged, convoluted veins with uneven walls. Varicose veins are another term used by medical professionals. They mainly affect the legs but can also occasionally involve the pelvic region. Many sufferers view even the “minimum variant,” the benign spider veins, as unpleasant on a cosmetic level.

These are the most minor dilated skin veins that shimmer through the skin with ramifications in purple or blue. Occasionally, these also cause local pain. A sclerosing treatment or laser therapy can improve the complexion.

However, once progressed, varicose veins are also a medical issue; thus, vascular disease is not simply about aesthetics. The affected legs often feel uncomfortably tense or swell over the day. Permanent skin changes and sometimes stubborn ulcers can occur. Sometimes venous thrombosis is the cause or consequence.

The muscle pump helps to transport the blood in the veins to the heart.

Background: Little vein knowledge

Except for the pulmonary veins, the veins take in the oxygen-poor blood from the tissues and transport it to the heart. They have to work against gravity. The “muscle pumps” on the legs help them: When the leg muscles contract, they squeeze out the deep veins like a sponge and pump the blood towards the heart.

The veins deep in the leg collect blood from the superficial leg veins. Venous valves, which act like check valves, prevent blood from flowing back when muscles relax. In addition, the suction effect of the heart and the pressure changes in the chest and abdominal cavity when breathing supports the return transport of blood from the deep veins of the legs.

From the superficial veins, there are venous connections to the deep vein system, the so-called perforating veins.

Widespread disease varicose veins

Varicose veins are common. For example, according to the results of the Bonn vein study published in 2003, around 14 percent of the population was significantly affected between 2000 and 2002. With increasing life expectancy and other contributory factors (more on this in the following section), venous disorders remain on an upward trend.

In other words: the vast majority of the population shows changes of varying degrees in the veins.

Where does the name “varicose vein” come from?

Contrary to popular belief, varicose veins do not cause cramps. The term comes from Old High German. In the Middle Ages, the meandering vessels were called “crooked veins”. Over time, the word “varicose vein” developed from this.

Causes: Why do you get varicose veins?

Doctors differentiate between primary and secondary varicose veins.

Primary varicose veins

In the primary form of varicose veins, the causes are varied and need to be clarified.

Risk factors for primary varicose veins include:

• Familial predisposition to the weakness of the connective tissue and vein disorders or hereditary weakness of the wall of the veins
• Female gender and increased hormonal influences during pregnancy
• lack of exercise
• Professional activity, mainly standing and in the warm (e.g. bakery salesman)
• Overweight

Many people have an inherited predisposition to connective tissue and vein weakness. This is the most significant of the risk factors mentioned.

More women (about 15 percent) than men (about 11 percent) are affected by varicose veins. The fact that women are in the lead in varicose veins is probably also because the female sex hormones of the estrogen type influence the structure of the vein wall and vein valves.

During pregnancy, under the influence of another female sex hormone, progesterone, the muscle and connective tissue loosens – including in the veins. In addition, the expanding uterus during pregnancy makes it more difficult for blood to drain from the legs.

Therefore, varicose veins often develop during pregnancy, and existing ones increase – mostly temporarily.

Just as skin becomes less firm over time, veins also become lax over time. This becomes more noticeable in the second half of life. In rare cases, a congenital absence of venous valves can be the cause of varicose veins.

Secondary varicose veins

If another disease causes varicose veins, it is secondary varicose veins. Deep vein thrombosis in the leg is the most common. Suppose deep leg veins are blocked due to thrombosis formation; blood transport via the superficial veins increases. Their transport capacity is overwhelmed in the long term, and they sag and develop into varicose veins.

Another cause of varicose veins can be cardiac insufficiency – if the right side of the heart is primarily affected, this is right-sided heart failure. The disturbed heart function can lead, among other things, to increased pressure in the leg veins. Typically, this leads to leg swelling (oedema) and dilation of the leg veins.

Primary or secondary varicose veins?

