Removing varicose veins through the ages
Musste bis zum Ende des vergangenen Jahrhunderts noch jede Krampfader der Stammvene mit der klassischen Stripping-Operation – also dem operativen Krampfadern Ziehen – über einen Schnitt in der Leiste erfolgen, so sind heute die schonenden, sogenannten endovenösen Verfahren die Behandlungsmethode der ersten Wahl. Die Bezeichnung „endovenös“ meint dabei, dass sich der Eingriff im Inneren der Vene abspielt – allen voran die Lasertherapie und die Radiofrequenzablation, dicht gefolgt vom neuesten Verfahren: dem Venenkleber.
Removing varicose veins with laser or radiofrequency
In laser or radiofrequency procedures, the treating physician inserts a probe into the diseased saphenous vein on the front or back of the leg via a small puncture and advances it to the junction of the saphenous vein and the deep vein (usually in the groin or knee bend). At the tip of the probe, the laser or radiofrequency then generates heat with temperatures of up to 120° Celsius in the vein, which leads to the vein wall being "welded" shut as the catheter is slowly and gradually withdrawn. This means that the vein no longer has to be removed from the leg with several incisions in the skin, as was previously the case, but can remain in the leg during treatment. This has several key advantages, which are discussed in more detail below. Over the next few months, the damaged vein is converted by the body into a strand of connective tissue and then finally broken down. The entire treatment is performed under constant ultrasound monitoring, also known asthe"eye of the phlebologist." This "eye" allows all steps of the therapy to be closely monitored and precisely controlled during the procedure. To protect the surrounding tissue from the effects of heat, sterile saline solution is injected into the leg around the vein as a kind of coolant. Depending on the patient's wishes, the procedure can be performed under light sedation or local anesthesia, in which case a local anesthetic is added to the cooling fluid.
Advantages of gentle varicose vein removal
The advantages of this method are immense:
- Significantly less damage to the soft tissue surrounding the vein, as the vein no longer needs to be pulled out, resulting in much less painful bruising (hematomas) after the procedure.
- The reduced damage to soft tissue means less stress on the entire body and a lower risk of infection than with open surgery.
- Compression stockings only need to be worn for two weeks after endovenous therapy, rather than six or more weeks after open surgery as was previously the case.
- Overall, mobility is regained more quickly and patients can usually resume their daily routine/work the very next day.
- Blood-thinning medication does not need to be discontinued prior to the procedure.
- The procedure is almost always performed on an outpatient basis.
Removing varicose veins with vein glue
The gentlest but also most expensive treatment method currently available is known as vein glue. Under local anesthesia, a small puncture of approximately 1 cm in diameter is made in the diseased vein under ultrasound guidance, and a small catheter is inserted into the entire diseased section of the vein. The adhesive (cyanoacrylate) is then applied in dots via this catheter and bonded to the vein wall by applying pressure from the outside with the hand, similar to superglue.
The biggest advantage over heat treatments using lasers or radio frequencies is that there is no heat exposure to the surrounding tissue and no cooling fluid needs to be injected. Immediately after the procedure, the patient gets up from the treatment table, is fully mobile right away, and can resume their daily routine and professional activities in full on the same day. Compression stockings do not need to be worn after treatment with vein glue either. Unfortunately, however, it is currently the most expensive treatment method for varicose veins in the saphenous vein, with the adhesive alone costing over €1,000. Many private health insurance companies now cover the costs of this procedure, but statutory health insurance companies do not.
Removing varicose veins – when should which treatment be used and how much does it cost?
Ask your doctor about the various treatment options and their advantages and disadvantages. There are many ways to achieve the same result, and there are often several treatment options available for your specific condition. Doctors who specialize in the treatment of veins (known as phlebologists) usually offer all treatment methods and will discuss your individual condition with you in detail to determine the best treatment method for you.
Many statutory health insurance companies now cover gentle endovenous procedures (laser and radiofrequency), which cost between approximately €1,200 for one leg and approximately €1,800 for both legs. However, many statutory health insurers still only cover the cost of traditional stripping surgery. You can easily find out which procedure is covered by your health insurance provider by contacting them directly. Private health insurers generally always cover the cost of laser and other procedures.
Häufig gestellte Fragen zum Krampfadern Ziehen
„Krampfadern ziehen” bezeichnet das klassische Stripping-Verfahren: Die erkrankte Stammvene wird über einen Schnitt in der Leiste operativ aus dem Bein herausgezogen. Diese Methode gilt heute als veraltet – moderne endovenöse Verfahren ersetzen sie in den meisten Fällen.
Kompressionsstrümpfe lindern Symptome, heilen Krampfadern aber nicht. Wer Beschwerden hat oder eine fortschreitende Venenerkrankung, sollte Krampfadern entfernen lassen – ein Phlebologe beurteilt im Ultraschall, welches Verfahren nötig ist.
Statt Krampfadern zu ziehen, stehen heute schonende endovenöse Verfahren zur Verfügung: Lasertherapie, Radiofrequenzablation und der Venenkleber (Cyanoacrylat). Alle drei Methoden behandeln die Vene von innen, ohne sie herauszuziehen.
Der Arzt führt über eine kleine Punktion eine Sonde in die erkrankte Vene ein. Laser oder Radiofrequenz erzeugen Hitze bis zu 120 °C, die die Venenwand verschweißt. Der Eingriff erfolgt ambulant unter Ultraschallkontrolle, in örtlicher Betäubung oder leichter Schlafnarkose.
Viele gesetzliche Krankenkassen übernehmen Laser- und Radiofrequenzverfahren (ca. 1.200 € pro Bein, ca. 1.800 € für beide Beine). Manche zahlen weiterhin nur das klassische Krampfadern Ziehen per Stripping. Privatkassen übernehmen die endovenösen Verfahren in der Regel. Am besten direkt beim Versicherer anfragen.
