There are different methods: compression stockings. Sclerotherapy or sclerotherapy, surgical intervention (crossectomy,stripping and miniphlebectomy ) laser or radio wave therapy, mechano-chemical ablation (MOCA) and bonding of the varicose (Venseal^TM)

When one speaks of varicose veins, one always means part of the superficial venous system.

The terms internal and external varicose veins are not medical but patients mean visible 

There are only a few real emergencies that require immediate or very short-term surgery or intervention for varicose veins. Varicose vein disease is a slowly progressing condition, so careful and cautious treatment planning is usually possible. A possible operation or intervention can always be planned and should, above all, be coordinated with your appointment and vacation planning.

There are drugs that easily combat the discomfort of varicose veins but the varicose veins do not disappear.

Men tolerate very large varicose veins without symptoms because they lack the hormone progesterone. Progesterone and symptoms seem to be linked, and progesterone, of course, only occurs in women. Very large varicose veins, if left untreated, have one in five chances of progressing to ulceration. In other words, the asymptomatic varicose veins i.e. varicose veins without symptoms can still lead to consequences or complications , and the possible complications are: Dark brown discoloration on the lower leg, infection, leg ulcer venous thrombosis.

Varicose veins can cause the following symptoms: heavy legs, tired legs, itching, swelling, cramps, pulling pain, numbness and heat sensation.

Moreover, the varicose veins have serious complications e.g. dark brown discoloration on the lower leg, infection, venous thrombosis ulcus cruris.

The varicose veins of the legs are divided into:

• Spider veins
• Perforating varicose veins
• Side branch varices
• Truncal varices

Nowadays in Germany varicose veins are considered as a medical problem.

Spider veins are seen as a cosmetic problem, but from the other side spider veins are the precursor of varicose veins.

Depending on the operation method, e.g. after a crossectomy 1-2 weeks but after VenaSeal the patient can go to work immediately after the operation.

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The ultrasound examination is sufficient to assess the leg vein system.

There are different methods for anesthesia but in our practice we operate under local anesthesia.

During surgery, only diseased sections of veins are removed or eliminated. Removal of the varicose veins results in improved outflow in the remaining healthy venous system.
In any case, the deep venous system remains untouched and takes over the return transport of the blood without any problems.

Gradually, the body creates / seeks a new healthy superficial vein network.

Yes, this is likely. This is because only veins that are proven to be diseased at the time of surgery are operated on. Healthy veins must remain in the body and must not be removed prophylactically.

Varicose veins disease is caused by various factors (heredity, hormones etc.)

The causes of varicose vein disease are not 100% known until today.
During varicose vein surgery, the sections of veins that are diseased at the time of surgery are removed. However, the general predisposition to varicose vein disease cannot be removed with a scalpel. This is why it is so important to have regular (annual) check-ups.
Smaller newly formed varicose veins can be removed with little effort (sclerotherapy) even in the early stages.

The predisposition to the development of venous diseases is congenital. Therefore, a person with varicose veins has a lifelong possibility of developing varicose veins, even after a successful operation.

In case of a relapse, the specialist should be consulted again in any case. Sometimes relapses can be remedied with minor surgery or even with sclerotherapy alone.
Often patients who suffer an externally visible relapse are disappointed and shy away from renewed treatment.
This is not without danger. If externally visible, even small relapses are left, extensive varicose veins can form again. In this respect, even after a successful operation, control examinations by means of color-coded duplex sonography should definitely be carried out at short to medium term intervals (depending on the findings).

In any case, a relapse should be detected early and treated early in order to keep the intervention small.

Varicose veins are a chronic disease that cannot be cured by surgery or medication. Varicose vein disease has a natural progression, therefore the claim never again varicose veins after varicose vein surgery is not true, but by the annual follow-up, if necessary sclerotherapy, the varicose veins remain in the initial stage.

No, this claim is not scientifically proven.

Varicose veins can develop or worsen during pregnancy, especially if you have a family history of them.

Hormonal changes and increased stress contribute to the easier development of varicose veins in pregnant women.

The increase in the hormone progesterone, especially in the early months, causes the connective tissue to loosen and the vein walls to become more pliable as the veins expand. In addition, blood return from the leg veins to the heart becomes worse as the thickening abdomen presses on the pelvic veins, which increases blood pressure in the leg veins.
All of the factors combined mean that new varicose veins can develop or existing ones can worsen. Fortunately, varicose veins often regress after childbirth or after weaning, as hormone levels and pressure levels return to normal. For this reason, varicose veins should rather not be treated during pregnancy, but wait until a few weeks after delivery to see if they regress.

Wearing compression stockings during pregnancy is recommended to prevent varicose veins.

The main cause of varicose veins is heredity. Additional factors that can aggravate varicose veins are a standing or sedentary job, pregnancy, obesity, birth control pills, or previous deep vein thrombosis. As a preventive measure, regular physical activity, Kneipp baths and exercises, or alternating cold and hot showers are recommended.

Insurance card and a referral from your family doctor or from a specialist in private practice (the referral is sufficient once a quarter).

Ask us or your family doctor which medications you are allowed or required to take (see also the surgery preparation form we provide).

Please note the following:

• You do not need to stay sober
• Do not put nail polish on your toenails
• On the day of surgery, please do not grease your legs
• Bring wide pants and wide, open shoes, as you will receive a thick, tight fixed bandage after the operation

In our practice we operate on varicose veins under local anesthesia, which means you do not need to be fasting.

