Vein surgery

Vein surgery deals with the treatment of venous diseases.

90% of all treatments are for chronic venous insufficiency (CVI) of the lower limbs, which leads to varicose veins. Varicose veins are caused by the widening and lengthening of the superficial veins.

Veins of the lower limbs

The veins of the lower limbs are divided into two vein networks.

One of the vein networks is called the deep vein network. It is located in the middle of the muscles, is directly connected to the arteries and provides 90% of the venous return. Venous return, or venous return, is the return of blood to the heart.

The second venous network is the accessory, superficial venous network. Its task is to drain the skin and subcutaneous tissue. In contrast to the deep venous network, it is responsible for only 10% of venous return.

The venous system is responsible for the return flow of blood to the heart. The latter depends on numerous factors such as:

  • Squeezing of the vein sole
  • Contraction of the calf muscles
  • Breathing
  • Pumping ability of the heart
  • Functioning of the return valves

Varicose veins

To date, the cause of varicose veins has not been clarified. However, varicose veins are five times more common in industrialised countries today.

There are, however, predisposing (favouring) factors:

  • Heredity. The risk of getting varicose veins is 20% if neither parent is affected. 50% if one parent is affected and 90% if both parents have varicose veins.
  • Age. Comparing different age groups, varicose veins are three times more likely to occur at age 70 than at age 30. After the age of 60, 70% of people are affected by varicose veins.
  • Gender. Varicose veins are more common in women.
  • Obesity and/or rapid weight gain, leading to lack of exercise and muscle wasting.
  • Standing or sitting for long periods of time, especially in a warm and humid environment (risk groups are, for example, shop assistants, waitresses or stewardesses).
  • Selected sports
  • Disturbances of the foot statics: flat or hollow foot.
  • Pregnancy leading to hormonal changes and compression of the veins in the pelvis.
  • Other causes: Chronic constipation, too tight clothing, unsuitable footwear (too high heels or lined boots), certain lifestyle habits such as tobacco and alcohol consumption or too spicy food, as well as heat trauma caused by sauna, steam bath, depilation with hot wax or prolonged sun exposure.

Symptoms

There are few or no symptoms of varicose veins. A distinction is made between clinical symptoms and aesthetic problems.

Clinical symptoms of problems caused by varicose veins:

  • Heavy legs
  • Tingling
  • Itching
  • Cramps
  • Pain in the varicose veins

Aesthetic problems are often the main concern, as the varicose veins are very conspicuous on the leg and the sight of them disturbs the patient, as well as causing psychological problems.

Diagnosis

During clinical diagnosis, patients are classified according to CEAP.  The CEAP classification is the classification of the severity of chronic venous disease.

During the diagnosis, the doctor will conduct a detailed interview. During the interview, the history, especially the family history, the favouring factors, the various complaints of the patient and the concomitant diseases are determined. A complete examination of the lower limbs is also carried out, during which venous ultrasound is performed. In the case of pelvic insufficiency, the examination is carried out with the help of phlebomagnetic resonance imaging (MRI).

Treatment

If varicose veins are not treated for symptoms, the following complications can occur.

In the skin area:

  • Oedema
  • Dermatitis: ochre-coloured or atrophic.
  • Hypodermitis: inflammation of the subcutis
  • Varicose eczema with scratch lesions.
  • Ulcer: little painful loss of skin substance on the inner ankle, revealing the dermis (second layer of skin).
  • Bleeding due to rupture of a varicose vein dilatation

If inflammation (phlebitis) of the superficial veins occurs, there is acute local pain and the varicose vein becomes inflamed.

Conservative, non-surgical treatment

In conservative treatment, there are several rules that affected people must follow. These include

  • Putting your feet up in bed
  • Regular cold showers
  • Wearing insoles
  • Avoid wearing clothes that are too tight
  • Avoiding tobacco and alcohol
  • Regular exercise such as walking, jogging, swimming or cycling

Treatment also includes compression therapy, using special socks, stockings or tights.

Surgical therapy

Surgery is considered when conservative measures can no longer relieve the symptoms sufficiently. Complications such as leg ulcers occur, or varicose veins put a mental strain on the person affected.

Today, various treatment methods are available.

Stenting technique with crossectomy and stripping

A total of two incisions are made below the groin and in the hollow of the knee, or ankle. First, the vein is tied off or clamped at the upper incision (so-called vein ligation). Then a long wire is inserted through the lower incision into the vein and advanced. A button-like attachment is used to pull the vein out of the groin.

Phlebectomy

When a phlebectomy is performed, several small incisions of a few millimeters are made along the affected vein. Using small hooks, the vein is pulled out through these incisions as far as possible. The vein is then cut and removed in several pieces.

Thermal therapy methods

In laser therapy or radiofrequency therapy, the vein is destroyed by the application of heat. The treatment is done under local anaesthetic and is relatively painless.

Chemical sclerotherapy (sclerotherapy)

Chemical sclerotherapy is a minimally invasive and outpatient procedure in which varicose veins are treated with the help of ultrasound or special sclerosing agents. The treatment usually requires several sessions and can be performed individually or as a complement to varicose vein surgery.

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