varicose veins

Varicose veins: description

Varicose veins (varicose veins, varicose veins, varicosis) are cylindrical protrusions or extensions of superficial veins. The blood vessels form tangles and tortuosities, which shimmer bluish through the skin, especially on the legs. Varicose veins can also occur on other parts of the body, such as in the area of ​​the esophagus. Varicose veins can cause discomfort such as swollen feet and sore legs as well as bleeding in the esophagus.

Varicose veins: legs

In Germany many people suffer from varicose veins. According to current estimates, about 20 percent of adults have at least slightly altered superficial veins. Women suffer from varicosis up to three times more frequently than men. Most often, the superficial veins of the legs are affected. The varicosis is usually noticed between the 30th and 40th year of life for the first time by the patients. Most people suffer from very fine, superficial varicose veins, the so-called spider veins.

Depending on the location and shape different forms of varicose veins are distinguished:

1. Root vein and side branch varices: These are varicose veins of medium sized and large veins. This type of varicosis is most common and usually occurs on the inside of the thighs and lower legs.
2. Perforating varices: The superficial veins are connected via connecting circuits to the deep veins of the legs. When these connecting veins expand and sag, one speaks of Perforans varices.
3. Reticular varices: Reticular varices are very small varicose veins of the legs. The diameter of these small veins is a maximum of two to four millimeters. Reticular varices are found mainly on the outside of the thighs and lower legs and in the popliteal fossa.

Spider veins

Read all important information about spider veins here.

In most cases, varicose veins cause no problems and are very weak. The older the patients become or the more they are limited in their mobility, the more pronounced the complaints become. In some cases, drug treatment or surgical removal of varicose veins may be required.

Varicose veins: esophagus (esophageal varices)

Varicose veins of the esophagus (oesophageal varices) are far less common than the varicosis of the legs. These varicose veins are covered at the esophagus only by a thin layer of mucous membrane. The esophageal varices can therefore bleed more easily and lead to life-threatening complications. Varicosis of the esophagus is usually caused by damage to the liver circulation in the case of scarring of the liver (liver cirrhosis). The blood backs up in the large circulation, and the bypass circuits on the esophagus, the abdominal wall or the rectum (rectum) are increasingly filled with blood. As a result, veins are sloughed off, causing varicose veins.

Varicose veins: symptoms

In the initial stage varicose veins usually cause no symptoms. Especially the very fine spider veins are usually harmless. They usually appear as harmless red, blue or purple veins in the skin of the legs and rarely cause pain.

Stages of Varicose Veins

Depending on the severity of the symptoms, the varicose veins are divided into different stages:

Initial stage (stage I): At the beginning of the disease, varicose veins usually cause no discomfort and are more of an aesthetic problem. However, many sufferers find the spider veins or varicose veins ugly and avoid showing them.

Heavy legs (stage II): In the further course, patients with varicose veins on the legs often suffer from the feeling of heavy legs and a distension of the legs. Legs get tired faster, and leg cramps occur more often at night. As a rule, these symptoms improve during lying and during movement, as the blood flow of the veins is then stimulated, which counteracts congestion. Some patients also report pronounced itching and symptoms that get worse in warm weather. The heat then causes the blood vessels to dilate, the blood can flow out worse, and the varicose veins cause pain.

Water retention (edema) in the legs (stage III): The longer the congestion in the veins, the more strained and permeable the vessel walls. Liquid, proteins (proteins) and blood breakdown products (hemosiderin) are then pressed from the varicose veins into the surrounding tissue. Initially, patients initially suffer from accumulation of fluid (edema) in the feet and legs in the evening. The chronic stagnation of the blood also causes reddish, itchy skin lesions (stasis dermatitis, stasis dermatitis). Especially in older patients, the skin thins out in the course (“parchment skin”), and there are slight injuries that can still heal.

Open leg ulcers (stage IV): With long-lasting congestion, the surrounding tissue is no longer sufficiently supplied with oxygen. Small injuries can then no longer heal properly. It forms ulcers (ulcers) of the skin, and it comes to the death of tissue in the form of “open legs” (ulcus cruris). The reduced blood flow allows only a very slow wound healing. The open ulcers must therefore be continuously supplied by a doctor to prevent the spread of bacteria.