It is sometimes difficult to assess which type of varicose veins the patient suffers from since both forms cannot be distinguished from one another immediately concerning symptoms and complications in the advanced stages of the disease.

The correct disease classification is vital for optimal advice and treatment. It is, therefore, advisable to consult an expert vein specialist, usually a phlebologist.

Symptoms: how do varicose veins feel?

Varicose veins often begin in adolescence or early adulthood. Gradually, spider veins, or bluish, nodular, thickened veins, become more and more visible through the skin. Varicose veins of large caliber sometimes appear like knots or strands.

They affect the trunk veins – the large and small saphenous veins (Vena saphena Magna and Vena saphena Parva) – or their side branches.

Large varicose veins are more likely to cause problems than spider veins. Many of those affected suffer from tension and heaviness or even pain in their legs after standing or sitting for a long time. The symptoms intensify during the day and with warm temperatures, and in women shortly before menstruation. Raising the legs or cooling bring relief.

Many patients also report symptoms such as discomfort, warmth and restlessness in the legs. Although those affected also complain more frequently about (nocturnal) calf cramps, these are not typical of varicose veins. They are mainly based on incorrect loads coinciding with joint wear and tear or overloading after tough physical training.

The tendency to swelling (oedema) may increase over time. It occurs because the blood volume and pressure in the diseased veins are increased. Fluid is then forced into the surrounding tissue.

Possible complications of varicose veins

Varicose veins sometimes lead to complications. These include, among others:

• phlebitis
• thrombosis (formation of clots in the veins) and pulmonary embolism
• chronic venous insufficiency
• varicose bleeding

Attention: If you have unusual pain or swelling in your leg, you should seek medical advice immediately, and if you suddenly have difficulty breathing or chest pain, call the emergency doctor (ambulance service, emergency call) immediately. There is then suspicion of a leg vein thrombosis or a pulmonary embolism!

Phlebitis

Varicose veins are the most common cause of phlebitis. The diagnosis is then varicophlebitis. The inflamed inner vein wall often gives the impetus for forming a blood clot (thrombus), which can occlude the vessel. In this case, doctors speak of varicothrombosis.

The symptoms are

• redness,
• overheating and
• Pains

At the appropriate place, a hardened, tender vein can often be palpated. Long stretches of inflammatory blockages in the case of varicose veins in the trunk of the leg are extremely painful. The great saphenous vein, the longest vein in the body, occurs on the inside of the leg, sometimes up to the groin.

A thrombosis of the small saphenous vein is noticeable on the calf, sometimes up to the back of the knee. In this so-called varicothrombosis, there is a visible and tangible inflamed and tender area and pain when walking.

Varicophlebitis/varicothrombosis can occur spontaneously due to slowed blood flow in the enlarged skin vein. Sometimes impact or pressure injuries, blood congestion due to extended, cramped sitting with little legroom, and severe fluid loss during sports or when the outside temperature is hot can be the trigger.

Thrombosis and pulmonary embolism

If the blood clot involved spreads from a superficial vein or varicose vein, i.e. a varicothrombosis, into the deep venous flow path, there is a deep vein thrombosis. Of course, clot formation can also originate in a deep vein.

Parts of such venous thrombosis can detach and be washed into the lungs via the veins. If they block one of the pulmonary vessels there, a so-called pulmonary embolism develops, which can be life-threatening depending on the extent.

Thrombosis: causes, therapies and prevention

Thrombosis means a blood clot forms in a blood vessel. The leg veins are often affected. More on signs, risk factors and treatment

Pulmonary embolism: symptoms, causes, treatment

A pulmonary embolism is the blockage of one or more pulmonary arteries, often due to a blood clot that has penetrated the lungs. This usually comes from the leg or pelvic veins, where a thrombosis has formed.

Chronic venous failure (chronic venous insufficiency)

Years or decades of severe varicose vein formation in superficial veins – especially truncal varicose veins – and clot or thrombosis formation in deep veins (phlebothrombosis) can turn into chronic venous failure. The doctor speaks of chronic venous insufficiency, in the case of an underlying venous thrombosis and a postthrombotic syndrome.

