Treating Varicose Veins
(Sclerotherapy)
Vein diseases usually begin with harmless spider veins that are simply visually unappealing. Unfortunately, spider veins can be a precursor to varicose veins or other serious venous diseases such as thrombosis. Varicose veins are not only aesthetically disturbing, they can also lead to calf cramps, fatigue, inflammation or ulcers. If such ulcers continue to grow and maybe even rupture, they can no longer be treated successfully. If the venous disease is still in its early stages, small veins, so-called spider veins, can be sclerosed.
How do I distinguish spider veins from Varicose Veins?
Spider veins are dilated leg veins. They are generally superficial. However, spider veins can be more than just an aesthetic problem if, for example, they develop into varicose veins. The formation of varicose veins indicates impaired circulation. Large quantities of blood can accumulate in varicose veins, which means that the blood cannot flow back to the heart quickly enough.
Preventing Varicose Veins
How can we maintain the important function of blood, which is to supply the body with nutrients? How can we avoid blood accumulation in the legs?
The important thing is to maintain the leg veins' transport function. The blood in the legs needs to flow uphill, especially when standing, walking and sitting. For this reason, we recommend:
- Moving the calf muscles so they can help pump blood in the veins towards the heart;
- Keeping the legs elevated;
- Wearing compression stockings or supports;
- Avoiding heat over 28° C;
- Regular cold showers for the legs;
- Reducing excess weight;
- Wearing flat shoes.
Varicosis in the legs
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Diagnosis of Varicose Veins by a physician
The treating physician will first ask about the patient's medical history, family history and previous therapeutic measures. This is followed by an examination for visible venous diseases through observation and examination while standing. Inflammation of the veins can be detected, for example, by warming the skin or pressure-sensitive areas. Sonography (colloquially known as ultrasound) allows the physician to accurately locate and assess the problem.
Ultrasound as a diagnostic method
Doppler or duplex ultrasound examinations are common methods for diagnosing varicose veins. The procedures are painless and can be performed without any radiation risks. Ultrasound waves can be used to visualize and treat veins that are not visible to the eye. Ultrasound ensures that the sclerosing agent is not accidentally injected into the surrounding tissue or blood vessels.
Treating Varicose Veins
During the past century, treating venous diseases was an extremely cumbersome and lengthy process. Fortunately, modern treatment options are much more effective. Today, venous diseases can be treated on an outpatient basis in a few days. Compression stockings form the basis for treating venous disorders. In combination with appropriate physical and medication therapy, they can help alleviate symptoms. However, this does not mean that the varicose veins will be removed.
Sclerotherapy is best suited for smaller varicose veins and spider veins. However, the prerequisite for this therapy is that the return flow of blood to the heart is not compromised. In the case of larger varicose veins accompanied by symptoms such as heavy legs, blood congestion, swelling and a sensation of tension, other methods of treatment should be used. After careful examination, the severity of the disease should be determined by a specialist, who should choose the appropriate therapy.
The following section describes various treatment options:
Interventional treatment and Sclerosis
Sclerotherapy is used to treat varicose veins and spider veins. Sclerotherapy is currently the most common treatment for varicose veins. The term sclerosis describes the hardening of tissue. Treatment is called interventional if it involves inserting a needle through the skin.
Sclerotherapy or sclerotic compression therapy involves treating varicose veins and spider veins by injecting an irritant substance. The injection of the sclerosing agent into the vein by means of a very thin needle artificially triggers inflammation of the veins and the vein walls stick together from the inside. The sclerosing substance induces an inflammatory reaction of the vascular wall. The principle behind this is to shut down the damaged vessels and thus transform the vein into a strand similar to connective tissue.
After the injection, a compression bandage is applied to the leg, compressing the vessels and turning the vein into a connective tissue-like cord. The collapsed vein eventually disappears because it is gradually broken down through the body's natural processes. As a result, the procedure is equivalent to removing a damaged vein. Today, polidocanol is the preferred agent used for sclerosis. The treatment is usually carried out by dermatologists and is mainly used for varicose veins in the legs.
There are various sclerosing agents. In the instance of small varicose veins which are mainly located on the outside of the leg and have a diameter of 2 - 4 mm, the sclerosing agent will be a liquid. With larger varices, sclerotherapy is usually carried out with foamed substances (foam sclerosing). This can also be used to effectively remove large varicose veins. Parallel to sclerotherapy, an ultrasound device is used for a visual examination. The ultrasound image helps with locating the veins and thus removing them. This ensures that the sclerosing foam is not accidentally injected into surrounding tissue or vessels.
Foam Sclerotherapy
Sclerotherapy is often performed with foamed substances. In (ultrasound-guided) foam sclerosis, the sclerosants, i.e. the established liquid sclerosing agents, are mixed with sterile air to produce foam. A very fine cannula is used to inject the foam into the varicose vein. The foam displaces the blood and has an adhesive effect on the vein wall. Since this foam consists mainly of air, it can be easily distinguished from the surrounding tissue by means of ultrasound. In addition, the foam comes into better contact with the vessel wall so that the larger vessels can also be treated more effectively.