Phlebitis

Patients with varicose veins often suffer from additional inflammation of the superficial veins (phlebitis). The chronic congestion of blood vessel walls are increasingly strained, and it can easily cause inflammation. On an inflamed vessel wall, a blood clot is easier to form, which can clog the blood vessel (thrombosis). The blood clot may also dissolve and be flushed into the pulmonary circulation via the large bloodstream. Here it can clog a lung vessel – it develops a pulmonary embolism. It is an emergency that needs immediate medical attention to prevent life-threatening complications.

Varicose Veins: Causes and Risk Factors

Varicose veins develop when the blood can not properly drain from the veins. The veins have to transport the blood against gravity back to the heart. The surrounding muscles and the elastic vascular wall of the veins help. In addition, so-called venous valves in the vessels ensure that the blood does not flow back.

Blood congestion in the veins

If the elasticity of the vessel walls diminishes or if the venous valves are damaged, the venous blood builds up and the vessel walls can overstretch and swell – varicose veins develop. In the absence of exercise or a long standing day, more blood accumulates in the leg veins, and patients often complain of heavy, distended legs.

Doctors distinguish between primary and secondary varices (varicose veins):

Primary varicose veins

The primary varices account for 70 percent of all varicose veins and arise without a known cause. However, there are several risk factors that favor the development of primary varicose veins: older age, obesity and smoking make vascular walls more susceptible to damage. Hereditary factors, female hormones and a lack of exercise also increase the risk of varicosis (varicose veins).

inheritance: A connective tissue weakness can be inherited and increases the risk of varicose veins. However, according to a recent study by the Capio Mosel-Eifel-Klinik, varicose veins are less often inherited than previously thought: 2,700 patients were examined, of whom only 17.2 percent had genetically-caused varicose veins. Other risk factors such as obesity, hormones or gender therefore predominate in the development of varicose veins. Accordingly, each individual can do a great deal for the prevention of varicose veins.

hormones: Women often get varicose veins than men. The female sex hormones (estrogens) often cause the connective tissue to relax – this promotes the development of varicose veins. Pregnancy also favors varicose veins: Every third pregnant woman gets varices. In most cases, however, varicose veins are only temporary in pregnancy – they usually return by themselves after birth. Nevertheless, the risk of varicosis increases with the number of pregnancies.

Lack of exercise: Physical activity and movement in the legs activates the muscle pump, which makes it easier for the veins to pump blood to the heart. If you stand or stand for long periods, the muscle pump relaxes and the blood becomes more easily blocked. When sitting, the veins of the popliteal fossa can also be bent, whereby the venous return of the blood is also hindered. Occupational activity, which is mainly performed while sitting, can thus promote the development of varicose veins.

Secondary varicose veins

The secondary varicose veins account for about 30 percent of all cases of varicosis. They are caused by an acquired drainage obstruction of the veins, usually after a blood clot in the deep leg veins (leg vein thrombosis).

Varicose veins: examinations and diagnosis

The right contact person for suspected varicose veins is a specialist in vascular surgery or phlebology. In a first interview, the doctor will ask you for the latest complaints and possible pre-existing conditions (anamnesis). For example, he can ask you the following questions:

• How old are they?
• Do you smoke and if so, how much?
• Do you suffer from a distension of the legs in the evening?
• Do you have the feeling that your legs are very heavy in the evening?
• In women: How many pregnancies have you had to date?
• Do other family members suffer from varicose veins?

Subsequently, the doctor will physically examine you looking for signs of varicose veins. He will look at both legs and feet in side comparison to identify any swelling, skin discoloration or ulcers. Subsequently, an ultrasound examination (sonography) or an X-ray examination of the vessels (angiography) can help to estimate the blood flow in the veins.

Ultrasound (duplex sonography)

A special ultrasound examination (duplex or Doppler ultrasonography) allows the accurate examination of the veins. Duplex sonography can image the blood flow and make it possible to tell in which direction the venous blood is flowing. The doctor can also see how permeable the veins are and whether the venous valves are damaged or intact. Duplex sonography is a simple and cost-effective method of examination that is considered the method of choice for varicose veins.