Possible visible signs of chronic venous failure are:

• Initially temporary, then persistent leg swelling
• A ring of spider veins or brush-like dilated small veins (corona phlebectatica) in the ankle area (usually the inner ankle)
• Various skin changes

Skin changes that occur in chronic venous failure are:

• eczema
• brown pigmentation
• white atrophy
• leg ulcer
• lipodermatofibrosis

As described above, permanent congestion in the veins can lead to fluid leaking into the surrounding tissue (oedema). Metabolism products also get into the tissue, which can damage it. Over time, this leads to inflammation, skin rashes (eczema), and permanent brown discoloration on foot and possibly on the lower leg.

If the small skin vessels in the ankle area are also damaged, they become painfully inflamed and stick together. The skin is initially red to violet, eventually turning white, appearing parchment-like and scarred (white atrophy, atrophy blanche).

Pronounced venous circulatory disorders lead in the long term to the most severe complication of chronic venous failure, the leg ulcer (Ulcus cruris varicosum or venosum, also “ulcerated leg”). This can be very painful and take a long time to heal. It then leaves a scar. It occurs relatively frequently on the inner ankle, the source area of ​​the large rosette vein.

Such an ulcer can also be caused by other circulatory disorders, for example, due to a disease of the arteries, such as arteriosclerosis. Vascular and nerve damage caused by diabetes (diabetes mellitus) can also cause tissue damage in the leg.

Lipodermatofibrosis or lipodermatosclerosis is another severe skin condition on the leg that can develop due to chronic venous failure. First, an oval, dark red discolored, initially slightly hardened, painful area forms on the lower leg above the inner malleolus. The area often swells as well. If left untreated, the skin, along with the underlying fat and muscle tissue, scars over time and contracts.

Swelling can only spread above or below the hardened zone and then bulge like a bulge. At worst, the contour of the lower leg resembles an upside-down bottle. There is persistent pain, even when walking.

In individual cases, chronic venous insufficiency can also result in stiffening of the upper ankle joint (so-called atherogenic congestion syndrome, according to Hach). This leads to a so-called pointed foot.

Of course, other diseases can also be hidden behind a pronounced reddening of the foot. You should go to the doctor immediately, especially if you have any accompanying symptoms, such as fever or swollen lymph nodes. It could then be, for example, erysipelas (erysipelas).

What helps with venous insufficiency?

Tired legs and thick ankles in the evening – indicate weak veins. The most common causes, typical symptoms and what you can do about it

Injuries to a varicose vein (variceal bleeding)

Bleeding from an injured varicose vein is rare. Depending on the size of the damaged vessel, it may bleed more or less heavily. Immediate treatment with a pressure bandage leads to arrest. If not, the bleeding vein must be surgically sewn up.

When to the doctor?

At the first sign of a vein problem (see Symptoms chapter), it is advisable to go to the family doctor. He determines whether the advice of a vein specialist (phlebologist) is required. Timely diagnosis and therapy help stop the disease’s progression and avoid complications. Examination of the vessels on the leg with ultrasound.

Diagnosis

The typical symptoms and a known family history of varicose veins are important preliminary information when talking to the doctor about the so-called anamnesis. Tortuous skin or varicose veins that protrude like knots, and of course also spider veins, are immediately apparent during the physical examination of slim people. The doctor mainly checks the condition of the skin on the legs.

Then he feels the openings of the superficial veins into the deep vein system in the groins, the back of the knees, and the lower legs. The patient assumes a standing, sitting and lying position in succession. The doctor also scans the arterial pulses to rule out a circulatory disorder in the arteries (peripheral arterial occlusive disease).

Apparatus examinations, above all ultrasound examinations (sonography), enable a more precise diagnosis to be made. So-called duplex sonography can show blood circulation disorders, insufficiently closing venous valves and the extent of the venous damage. By adding a color scale, the flow direction of the blood can be seen, i.e. whether the blood flows “correctly” towards the heart or “wrongly” away from the heart (color duplex sonography).

