What can you do about varicose veins?

Varicose veins mainly affect the veins on the leg and their connections to the inside. Treated early can prevent complications

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An overview of the leg veins: The superficial and deep veins of the leg are connected by the so-called perforating veins

© W & B / Dr. Ulrike Möhle

Varicose veins - briefly explained

Varicose veins are dilated, irregularly tortuous veins. If it is not just the tiny, superficial spider veins, varicose veins can also be a medical problem and result in complications such as venous thrombosis. In the case of varicose veins, you should therefore consult a doctor and clarify whether treatment is necessary. Depending on the severity of the disease, various measures can also be used in combination. These include surgical removal, elimination using thermal catheter procedures (laser, radio waves), sclerotherapy or conservative measures such as compression treatment.

What are varicose veins?

Varicose veins are permanently dilated, irregularly tortuous veins. Doctors also speak of varicose veins, varicose veins, or varices. They are mainly found on the legs, sometimes also in the pelvic area. Even the "minimal variant", the actually harmless spider veins, find many sufferers to be cosmetically annoying. These are the smallest enlarged skin veins that shimmer through the skin with their branches in purple or blue. Occasionally these also cause local pain. Sclerotherapy or laser therapy can improve the complexion.

However, the vascular disease is not just about beauty: once advanced, varicose veins are also a medical problem. The affected legs are often uncomfortable or swell up during the day. Permanent skin changes and sometimes stubborn ulcers can occur. Sometimes a vein thrombosis is also the cause or consequence.

The muscle pump helps to transport the blood in the veins to the heart

© W & B / Setzer / arr. Jörg Neisel

Background: Small venous science

With the exception of the pulmonary veins, the veins absorb the oxygen-depleted blood from the tissues and transport it to the heart. In doing so, they have to work against gravity. The "muscle pumps" help them on their legs: when the leg muscles contract, they squeeze out the deep veins like a sponge and convey the blood towards the heart.

The veins deep in the leg collect blood from the superficial leg veins. Venous valves, which act like a check valve, prevent blood from flowing back when the muscles relax. In addition, the suction effect of the heart and the pressure changes in the chest and abdomen when breathing support the return of the blood from the deep leg veins.

From the superficial veins there are venous connections into the deep venous system, the so-called perforating veins.

Unremarkable 9.6%

Spider veins, reticulate varicose veins 59 %

Varicose veins 14.3 %

Leg swelling 13.4%

Skin changes 2.9%

Healed ulcer 0.6%

Open ulcer 0.1%

Frequency of chronic venous disorders (according to the Bonn vein study: 3072 women and men aged 18 to 79, questionnaire, medical examination; Rabe et al .: Phlebologie 32: 1-14).
If you move the mouse over the picture, you will see the corresponding numbers

© Wort & Bild Verlag Konradshöhe GmbH & Co. KG

Common disease varicose veins

Varicose veins are common. For example, according to the results of the Bonn vein study published in 2003, around 14 percent of Germans were significantly affected between 2000 and 2002. In view of increasing life expectancy and other favorable factors (more on this in the following section), venous disorders are still on an upward trend. In other words: the vast majority of the German population shows changes to varying degrees in their veins.

Where does the name "varicose vein" come from?

Contrary to popular belief, varicose veins do not cause cramps. The term comes from Old High German. In the Middle Ages, the winding vessels were called "crooked veins". Over time, the word "varicose vein", which is used today, developed from this.

Video: How do varicose veins develop?

Causes: why do you get varicose veins?

Doctors differentiate between primary and secondary varicose veins.

Primary varicose veins

In the primary form of varicose veins, the causes are varied and not entirely clear.

Risk factors for primary varicose veins include:

  • Familial predisposition to connective tissue weakness and venous disorders or hereditary wall weakness of the veins
  • female gender and increased hormonal influences during pregnancy
  • Sedentary lifestyle
  • Professional activity predominantly standing up and in the warm (e.g. bakery saleswoman)
  • Obesity

Many people have an inherited predisposition to weak connective tissue and veins. This is the most important of the risk factors mentioned.

More women (around 15 percent) than men (around 11 percent) are affected by varicose veins. The fact that women are ahead with varicose veins is probably due to the fact that the female sex hormones of the estrogen type influence the structure of the vein wall and venous valves. During pregnancy, under the influence of another female sex hormone, progesterone, the muscle and connective tissue loosens - also in the veins. In addition, the enlarged uterus makes it difficult for the blood to drain out of the legs during pregnancy. This is why varicose veins often develop during pregnancy, and existing ones increase - usually temporarily - in weight.

