Varicose veins (varices) on the legs

Varicose veins on the legs: what’s that?

A varicose vein (varice) is an extended, gyrose vein in the skin and subcutaneous fat tissue in which the venous valves no longer function correctly. In these pathologically changed veins, the blood is not transported fast enough to the heart when you are standing or sitting. The result is the so-called “venous congestion”. Varicose veins are incurred in various forms and need not all necessarily be treated medically.

Very fine, small varicose veins in the upper skin layers with up to one millimetre diameter are called spider veins (micro varices).

Larger varicose veins normally arise in the subcutaneous fat tissue veins and are therefore normally also visually prominent. Surface venous thrombosis is a frequent complication associated with suffering from a distinct varicose vein problem. Here, a hard, red and painful tract is palpable along the course of the varicose veins.

The surface venous thrombosis must be treated by a physician immediately because otherwise it can spread further and blood clots can also advance further into the deep venous system. As a result of untreated varicose vein diseases, a chronic venous insufficiency with swelling tendency and changes to the skin up to an “open leg” (ulcus cruris) can develop.

Symptoms of varicose veins

Normally, the major symptom of varicose veins is a tendency to swelling of the legs. During the initial stage, normally only surface expansions of the veins can be seen. If the varicose vein disease (varicosis) progresses, water accumulates (oedemata) in the legs and changes to the skin take place. Ulcers may also be caused. Further results of varicosis include painful inflammation (so-called varicothrombophlebitis) or severe bleeding. If varicose veins remain untreated, long-term complaints may be incurred.

Causes of varicose veins on the legs

Generally, we distinguish primary and secondary varicose vein diseases (varicosis).

Primary varicosis occurs as a result of hereditarily cause venous weakness if favouring factors such as overweightness, pregnancy, long activities when standing or right cardiac insufficiency come on top. Also a genetic disposition – or hereditarily caused tendency – is possible.
Secondary varicosis arises as a result of the occlusion of the deep leg veins (venous thrombosis) with subsequent drainage disorder, increased venous pressure and vein valve insufficiency.

Amongst healthy people, the blood is transported from the deep leg veins to the heart via muscle contraction, e.g. from the calf muscles. Venous valves prevent that the blood – due to gravity – flows back again. The venous valves for the surface leg veins don’t close tightly enough amongst patients with varicosis. Therefore, blood from the surface veins can flow back into the deep venous system (so-called insufficiency). This results in a stasis in the deep venous system with an expansion of these blood vessels, also causing leakiness of the deep venous valves. As a consequence, overall venous pressure rises and as a result ulcers (so-called ulcera) may develop.

Also a lack of exercise, mostly standing or sitting activities without variety or movement, overweightness and smoking can potentially cause varicosis.

Diagnosis of varicose veins in the legs

In addition to the patient history (case history) and a clinical examination, primarily colour ultrasound (colour-coded duplex sonography) of the veins plays an important role. During the clinical examination, the physician assesses the ailments visually externally and palpates the affected leg when sitting, standing and lying down.

Using colour-coded duplex sonography, both the deep and surface veins can be judged. Moreover, with it the spread (localisation) and extent of non-functioning venous sections can be recorded and also insufficient connecting veins between deep and surface veins  (so-called perforating veins) can be depicted.
In case of unclear running or lower-lying leg veins, phlebography (X-ray with contrast agent) can be applied. Further diagnostic procedures include light reflection rheography (LRR) and also photoplethysmography.

The most important step for planning optimum therapy is a diagnostically conclusive duplex sonography.

How can varicose veins on the legs be avoided?

“Better lie and walk than sit and stand”: stick to this rule of thumb to avoid varicose veins, because some simple measures contribute to maintaining a healthy vein function as long as possible.

The following tips are recommended for avoiding heavy legs and varicose veins:

• Healthy lifestyle: balanced high-fibre nutrition, weight control, exercise, sufficient sleep, tobacco abstinence
• Calf muscle training: as much exercise as possible such as walking/running, swimming, cycling and vein gymnastics
• Circulation stimulation: walking barefoot, contrast showering, Kneipp baths/pours
• Avoiding heat and saunas: heat expands the blood vessels
• Do not use a sitting position with crossed legs: this would hinder blood reflux
• Change your sitting position frequently or stand up and move at least once per hour: helps blood circulation
• Medical compression therapy: reduces venous congestion and supports blood circulation
• Propping painful, swollen legs up: relief for the veins
• Massage of tired legs with a circulation-stimulating oil: supports blood circulation

What therapy options are available for varicose veins?

The main target of the treatment of varicose veins is to normalise or improve venous blood reflux. This can relieve or eliminate congestion complaints such as heavy legs, a feeling of tension, heat and pain. Also the accumulation of water (venous oedemata) can be reduced or prevented. Moreover, a normalisation or improvement of the venous blood reflux can cause the healing of existing ulcers or restrict their recurrence.

Conservative therapy
In principle, conservative therapy – i.e. treatment without an operation – is possible and makes sense during all stages of the disease. The conservative therapy includes mostly treatment with phlebological compression bandages or medical compression stockings as well as manual lymphatic drainage or instrumental intermittent compression using leg cuffs.
Conservative therapy using medical compression stockings, for example with BORT AktiVen^® , has the target of reducing venous pressure in the entire leg and ensuring better blood circulation.

Operative therapy
Depending on the disease pattern and stage, various procedures are applied for operative treatment.
Atrophy (sclerotherapy) of light varicose veins causes an artificial inflammation of the veins by injecting liquid or foam. This sticks the venous walls together, the body destroys these closed vessels gradually.
For laser therapy, a laser probe is positioned at the corresponding locations and the occlusion of the vessels achieved by heating the vein tissue. During the course of a long process, the body destroys the changed tissue. As opposed to sclerotherapy, laser therapy is viewed as the more gentle method.

Further operative procedures include stripping, crossectomy and phlebectomy. These methods remove the veins completely.

After all surgical procedures, patients should wear medical compression stockings such as BORT AktiVen^®. The treating physician always decides regarding the type and duration of compression therapy.