The ultrasound has now completely replaced the X-ray examination of the veins with a contrast medium (phlebography) as the standard examination for varicose vein disease. Venography is reserved for selected cases with particular problems, for example, certain forms of recurring varicose veins (recurrent varicose veins) or thrombosis (recurrent thrombosis).

An imaging of the veins using magnetic resonance imaging or contrast-enhanced computed tomography (MR(T) or CT phlebography) is only used for rarer clinical pictures such as congenital vascular malformations, possibly also for pelvic vein varices and the diagnosis of venous thrombosis in the abdominal and pelvic area.

After careful consideration, the methods can also be used to diagnose thrombosis during pregnancy in ambiguous situations. Due to the lack of radiation exposure, MR-based diagnostics are preferred.

Light reflection rheography and plethysmography provide information about the compensation for venous disease. While light reflection rheography records the pumping function of the veins, plethysmography measures the capacity of the veins and the outflow (drainage) of the blood.

The pumping function is reduced with severe varicose vein formation, and capacity or drainage is increased.

How can you prevent varicose veins?

Many people with an increased risk of varicose veins would like to do something to prevent the condition. In some cases, this is entirely possible, but it is worth trying. If you have healthy veins, you can take the following measures to preserve vein function for as long as possible:

• Keep weight within normal range
• regular endurance sports, such as walking
• vein gymnastics
• Cold lower leg or knee affusions, according to Kneipp (pre-existing conditions only after consultation with the doctor)

Treatment: what to do with varicose veins?

The decision as to which treatment method is best for the individual depends on the type of varicose vein disease, the stage of the disease, any concomitant diseases and the wishes of the patient.

Visually disturbing spider veins or bulges in the veins cannot be remedied with medication. If the trunk veins “overflow”, so to speak, because the venous valves are no longer working correctly, this can ultimately only be treated by switching off or removing the diseased veins.

The method most suits the individual case is decided during a medical consultation based on the previously obtained examination results and in coordination with the patient’s wishes. The advantages and disadvantages of the particular treatment methods are weighed against each other.

It must also be clarified whether an intervention must be carried out urgently (e.g. in the case of varicophlebitis with growth into the deep vein system) or whether the appropriate time can be chosen at leisure.

Movement

Any form of exercise is essential and will prevent further aggravation. A lot of walking, where possible, also barefoot, supports the muscle pump function and thus the return of the blood to the heart. For example, climb the stairs instead of using the elevator!

There are also simple but very effective vein exercises. Ten minutes a day improve the performance of the veins and general well-being. But you can usually find a gap even on days with a busy schedule.

Physical therapy

To alleviate the symptoms, vein specialists recommend physical measures such as Kneipp applications, cold affusions on the lower legs or treading water, and other treatments for all forms of varicose veins.

A doctor should check in advance whether there are other cardiovascular diseases or other diseases that speak against such applications—the dilated veins contract when they come into contact with cold water.

In the case of severe chronic venous insufficiency, further measures such as manual or mechanical lymphatic drainage can be used – according to medical instructions and in selected patients. This successfully decongests the affected leg, especially when compression therapy with bandages and special stockings alone is ineffective.

Lymphatic drainage: when it makes sense

Therapists use special techniques to relieve swelling in the arms and legs. Who is helped by lymphatic drainage, who offers it, and what should you consider?

Vein remedy

Vein remedies are available in pharmacies in the form of sprays, ointments, or gels to be applied to the skin or as capsules to be taken. They can have a slight decongestant effect and subjectively alleviate the symptoms. Vein agents cannot and should not replace necessary compression therapy.

Their use can be helpful for a limited period if compression therapy is not possible – for example if you have a tendency to allergies or are very hot – and if a subjectively favorable effect can be achieved.

The substances used here include, for example:

• Horse chestnut extracts (contain the component aescin)
• Extracts of red vine leaves (the polyphenols are mentioned here as pharmacologically active components)
• oxerutin

Horse chestnut: Helpful against venous insufficiency?