Generally, TLA is a painless and uncomplicated procedure. It is defined as an injection of a highly diluted anesthetic is injected into the problem area to be treated. The direct effect of the injection is freedom from pain while awake and a loosening in the tissue around the vein being treated. Thus, it is easier to eliminate the vein, and bleeding and swelling are clearly minimized. Nevertheless, TLA can be extended to include the administration of a sleeping or sedative agent, depending on the patient's needs or wishes. However, excessive sedation is undesirable; in order to ensure rapid mobilization after surgery, as part of the outpatient procedure.

Usually for one night.

As a rule, this is worn for 1-2 weeks; however, this can vary greatly from case to case; please ask your surgeon.

After a week but you can always wash the other leg with washcloth.

On the day of the surgery - after the surgery we advise not to be too active (risk of increased bleeding). But the activity can be increased from the next day. Jogging/sports after two weeks.

As a rough rule: One leg = 1 week. Two legs = 2 weeks. In the context of minimally invasive surgical techniques, the incapacity for work can be reduced accordingly to 3-6 days, depending on the findings and profession.

As a rule, the postoperative check-up is performed one week after the surgery, and then once a year.

Yes, for at least 4 days, in rare cases longer.

Mostly there is no pain, the postoperative pain is rare, if you have such pain, please take simple painkillers (e.g. Ibu 400, Voltaren, Paracetamol...). In case of doubt, please call us. Outside opening hours, you will be given an emergency number to dial in this case.

If bleeding is very slight, which can lead to some dampness and red discoloration, this is normal and there is no urgent need for action.

But if it is tense and you have severe pain, please call us in the office or on emergency number.

Wearing compression stockings often alleviates

• the discomfort of varicose veins, such as heaviness and swelling, but it does not eliminate the visible varicose veins in principle
• the discomfort of lymphedema
• the discomfort of chronic venous insufficiency

This was a therapeutic aspect for the compression stockings. There is also a prophylactic aspect, e.g. wearing compression stockings when flying (prophylaxis against venous thrombosis).

• Anziehschwierigkeiten
• Difficulty putting them on
• Sweating
• Constriction
• Dry skin
• Tightness

However, they are not an alternative to a medical compression stocking for a varicose vein condition. The required effect is not provided by a support stocking. Neither the pressure nor the pressure curve meet the requirements necessary for a medical effect. A support stocking therefore does not have a preventive or therapeutic effect.

Superficial, tortuous branch varices are neither stripped nor treated thermally. They are removed by so-called phlebotomy. This involves making incisions of about 1 mm in the skin, inserting a hook under the skin, angling the varicose vein with it, and removing it from the body. Phlebectomies are equally combined with thermal ablation or stripping. Instead of phlebectomy, branch varices can be chemically obliterated by sclerotherapy, both in combination with thermoablation and stripping.

This is possible

Nowadays, thermoablation is considered the standard therapy for varicose veins and conventional vein surgery (so-called crossectomy) is the exception.

An adhesive (cyanoacrylate) is injected into the vein via a catheter, resulting in its closure. This procedure is mostly painless, if the simultaneous removal of branch varices is omitted. In addition, the costs have so far been higher than for thermal ablation.

Sclerotherapy is an effective and safe treatment method for the elimination of varicose veins. In this minimally invasive, low-pain procedure, pathologically altered veins are eliminated by the so-called sclerosing agent. Anesthesia is not necessary. Sclerotherapy is a proven method of eliminating varicose veins (especially small and medium-sized varicose veins).

Depending on the number and size of the varicose veins to be treated, the therapy is performed in more than one session.

Through sclerotherapy with a sclerosing agent, the pathologically altered veins are eliminated and the blood seeks a new path to the heart.

• Liquid sclerotherapy
• Foam sclerotherapy
• Duplex guided sclerotherapy (with the help of ultrasound)

The principle of action is the same as for sclerotherapy with liquid sclerosant, except that the foam has a slightly stronger adhesive effect on the vein wall.

As with all other treatment methods, including surgery, new varicose veins may reappear after some time. This is due to the congenital weakness of the connective tissue, which cannot be cured.
Another disadvantage or possible complication for sclerotherapy is the hematoma or bruise.

• Sclerotherapy is a safe and effective treatment method
• Sclerotherapy can be combined with other methods (laser, RFA,MOCA or VenaSeal....)
• No anesthesia
• Rare complications

Small skin bleedings, bruises and temporary discolorations may occur, which usually disappear soon.

Very rarely, systemic allergies or circulatory reactions may also occur.

Deep vein thrombosis affects the deep vein system and therapy lasts at least 3 months.

Superficial venous thrombosis affects the superficial venous system and therapy lasts from 3 weeks to 3 months.

The most serious complication of venous thrombosis is pulmonary embolism, which is more frequent after deep vein thrombosis.

Painful forced pauses when walking due to narrowing of the arteries of the leg.

You start by filling out a questionnaire. This is followed by a preliminary examination for the leg veins by the physician assistant. This is followed by a detailed personal consultation in which you explain your concerns. We then perform the clinical and sonographic examination. Ultrasound provides a painless but detailed examination of the leg veins. It provides information about their location, shape and size, as well as the direction and intensity of blood flow. At the end of the consultation, we discuss the findings with you and, if indicated, options for treatment.