Phlebology Düsseldorf

My services in phlebology

I offer the entire spectrum of venous vascular medicine.

Modern phlebology in Düsseldorf: Gentle treatment of varicose veins

Varicose veins are abnormally enlarged, visible, and twisted veins under the skin, in which a weakness of the venous valves causes blood to pool in the vein, leading to its enlargement. Varicose veins are not always immediately visible from the outside. Some varicose veins are located deeper in the leg and can only be detected with an ultrasound examination. Varicose veins are a widespread disease, with 30% of all adult Germans suffering from serious venous insufficiency that requires treatment. The aim of treatment is always to remove the diseased veins from the blood circulation in order to avoid late complications such as skin changes or open sores on the lower legs. In accordance with international guidelines, gentle and extremely painless endovenous procedures such as laser, radiofrequency, or vein glue are primarily used today.

Sclerotherapy is the most effective treatment for spider veins.

Spider veins are very fine, bluish-reddish veins with a diameter of no more than 1 mm that shine through the skin. They are a type of varicose vein and are therefore a medical condition, even though they are usually only a cosmetic problem. They get their name from their appearance: with their typical branching pattern, they resemble birch twigs, which were formerly tied together to make brooms ("Besenreiser").

Occasionally, they cause burning pain, a feeling of pressure or warmth, or local swelling. The best treatment is to inject polidocanol into the spider vein. This alcoholic solution causes inflammation of the vein wall, leading to shrinkage and breakdown of the spider vein within a few weeks.

However, an ultrasound scan should always be performed to check whether a varicose vein that is not visible from the outside is the cause of the spider vein. In this case, sclerotherapy would not be effective. For this reason, every new patient at our practice undergoes an ultrasound examination of the leg veins before their first sclerotherapy treatment.

Vein inflammation is part of everyday life for the Düsseldorf phlebologist

The causes of phlebitis can be varied, but are usually due to an inflammatory reaction in the body—not caused by bacteria—in response to a blood clot (thrombus) in a superficial vein. This inflammation is often caused by an intravenous catheter during a hospital stay. As a rule, however, antibiotics are not necessary and superficial thrombosis with accompanying inflammation can be treated with cooling bandages and blood-thinning medication. Treatment is almost always outpatient, and the diagnosis is made through a clinical examination in combination with an ultrasound examination. Occasionally, however, superficial thrombosis also occurs in the context of other diseases and must then be further investigated.

Phlebology today – Treatment of deep vein thrombosis by Dr. Kusenack in Düsseldorf

Thrombosis refers to the formation of a blood clot in a deep or superficial vein in the body, usually in the leg or pelvic area. However, the arm can also be affected—often in athletes after strenuous exercise and strain on the arm (known as "thrombosis par effort"). The clot in the vein (thrombus) causes blood to back up in the affected limb, leading to extensive and acute swelling.

Therefore, any new swelling in the arms or legs without a recognizable cause (e.g., injury) should and must be immediately investigated for thrombosis using an ultrasound examination. This simple and painless examination allows the clot to be detected, the appropriate diagnosis to be made quickly, and adequate therapy to be initiated, usually on an outpatient basis, with compression and blood-thinning medication (known as NOACs).

Phlebology explained simply—I offer consultations at my practice in Düsseldorf.

Phlebology is the medical treatment of venous disorders. Several hundred years ago, doctors were already attempting to relieve their patients of varicose veins. Back then, treatment involved bloodletting from the veins, circular incisions around the entire leg, or the application of leeches. Today, minimally invasive and gentle endovenous treatment methods such as laser, radiofrequency, vein glue, and others enable quick and effective treatment of varicose veins.

The second major subfield of phlebology encompasses the treatment of thrombosis in the deep and superficial veins of the legs and arms, as well as in the large vena cavae in the abdomen and chest.
Here too, treatment has changed significantly in recent years. Whereas in the past, a patient with a fresh thrombosis in the leg was consistently prescribed bed rest, today they are mobilized as quickly as possible with compression stockings and treated with modern blood thinners in tablet form.

Diagnostics have also improved over the years: ultrasound examinations have revolutionized phlebology and have now rendered imaging with X-ray contrast agents, known as phlebography, obsolete. With the help of ultrasound examinations, almost any venous condition can now be diagnosed and its extent determined.

I offer all of these diagnostic and therapeutic procedures in my practice.

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Frequently asked questions for your phlebologist in Düsseldorf

What symptoms do varicose veins cause?

Typical symptoms include a feeling of heaviness and fatigue in the affected leg, but constant restlessness in the leg may also occur. The legs swell in the ankle region, especially in the evening. More advanced stages manifest themselves in permanent skin changes such as brownish discoloration ("purpura jaune d'ocre") and white scarring ("atrophie blanche") as well as thickening ("dermatoliposclerosis") of the skin, frequent inflammation ("eczema") and open sores ("ulcus cruris" or skin ulcers).