Horse chestnut extracts are said to support the function of the veins and help against varicose veins.

Red vine leaves, red grapevine

Preparations made from red vine leaves can alleviate the symptoms of mild venous insufficiency.

Compression therapy

Consistent compression therapy is the most important and most effective measure in the case of severe venous diseases. Above all, indispensable in the case of venous thrombosis with leg swelling and the advanced stages of varicose vein disease.

Compression therapy relieves congestion-related symptoms in acute thrombosis and reduces the frequency and severity of chronic venous failure or postthrombotic syndrome in the long term. It heals ulcers, whether caused by varicose veins or thrombosis.

The compression supports the work of the muscle pumps and the venous valves. The primary mechanism is to improve blood flow to the heart by constricting the vein diameters of both superficial and deep veins. This counteracts congestion in the leg very well.

Compression bandages are mostly used in acute illnesses and compression stockings in chronic diseases. Compression stockings are available in different strengths and lengths. The doctor prescribes them, and the specialist retailer adapts them individually. After about six months, a compression stocking is usually obsolete because it no longer builds up the required pressure.

Following a special treatment, such as sclerotherapy, the stockings are worn for a few hours to days and after vein surgery, laser or radio wave therapy for about four weeks. Severe vein problems require lifelong treatment.

In addition to or as an alternative to compression bandages, so-called medically adaptive compression systems (MAK) can contribute to decongestion in oedema and the healing of leg ulcers. They are adjustable with a Velcro fastener so that the patient or their relatives can usually readjust them.

In suitable cases, a so-called intermittent pneumatic compression is used using a decongesting device to alleviate venous symptoms. After the leg cuffs have been put on, a predetermined pressure is exerted on the leg veins from the outside and released again at certain intervals.

In certain situations, such as diabetic peripheral neuropathy, compression treatment must be handled with a particular skill to avoid pressure damage to the skin and nerves. In exceptional cases, compression treatment is out of the question, for example, in the case of advanced arteriosclerosis of the leg vessels or an abnormal cardiac insufficiency.

Compression stockings: How to use them correctly

Compression stockings make work easier for veins—tips for common problems.

Obliteration of the varicose vein: The foam leads to inflammation, which leads to vascular occlusion

Sclerotherapy (sclerotherapy of varicose veins):

A phlebitis is artificially created by injecting a sclerosing agent into the vein so that the veins walls stick together from the inside. They scar over time. To treat small veins (spider veins, reticular varicose veins), the doctor injects the sclerosing agent in liquid form, and in the case of large veins (truncal veins, side branches) as a foam. This is followed by compression therapy for a few hours to a few days.

Several therapy sessions are usually necessary. Since the predisposition to varicose veins persists, the procedure usually has to be repeated after a year or two. The contraindications include a known allergy to the sclerosing agent, acute venous thrombosis, oedema, infections in the sclerosing area and arterial occlusive disease.

In the case of radio waves or laser therapy, the heat damages the vascular wall and leads to buttock closure.

Thermal procedures (endovascular, endoluminal)

Only the two methods with which the most excellent experience is available are listed here as examples: laser therapy and radio wave therapy. Endoluminal (or endovascular) means that the varicose vein is treated from the inside via an inserted probe.

The treatment principle consists of boiling off the proteins present in the vein wall by supplying energy (laser energy or radio waves) and thereby sticking the vein wall together from the inside. The veins destroyed in this way degrade by themselves over time and can no longer be detected during the ultrasound check.

Both methods are suitable for the treatment of not very pronounced varicose veins of the trunk veins with a relatively straight course. The procedure usually takes place on an outpatient basis under local or regional anaesthesia. Through a small incision in the leg, the doctor treating you inserts a catheter with laser glass fibers or a radio wave heating coil into the affected varicose vein under ultrasound control.

Since high temperatures are generated during the interventions, the tissue around the varicose vein must be protected from heat damage. For this purpose, a liquid (tumescent solution) is injected along the entire vein to be treated. After the procedure, patients wear compression stockings. The length of time varies and is up to about four weeks.

