varicose veins
Minimally invasive treatment of varicose veins in
Varicose veins – medically known as varicosis or varices – are not only unsightly, they also represent a clinical condition with an increased risk of vein inflammation (phlebitis), varicose vein bleeding, or thrombosis. They can also be extremely painful for those affected and cause persistent swelling and a feeling of heaviness in the legs. Because varicose veins cause the valves in the affected veins to leak, the calf muscles can no longer pump blood from the legs back to the heart sufficiently, and the blood pools in the lower leg tissue. The resulting increase in blood volume leads to a vicious circle of further damage to healthy sections of the veins in the leg. Leaving varicose veins untreated therefore carries the risk of serious long-term damage to the leg veins (known as CVI = chronic venous insufficiency) and, in the final stage of the disease, the formation of open sores on the lower leg that are difficult to heal (known as leg ulcers). These are also referred to as lower leg ulcers or, colloquially, as "open legs."
Therefore, in addition to the aesthetic aspect and relief of symptoms, the removal of varicose veins is always a preventive and medically indicated procedure.
What are varicose veins?
treatment options
Varicose vein therapy
Radio wave therapy and laser procedures as gentle treatment methods
The technique of endovenous surgery offers both functional and cosmetic advantages:
In contrast to traditional open surgery, which involves making an incision in the groin and removing the insufficient saphenous vein with a stripper, the gentle endovenous procedure involves inserting a catheter probe through a small puncture in the vein and sealing the varicose vein from the inside using high-frequency radio wave energy or laser beam energy. The principle behind the procedure is very simple: after the probe has been precisely positioned and checked using ultrasound, the diseased vein is closed off by the heat generated. The surrounding tissue remains intact and the heat causes the varicose vein to transform into a strand of connective tissue, which is then broken down naturally by the body over time. No foreign material remains. This minimally invasive treatment method does not usually involve any skin incisions that could leave large scars. Instead, the varicose vein to be treated is simply punctured with a cannula, through which the appropriate probe is then inserted.
And as a patient, you can resume your daily routine more quickly after gentle endovenous treatment than after traditional surgery.
vein glue
Recently, it has also become possible to close the large saphenous veins in the leg (great saphenous vein, small saphenous vein) with adhesive (cyanoacrylate).
Under local anesthesia, a catheter is inserted into the varicose vein via an ultrasound-guided puncture of the saphenous vein, and the adhesive is injected into the vein. By gradually withdrawing the catheter, the entire diseased section of the saphenous vein is glued shut. You will usually be fully fit for work again on the day of the procedure.
The procedure does not involve any heat treatment and there is no need to wear compression stockings afterwards.
Gentle but effective foam sclerotherapy
Larger varicose side branches of varicose veins can also be closed using another gentle method known as foam sclerotherapy. This involves injecting a few milliliters of a sclerosing foam (polidocanol) into the vein to be treated, which causes the varicose vein to shrink and close. This means that no incisions are necessary to remove the diseased vein. Compression stockings should then be worn for a short period of time to optimize the treatment results.
Treatment using the classic surgical method (vein stripping)
This classic surgical method , which is well known among the general public, is generally no longer necessary today. However, for the sake of completeness, it should be mentioned here: An incision is made in the groin and the junction of the varicose vein and the deep vein is severed (known as crossectomy). The varicose vein is then threaded onto a probe and pulled out of the leg (known as stripping of the saphenous vein). Any additional smaller varicose veins are removed from the tissue using a crochet method via tiny skin incisions of only 1 to 2 millimeters in length. The wound in the groin is sutured at the end of the operation. The remaining smaller skin incisions are closed with adhesive strips after the procedure and are not usually sutured.
In all procedures, the healthy veins that remain after the varicose veins have been removed take over the function of the removed veins. Varicose veins can therefore be treated in a variety of ways. Whether removal without incision, first aid for pain, or simple prevention are already effective—please contact us for possible treatment or consultation.