Furthermore, the foam is not diluted by the blood and even small amounts of foam have a stronger effect than liquid sclerosing agents, which increases the effectiveness of the treatment. In addition, foam sclerotherapy has very few side effects and the treatment is much faster. The tolerable amount of the required sclerosing agent is a limiting criterion. The frequency of treatments therefore depends on the number and size of the varicose veins.
Compression in combination with Sclerotherapy
Sclerotherapy only works in combination with compression stockings or bandages, which can prevent or reduce side effects. In most cases, the patient is prescribed a medical compression stocking before the start of treatment. It should be worn before the start of sclerotherapy to ensure that it fits perfectly. Depending on the size of the injected veins, the stocking or bandage must be worn from several days (small varices) to several weeks (larger varices). After a sclerosing agent has been injected into the veins, the compression pressure ensures that the vessel walls stick together. The clotted veins are thus immobilized and can no longer transport blood. This transport function is performed by other adjacent veins.
For the above reasons, compression stockings or bandages must be worn for a certain period of time after the varicose veins have become sclerosed, as they ensure the longevity of success and optimal results. The reason for this is that the body will try to restore the varicose veins damaged by the sclerotherapy until the veins finally stick together. Without appropriate compression, the treatment result could be unsatisfactory. Our tip: you should put on compression stockings before getting up in the morning and include your foot to avoid fluid retention and swelling.
Pain and side effects during Sclerotherapy?
There is no anesthesia available for the procedure. The injection needle is very thin, so the patient will hardly feel any pain during the treatment. For this reason, sclerosing varicose veins is largely painless, apart from the act of puncturing the veins. After the procedure, it is common for slight bruising and discoloration to form at the injection sites, but these are usually harmless and disappear quickly. There are no unpleasant scars and the procedure usually does not restrict the patient further. Intolerance, allergic reactions, the formation of new spider veins or inflammation of the skin with scarring are very rare consequences. In such cases, a doctor should be consulted immediately.
Important before treatment!
Before starting sclerotherapy for varicose veins, it is important to check whether the venous valves in the large thigh vessels function properly. If this is not the case, sclerotherapy of the damaged vessels wouldn't be effective and other treatment methods would have to be used. The predisposition to connective tissue weakness persists even after the treatment. After a certain time, the treatment may have to be repeated.
Contraindications
Sclerotherapy should not be performed if the following contraindications exist:
- Allergies to the sclerosing agent
- A severe systemic disease
- Acute superficial or deep vein thrombosis
- Infections
- Immobility or bedriddenness
- Advanced occlusive disease
- Pregnancy
Risks and complications
Like any surgical intervention, sclerotherapy involves risks. It is normal to feel tension in the treated area immediately after the treatment. However, complications caused by sclerotherapy are rare. If the substance is accidentally injected into the surrounding tissue, it can lead to local inflammations which only heal slowly. If the drug enters an artery, it can cause the formation of blood clots and ulcers. This will slow down the blood flow and the underlying tissue will not receive enough oxygen and will be damaged. In some rare cases, the treatment can result in a permanent brownish discoloration of the skin.
Allergic reactions to the sclerosing agent are also rather unusual. The attending physician should inform the patient about the risks and side effects beforehand.
Therapy success (important steps after Sclerotherapy)
Immediately after the treatment, the doctor will recommend walking around for about half an hour. As a result of the treatment, it will take a few days until daily activities such as work or household tasks can be resumed. The patient can resume exercise after one week at the latest. Exercise is important to stimulate blood flow.
The general rule is:
Walking + lying = good
Standing + sitting = bad
The following things are recommended:
- Plenty of exercise
- No tight clothing for the legs
- Wearing compression stockings
- No heat
- Elevating the legs
The treated veins are checked two to five days after the treatment. The veins will become functional after three to six months.
Alternative treatment methods for Varicose Veins
In addition to sclerotherapy, there are other treatment methods for venous diseases. The physician in charge has to decide which procedure is best suited for the individual case based on the existing diagnosis and circumstances.
The following are some of the common alternatives:
Laser therapy for small spider veins
Laser therapy is particularly suitable for small spider veins. The laser is aimed at the affected area. The laser light is absorbed by red blood cells, which swell and close the vessel. Although this therapy option is painful, it does not require subsequent compression.
Surgery
In the case of larger varicose veins, surgery might be necessary. During surgery, varicose veins are removed and connections to leg veins are blocked. This medical procedure usually requires follow-up treatment and can leave scars. In order to make the procedure as gentle as possible, side branches of the varicose veins are left to be removed later, for example with sclerotherapy.
Stripping
Stripping is another common procedure. The specialist inserts a probe into the blood vessel by making a small incision in the groin. The probe is used to pull out the diseased vein with its side branches in one piece. One possible consequence of stripping is that small nerves in the thigh or lower leg may become injured, resulting in numbness or tingling. Blood effusions are also frequent.
Radio Wave/Radio Frequency Therapy
This therapy involves pushing a probe from the ankle into the collecting vein to the main vein whilst being monitored by ultrasound. At this point, the radio waves are activated and the probe is slowly retracted. At a temperature of 80 - 90 degrees Celsius, the main vein and connecting veins are "melted" and closed from the inside. The glued vein will gradually be broken down by the body's natural functions.