Short-term treatment with heparin injections over a few days helps to avoid excessive blood clot formation. Laser or radio wave therapy can eliminate the treated vessels immediately and permanently in over 90 to 95 percent of cases. The length of time varies and is up to about four weeks. Short-term treatment with heparin injections over a few days helps to avoid excessive blood clot formation.

Laser or radio wave therapy can eliminate the treated vessels immediately and permanently in over 90 to 95 percent of cases. The length of time varies and is up to about four weeks. Short-term treatment with heparin injections over a few days helps to avoid excessive blood clot formation. Laser or radio wave therapy can eliminate the treated vessels immediately and permanently in over 90 to 95 percent of cases.

Laser energy – albeit with a completely different device (Neodymium Yag laser) – is also used to treat the smallest, superficial, reddish-violet spider veins on the leg, here as an alternative method to sclerotherapy (sclerotherapy).

Partial stripping: This is how varicose veins can be removed

Surgical removal of varicose veins

The complete or partial removal of varicose veins aims to preserve or regain the function of the remaining veins. The procedure is minimally invasive, i.e. with few and small incisions.

The main areas of application are pathologically altered truncal veins, but also their side branches and diseased perforated veins.

The stripping operation was introduced in 1907 by the surgeon Babcock. At that time, he still removed the entire large saphenous vein from the groin to the ankle.

Since 1981, according to Hach (partial stripping), the stage-appropriate operation has been carried out. Only the diseased vein sections are removed; the healthy ones remain and are available for a later bypass operation on arterial vessels, for example, the coronary arteries.

In principle, a flexible probe is inserted through a small skin incision in the groin into the dilated vein, advanced to the “stop” (this point corresponds to a functioning venous valve) and then brought out again. The varicose vein is severed at both ends and pulled out over the probe.

A variant of this procedure is cold therapy (cryo method): The stripping manoeuvre is carried out with the help of a cold probe, to which the varicose vein freezes and can then be easily removed. Stripping operations are usually performed on an outpatient basis and usually under local anaesthesia.

Dilated connecting veins (perforating veins) are removed through a small local incision in the area, either as a stand-alone procedure or with stripping or an endoluminal system in the same session.

Mini-phlebectomy aims to remove enlarged side branches, which are pulled out through tiny incisions with a “crochet needle”. The method can be performed alone or in combination with the stripping operation and endoluminal techniques.

CHIVA is a French abbreviation for “outpatient, vein-sparing, blood flow-correcting treatment for varicose veins”. With this method, the doctor localizes pathologically altered vein sections using ultrasound under local anaesthesia and then ties them off. After some time, this regress and become deserted. The procedure is not recommended for severe varicose veins.

Nothing is removed, even with external (extraluminal) valvuloplasty (EVP). Instead, the doctor narrows the opening area of ​​the large saphenous vein (Vena saphena Magna) in the groin from the outside by sewing in a small cuff made of polyester under local anaesthesia. The reduced circumference of the vein makes the venous valve functional again.

After the correction, the dilated artery can “recover” again; the vein is thus preserved and can be used entirely for an operation on the heart that may be necessary later. However, the procedure is only suitable for mild cases, i.e. a barely enlarged saphenous vein with a defective orifice valve.

Risks after the operation (postoperative), such as secondary bleeding, blood clot formation and accumulation of lymphatic fluid (lymphatic cysts), can be minimized by compression therapy. This is usually done for four weeks and with a compression stocking right from the start.

When treating dilated connecting veins (perforating veins), the area is additionally bandaged for at least two weeks.

Even after surgical or endoluminal treatment, a patient is not protected from new varicose veins. Of course, the same vein cannot come back, but the predisposition remains, which is why preventive measures are still helpful, as are regular follow-up examinations by the treating specialist (vascular specialist, phlebologist).