Frequently asked questions about varicose veins
The word "varicose vein" comes from "Krummader," meaning a dilated and winding vein running under the skin. There are both external and internal varicose veins on the legs. Internal varicose veins cannot be seen with the naked eye, but often have a much greater impact on the health of a leg than visible external varicose veins. Internal varicose veins, known as insufficient trunk veins (large or small saphenous veins), can only be diagnosed with an ultrasound examination. In addition, there are also so-called "spider veins," small dilated veins in the skin that get their name from their resemblance to the broom twigs of yesteryear. Only a certain proportion of varicose veins on the leg can be seen with the naked eye, and only an ultrasound examination by a phlebologist or vascular surgeon can reveal the full extent of the disease.
The classic stripping operation of the saphenous vein with a surgical incision in the groin is no longer necessary today, although it is still frequently performed. The method of choice for treating the deeper trunk veins (great saphenous vein, small saphenous vein, anterior accessory saphenous vein) is now always a minimally invasive procedure, as this is almost always possible. In recent years, lasers have increasingly replaced radio waves, as they have a broader range of applications and, in many studies, a better permanent closure rate.
Since varicose veins are a medical condition (ICD 10), health insurance companies (both public and private) cover the costs of treatment. However, as a private doctor, patients with public health insurance are required to pay out of pocket, and public health insurance does not reimburse the costs of private medical treatment. Private patients receive full reimbursement for the costs of their treatment from their health insurance company. In general, statutory health insurance companies do not cover the costs of polidocanol foam sclerotherapy, regardless of which doctor is involved. Some statutory health insurance companies cover minimally invasive therapy of the trunk vein with laser or radio waves for certain contracted doctors. As a patient with statutory health insurance, you should ask your health insurance company whether and with which doctors they have a treatment contract for the respective minimally invasive therapy procedure.
The gentlest and therefore first-choice therapy is the so-called minimally invasive endovenous (performed in the lumen of the vein) procedures for treating deeper trunk vein insufficiency. These minimally invasive procedures include laser ablation, radiofrequency closure, cyanoacrylate (vein glue) bonding, and sclerotherapy with foamed polidocanol (foam sclerotherapy). All of these procedures have the decisive advantage that they do not require an incision in the skin, but only a small puncture through the skin (similar to a blood sample) to close the diseased trunk vein from the inside. This harmonizes the blood flow from the leg to the heart, as blood can no longer flow back into the diseased vein with the force of gravity in the leg. The affected saphenous vein is not removed traumatically by the classic method of pulling it out (known as "stripping"), but is gently closed from the inside and the body breaks down the treated vein in the months following the treatment. Currently, the laser ablation we use is the procedure of choice. However, veins that are visible from the outside cannot be treated with lasers, radio waves, or vein glue, as the catheters required for this cannot be advanced through the veins that run in a winding pattern under the skin. These varicose veins are either gently removed using a mini-phlebectomy according to Varady ("crochet method") via very small incisions in the skin or, alternatively, obliterated using polidocanol foam sclerotherapy. In terms of cosmetic results, the crochet method usually produces better results, as foam sclerotherapy can lead to stubborn brownish discoloration (hyperpigmentation) over time. After a minimally invasive procedure—including mini-phlebectomy—the patient is immediately mobile and can return to work on the same day if necessary. Many patients walk several kilometers on the day of the procedure. Exercise is usually possible again the day after the procedure, and the entire postoperative process is very painless.
After minimally invasive varicose vein treatment with laser and/or mini-phlebectomy (Häkel method), the patient is fit immediately after the procedure. Whenever possible for the patient, the procedure is performed under local anesthesia. Most patients walk several kilometers on the same day after the operation and are advised to move around a lot. As a rule, sports can be resumed the next day. Depending on the profession, patients can return to work immediately or may be restricted for a few days if their work is predominantly sedentary. A compression stocking to reduce postoperative discomfort is optionally recommended for 1 week after the procedure, but it is not mandatory. These are all major differences compared to traditional stripping surgery.
Impressions from practice
