Varicose Veins - Diagnosis And Therapy

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-08-25 11:04

Varicose veins: diagnosis & therapy

A cure is practically impossible with varicose veins. However, with early treatment, there is a good chance that the disease will not get worse, but rather improve. The therapy is aimed at relieving symptoms and preventing complications and depends on the type of varicose veins, the location and extent of the venous changes and the symptoms. It is generally advisable because varicose veins can lead to phlebitis, eczema and, in the worst case, to leg ulcers.

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• How is the diagnosis made?
• How is varicose veins treated?
• Whom can I ask?
• How are the costs going to be covered?

How is the diagnosis made?

The doctor takes the anamnesis and performs a physical examination, especially of the skin on the legs. Furthermore, the patency of the veins and the function of the venous valves can be checked using ultrasound. The so-called plethysmography allows an assessment of how well the blood can be pumped out of the veins when the leg is moved. In addition, advanced imaging tests may be required. Last but not least, these serve to rule out other venous diseases such as deep vein thrombosis.

How is varicose veins treated?

A cure is practically impossible with varicose veins. However, with early treatment, there is a good chance that the disease will not get worse, but rather improve. The therapy is aimed at relieving symptoms and preventing complications and depends on the type of varicose veins, the location and extent of the venous changes and the symptoms.

Basic therapy

The most important and most effective measure is compression therapy with compression bandages, medical compression stockings or tights. The compression bandage is used to treat open ulcers, phlebitis and, above all, to decongest swollen legs, e.g. before fitting compression stockings.

The compression stocking itself is mainly prescribed for long-term therapy of venous diseases. It exerts pressure on the body tissue from the outside, making the venous valves functional again and venous congestion can be avoided. The effect of compression stockings and tights depends on the strength of the pressure.

A distinction is made between four different classes, which are prescribed individually depending on the type and extent of the venous disease present. With a compression stocking, edema cannot be flushed out, only the re-swelling of a leg can be prevented. This is also the reason why compression stockings or tights have to be put on in bed in the morning if the legs are unblocked.

Tip If you have received a prescription for compression stockings from your doctor, take them to a medical supply store. There your leg will be measured exactly and, depending on the result, compression stockings will be delivered in standard size or made to measure. Never allow compression stockings to be taken off the shelf - insist on an accurate leg measurement!

People with restricted mobility, joint and spinal problems as well as being overweight often find it particularly difficult to put on compression stockings. However, this problem can usually be solved by so-called dressing aids.

Note Compression stockings are not suitable for every patient. They must not be used, for example, in the case of arterial circulatory disorders, heart failure, coronary artery disease, weeping eczema or open leg ulcers.

Venous medication

Accompanying or as an alternative to compression therapy, various herbal, well-tolerated medicinal products are used to treat edema, for example with the active ingredients oxerutin, diosmin or horse chestnut seed extract. These so-called edema protectors are supposed to strengthen the inner lining of the veins and thereby make them more impermeable to the escape of fluid into the surrounding tissue. This reduces fluid retention, which causes the feeling of tension and heaviness, and improves the supply of the tissue.

Furthermore, other physical decongestion measures, manual lymphatic drainage, mechanical compression, hydrotherapy (cold water applications or alternating baths), etc. can be helpful to alleviate the symptoms of varicose veins and to avoid or improve complications.

For more information, see What can I do myself if I have venous disease?

Vein occlusion

In the so-called endovenous procedure, the veins remain in the body and are closed from the inside, shrunk or converted into a cord of connective tissue. In most cases, treatment is carried out on an outpatient basis. After that, compression stockings should be worn for up to six weeks. In most cases, the deactivated varicose vein disappears completely over the course of a few months as a result of subsequent degradation processes.

• Conventional obliteration: a fine needle is used to inject a drug into the varicose vein, usually in several treatment sessions, which causes inflammation and thereby closes the varicose vein. This method is only suitable for thin varicose veins and spider veins.
• Foam obliteration: Foam is injected into the vein with fine needles, which makes the vein more sticky. Usually only one treatment session is required. This can also be used to close larger veins.
• Laser therapy: The vein is destroyed by means of local heat using an inserted laser fiber.
• Radiofrequency therapy: The vein is closed by means of a catheter using controlled heating.

Operation (vein stripping, crossectomy)

Major surgical interventions may be necessary if the venous disease is very pronounced and / or there is a risk of long-term effects and complications. In the case of a trunk varice, a flexible special probe is inserted into the pathologically enlarged vein, pushed forward to its end and then discharged again. The varices are then cut through above and below, fixed on the probe and pulled out (= stripping).

In contrast to before, functional vein parts can already be preserved today. The stripping operation can be performed under general anesthesia, partial anesthesia or also under local anesthesia; it can be carried out on an outpatient or inpatient basis. The decisive factor here is the severity of the findings, the condition and the psychological state of the patient. After the operation, compression with elastic bandages or compression stockings is recommended for three to six weeks in order to prevent swelling of the operated leg and to prevent postoperative venous thrombosis. In addition, an anticoagulant treatment with heparin should be carried out for several days to avoid thrombosis and embolism.

Whom can I ask?

If you suspect varicose veins, you should contact one of the following:

• General Practitioner,
• Specialist in internal medicine,
• Specialist in skin and venereal diseases.

How are the costs going to be covered?

All necessary and appropriate therapies are covered by the health insurance carriers. Your doctor or the outpatient clinic will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS, BVAEB). However, you can also use a doctor of your choice (ie doctor without a health insurance contract) or a private outpatient clinic. For more information, see Costs and Deductibles.

There is a deductible for compression stockings prescribed by the doctor, which the patient has to wear himself. Depending on the health insurance provider, a pair of compression stockings is approved every six months. Treatments required for cosmetic reasons must be paid for by yourself.