Just as the skin loses firmness over the course of life, so do the veins over time. This is more noticeable in the second half of life. In rare cases, a congenital lack of venous valves can be the cause of varicose veins.

Secondary varicose veins

If varicose veins are caused by another disease, it is a secondary varicosis. Deep vein thromboses in the legs are particularly suitable. When deep veins in the legs become blocked as a result of thrombosis, this increases the blood transport via the superficial veins. In the long term, their transport capacity is overwhelmed, they sag and transform into varicose veins.

Another cause of varicose veins can be heart failure - if the right half of the heart is particularly affected, right heart failure. The disturbed heart function can, among other things, cause the pressure in the leg veins to rise. Typically, this results in leg swelling (edema) and enlargement of the leg veins.

Primary or secondary varicose veins?

The type of varicose veins a person has is sometimes difficult to assess, as the two forms cannot be distinguished from one another in terms of symptoms and complications in advanced stages of the disease. Correct assignment of the disease is very important for optimal advice and treatment. Therefore, it is advisable to seek advice from a knowledgeable vein specialist, usually a phlebologist.

Symptoms: how do varicose veins feel?

Varicose veins often begin in adolescence or early adulthood. Gradually, spider veins or bluish, knotty, thickened veins become more and more visible through the skin. Large-caliber varicose veins sometimes protrude like knots or strands. They affect the trunk veins - the large and small rose veins (Vena saphena magna and Vena saphena parva) - or their side branches.

Large varicose veins are more likely to cause discomfort than spider veins. Many sufferers suffer from a feeling of tension and heaviness or pain in their legs after long periods of standing or sitting. The symptoms worsen during the day and at warm temperatures, and in women shortly before menstruation. Elevation of the legs or cooling bring relief.

Many patients also report complaints such as paresthesia, warmth and restlessness in the legs. Affected people also complain more often of (nocturnal) leg cramps, but these are not typical of varicose veins. They are mostly based on parallel incorrect loads in the case of joint wear or overloads after unusually hard physical training.

The tendency to swelling (edema) can increase over time. It arises from the fact that the blood volume and the pressure in the pathologically altered veins are increased. Then liquid is pressed into the surrounding tissue.

Possible complications with varicose veins

Varicose veins can cause complications. These include:

  • Phlebitis
  • Thrombosis (clot formation in the veins) and pulmonary embolism
  • chronic venous insufficiency
  • Varicose vein bleeding

Attention: In the event of unusual pain or swelling in the leg, you should seek medical advice immediately; in the event of sudden shortness of breath and chest pain, you should immediately call the emergency doctor (ambulance service, emergency number 112). There is then a suspicion of a leg vein thrombosis or a pulmonary embolism!

Phlebitis

Varicose veins are the leading cause of phlebitis. The diagnosis is then varicophlebitis. The inflamed inner wall of the vein is often the impetus for the formation of a blood clot (thrombus), which can block the vessel. In this case, doctors speak of a varicothrombosis.

The symptoms are

  • Redness,
  • Overheating and
  • Pain

in the appropriate place. A hardened, tenderness-prone vein cord can often be felt. Long inflammatory occlusions in varicose veins of the trunk veins on the leg are extremely painful. In the case of the large rose vein, the longest vein in the body, these occur on the inside of the leg, sometimes up to the groin. A thrombosis of the small rose vein is noticeable on the calf, sometimes up to the hollow of the knee. This so-called varicothrombosis not only results in the visibly and tangibly inflamed and tender areas, but also pain when walking.

Varicophlebitis / varicothrombosis can occur spontaneously due to the slowed blood flow in the dilated cutaneous vein. Sometimes bumps or pressure injuries, blood congestion due to long, cramped sitting with little legroom, as well as severe fluid loss during exercise or in hot outside temperatures can be triggers.

Thrombosis and pulmonary embolism

If the blood clot involved expands from a superficial vein or varicose vein, i.e. a varicothrombosis, into the deep vein, it is a deep vein thrombosis. Of course, clot formation can also originate in a deep vein per se. Parts of such venous thrombosis can become detached and washed into the lungs via the veins. If you block one of the pulmonary vessels there, a so-called pulmonary embolism occurs, which, depending on the extent, can be life-threatening.