What treatment options are available for varicose veins?

Nowadays, varicose veins in the large saphenous veins (great saphenous vein and small saphenous vein) are treated using a minimally invasive and therefore gentle endovenous procedure. The options available here are so-called heat procedures using laser or radiofrequency, or alternatively vein glue. In thermal procedures, the saphenous vein is "sealed" from the inside using heat, and the treated vein is transformed into a scarred strand that is broken down by the body over several months. The advantage of these procedures over classic open stripping surgery, in which the saphenous vein is removed from the leg, is their low invasiveness: only a puncture of the vein is made without an incision, and the laser or radiofrequency probe is inserted into the vein and welded from the inside out.
The vein glue works without any heat at all. A type of medical superglue (Histoacryl) is inserted into the saphenous vein, which is then glued shut by pressing it together from the outside. Other options include foam sclerotherapy (injecting a polidocanol-air mixture into the saphenous vein) or classic stripping surgery.

Is varicose vein treatment painful?

Thanks to modern treatment methods using laser/radiofrequency or vein glue and foam sclerotherapy, invasive therapy for varicose veins causes virtually no pain today. In the vast majority of cases, a puncture of the vein or a small incision in the skin is sufficient to gain access to the diseased vein. In laser/radiofrequency treatment, an anesthetic is also injected around the vein to be treated, along with large amounts of physiological saline solution as a coolant. This can cause a feeling of pressure in the leg during treatment. These gentle treatment methods are characterized by very low pain levels. If necessary, however, a short and light sedative can be administered by an anesthetist, in which case the treatment will not be felt at all in the leg.
In classic stripping surgery, where the saphenous vein is removed from the leg, pain and bruising may occur in the treated leg for a few days, which can be treated effectively with a compression stocking and painkillers.

Can varicose veins also be treated in summer?

Varicose veins can be treated at any time of year —even in summer. The widespread belief that varicose veins can only be treated during the colder months (fall to spring) is a misconception.

Only after sclerotherapy of spider veins or larger varicose veins (no surgery!) should the treated areas not be exposed to direct sunlight for approximately 6 weeks, as this can lead to brownish skin discoloration (hyperpigmentation) in these areas.

Depending on the chosen treatment method, compression stockings should either not be worn at all (vein glue), worn approximately 14 days after a gentle endovenous procedure such as laser or radiofrequency, or worn approximately 4–6 weeks after open vein stripping. However, since patients with untreated varicose veins should wear their compression stockings consistently, especially during the hot season, to counteract vein dilation caused by heat, treatment even in summer can significantly reduce the duration of compression stocking wear.

What treatment options are available for spider veins?

The most effective treatment for these enlarged fine veins in the skin is the injection of a special alcoholic agent called polidocanol. This causes the vein wall to stick together via an inflammatory reaction, and the spider vein is slowly absorbed by the body over the following weeks. It does not disappear immediately after treatment and remains visible for several weeks. After treatment, compression stockings should be worn for 14 days to improve the results, and the treated skin area should not be exposed to direct sunlight for 6 weeks. Otherwise, this will lead to increased brownish hyperpigmentation of the skin due to iron released from the red blood cells—a discoloration that often takes many months to fade.

In addition to the injection of polidocanol, which has been shown in studies to be the most effective treatment for spider veins, there is also the option of transcutaneous laser or electrical treatment. However, the results of these treatments are usually poorer and sometimes leave tiny whitish scars.

What are the risks associated with thrombosis?

The greatest danger of thrombosis, whether located in the deep or superficial vein, is pulmonary embolism. This occurs when a piece of the clot is carried away from the vein by the bloodstream and into the pulmonary vessels, where it leads to a disruption in the oxygen supply to the blood. This usually happens within the first 72 hours after the onset of thrombosis. It is therefore important to have any new and unexplained swelling of a limb checked for possible thrombosis using ultrasound. If thrombosis is present, treatment today is almost always outpatient with further mobilization (i.e., no bed rest!) and the use of blood-thinning medication for 3-6 months. The use of Marcumar has also become much less common today due to the introduction of "new anticoagulants" (known as NOACs).

How do compression stockings work and what should be considered?

External compression causes the leaky valves in the vein to close and thus function properly again. This can be achieved by wearing stockings with different compression classes—usually class II for varicose veins.

Compression stockings should be measured in the morning on the slim leg at the medical supply store. If the leg deviates from the standard measurements at some measurement points, a custom-made compression stocking must be made, which can sometimes take a few days.

Compression stockings are usually only worn during the day and can be taken off at night.

In mild cases of varicose veins, compression stockings are often sufficient to eliminate the symptoms without surgery. However, many patients like to wear the stockings permanently because they simply make their legs feel lighter.