Angiography of the veins (phlebography)

If a duplex ultrasound is not sufficient or not available, a visual representation of the veins can also be done with contrast medium (phlebography). If suspected thrombosis of the leg veins, the phlebography can also provide diagnostic evidence. The doctor punctures a vein in the groin or on the foot and introduces contrast media. The contrast agent causes the veins to become visible in the X-ray. A discontinuation of the contrast agent course on the X-ray image thus indicates a vascular occlusion.

Varicose veins: treatment

The goal of treating varicose veins is to improve the blood flow of the veins and thus counteract congestion. The surrounding tissue should be supported to prevent water retention in the tissue (edema). The better the venous blood flow, the lower the risk of possible circulatory problems and ulcers or open legs.

Varicose vein treatment options include general measures, wearing stockings, and surgery and vascular obliteration to remove varicose veins.

General measures

There are several ways to improve the perfusion of the leg veins, which can help prevent other varicose veins. These include sufficient physical activity, raising your legs, avoiding extreme heat and changing showers.

Exercise in everyday life: You can already improve the circulation of your veins with simple exercises in everyday life. Try to avoid prolonged standing and sitting as it promotes blood flow in the veins. If possible, you should walk around regularly to stimulate the bloodstream of the veins.

Elevating the legs: Especially at night you should be careful to store the legs a bit higher. This facilitates the transport of the blood from the legs towards the heart. Most patients report that elevating the legs improves the feeling of tightness in the legs and relieves stress.

Avoiding heat: Those affected suffer from the symptoms of varicose veins, especially in the summer when it is very hot. The leg veins then widen and can no longer transport the blood sufficiently to the heart. Consequently, patients suffer from thick, swollen legs. Avoid extreme heat and sauna visits.

Contrast showers: When showering, you can alternate the legs alternately cold and hot every 30 seconds. The cold water causes a contraction of the varicose veins, while the hot water then causes an expansion of the blood vessels again. The change stimulates the movement of the vessel walls and thus improves the blood circulation of the legs. The changing shower can be easily implemented with every shower and often reduces swelling of the legs.

compression stockings

Compression stockings (support stockings) are very tight stockings that compress the calf tissue and are often used in varicose veins as a treatment of choice. The applied pressure of the stockings on the legs reinforces the muscle pump of the veins, closes the venous valves better and any fluid leakage from the veins into the surrounding tissue (edema) is counteracted. The patient is advised to put on the stockings while lying down, since the blood quickly gets stuck in the legs while standing and the stockings can no longer produce the same effect.

For varicose veins, the compression stockings should fit exactly. The socks are divided into so-called compression classes (class I to IV). Many patients can therefore be made to measure. Depending on the location and degree of expansion of the varicose veins, the compression stockings reach to the calf, over the knee or even to the thigh. The compression stockings are available in different colors and should be replaced after about four to six months.

drugs

So far, there are no special medicines for varicose veins. However, numerous preparations are sold which are said to have a protective or soothing effect on varicose veins. Various medicinal plants such as horse chestnut, butcher’s broom or clover are said to have a vaso-sealing effect (edema-protective).

Various ointments (also based on plants or with the anticoagulant Heparin) can be applied externally. However, it is still highly controversial whether these ointments really penetrate the skin and can exert a protective effect on the leg veins. However, many patients find massaging their legs very beneficial, which is why regular use of creams and ointments is recommended.

Remove varicose veins

Read all important information about removing varicose veins here.

Varicose veins: disease course and prognosis

With increasing age, the risk that a vein develops into a varicose vein also increases because the connective tissue loses its elasticity with age. However, you can do something about it to prevent varicose veins:

• Regular exercise such as swimming or cycling prevents the development of varicose veins. It ensures a tight connective tissue and strengthens the vein-supporting muscle pump.
• Stimulate the circulation of the legs with daily alternating showers.
• Avoid sitting or standing for too long and take regular breaks in which you walk around.
• Pregnant women should consult with their specialist in gynecology and wear compression stockings in case of suspected varicose veins.

complications

In very advanced varicose veins, the blood flow in the legs is often limited enough to form badly healing ulcers (ulceration) of the skin. The badly healing ulcers are also referred to as “open legs”. The poorly perfused tissue provides a good breeding ground for bacteria that can easily spread through the blood vessels. Kicking in the context of varicose veins such ulcers, they must be continuously supplied with medical attention to prevent a spreading infection.