If new varicose veins appear in the operated area, these are usually side branch varices. Often these are so small that they require no treatment or only sclerotherapy. Sometimes, however, more significant varices can also form. Or a second vascular trunk in the already operated region, which was initially normal, becomes varicose over the years.

This can lead to another operation (recurrent operation). The indication is preferably made by experienced specialists after careful consideration.

What are the chances of healing varicose veins?

Usually, varicose veins are chronic. Once “worn out”, the veins do not find their way back to their old form. As far as spider veins are concerned, they sometimes reappear after desolation. Even after an operation on the veins, there is a tendency to relapse (tendency to recur) since the predisposition to varicose veins is retained.

The good news: Varicose veins that develop during pregnancy often recede after childbirth. However, this can take up to a year.

Treatment of complications

Inflammation of varicose veins (varicophlebitis)

In the case of superficial leg vein inflammation, compression therapy is of central importance, as it usually relieves the symptoms immediately. It can be done with an elastic bandage or with a compression stocking. The doctor may prescribe an anti-inflammatory drug for a short time, a so-called non-steroidal anti-inflammatory drug or an anti-rheumatic drug.

A small blood clot that can be felt in a skin vein can be squeezed out of the vein through a tiny incision after local anaesthesia. This brings immediate relief. A wound dressing is then applied. In order to promote blood circulation, those affected should move enough. Cooling compresses and bandages with heparin ointments are often found to be soothing and comfortable.

If a patient is not mobile enough to move the leg sufficiently, or if the blood clot is close to where it enters the deep venous system, an anticoagulant substance (e.g. low molecular weight heparin or subcutaneous fondaparinux) is required to protect against thrombosis. The aim of this treatment, which involves injections under the skin, is to prevent the clot from growing more profound.

It may be advisable to continue the anticoagulant treatment (anticoagulant therapy, “blood-thinning treatment”) subcutaneously or with tablets to be taken, i.e. orally, for a certain period.

Leg ulcer (Ulcus cruris)

Professional compression treatment is essential to relieve leg pain and heal the ulcer. Compression bandages are usually applied first, followed by a compression stocking if the progression is favourable. The patient should remain in motion but elevate the leg when at rest.

Conservative wound treatment follows modern principles:

• The wound should not dry out.
• The dressing should be changed gently.
• The dressing material should not irritate the skin.

This and the other measures depending on the condition of the wound. In the event of an infection, for example, it is flushed with saline solution and disinfected with well-tolerated germicidal solutions. A suitable covering is vital in each case to keep the wound moist.

Today, wound dressings made of polyurethane foam or hydrocolloidal material are often used. It may be necessary to take an antibiotic, which the doctor prescribes specifically after determining the germs in the wound swab. If the leg has to be immobilized, the patient is temporarily given thrombosis protection, for example, with heparin injections.

In most cases, the ulcers can be healed with conservative measures alone. If not, surgical wound cleaning (debridement) is necessary. In the case of ulcers that do not heal within three months, a malignant tumor should also be considered, and a dermatologist should be consulted.

Varicose veins in other parts of the body

It is not uncommon for varicose veins to occur on the testicles (“varicose vein fracture”, also “varicocele”). Here, a venous network on the spermatic cord expands, often on the left side. The change can already occur in childhood and lead to various symptoms, including after infertility. It is not uncommon for the varicocele to recede on its own over time – especially if there is no specific cause. The specialist to be consulted is the urologist or pediatric urologist.

Varicose veins under the lining of the esophagus (esophagus) are called esophageal varices. They occur when the pressure in the portal vein (vena portae) is increased. This important vessel, a vein, carries nutrient-rich blood from the digestive organs to the liver. The pressure there can be increased, for example, in some liver diseases, such as cirrhosis.

The blood then escapes via the veins in the stomach and esophagus. However, the vessels soon reach the limit of their capacity. They expand greatly and become varicose veins. The problem: Swallowing hard or angular bites and contact with stomach acid can injure these varices, causing them to rupture and possibly bleed heavily. The responsible specialist is the gastroenterologist.

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