Various treatment methods are used for pathologically dilated superficial leg veins (varicose veins). In addition to surgical removal (stripping), endovenous (minimally invasive) procedures have also been available since 1990. With endovenous procedures, doctors do not have to remove the vein, but instead cauterize and seal it from the inside using various methods.
Find out more about endovenous therapy and find selected specialists here.
The principle of varicose vein treatment is to remove the dilated section of vein (the varicose vein). This prevents the increased backflow of blood into the varicose vein and blood stasis in the leg.
During stripping, doctors remove the diseased vein. In minimally invasive (endovenous) procedures, they glue the varicose vein from the inside with heat.
This can be done as follows:
The most important endovenous procedures include
In sclerotherapy, doctors inject an alcohol-based sclerosing agent (polidocanol; Sclerovein®, Aethoxysklerol®) into the vein in liquid or foamed form.
This procedure is used in particular for spider vein varicosis. It is only indicated for larger veins in exceptional cases.
The sclerosing agent obliterates the vein from the inside, glues it together and ultimately forms a scar cord after a few days to weeks.
Sclerotherapy can be performed without anesthesia. It takes a few minutes to half an hour. The patient can then go home again.
Sclerotherapy of larger veins is followed by treatment with medical compression stockings, which the patient should wear for 2-4 weeks.
Compression therapy is not indicated for spider veins, unless the patient has used them regularly beforehand and tolerated them well.
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Small spider veins in particular are ideal for sclerotherapy @ Dimid /AdobeStock
Radiofrequency therapy uses radio waves that damage the diseased vein through the heat generated. To do this, doctors puncture the vein below the knee. They then place a probe in the affected vein.
This brings the radio wave energy to the vein wall. The radio waves heat the vein wall to up to 120° Celsius, destroying proteins in the inner wall of the vein. This leads to swelling of the cell wall and the walls then stick together. The vein closes.
Radiofrequency therapy can also be performed on an outpatient basis and without general anesthesia. However, doctors must infiltrate a liquid with local anesthetics (tumescent solution) into the entire course of the vein.
The aim is to minimize pain during and after the treatment. The fluid also increases the distance between the vein and the skin. Doctors can minimize the risk of burns on the surface of the skin.
Compression therapy is recommended for 2-4 weeks, depending on the extent and size of the varicose veins. In many cases, however, it is not absolutely necessary. A follow-up examination is carried out as recommended by the attending physician.
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Radio wave therapy is a gentle catheter procedure for the treatment of varicose veins @ rh2010 /AdobeStock
Endovenous laser therapy (EVLT) also involves a small puncture of the vein on the inside of the lower leg just below the knee.
Doctors then insert a vein laser into the varicose vein just below the groin. They then heat the laser probe and slowly and gradually withdraw it.
This heats and cements the vein along the entire length of the thigh to just below the knee joint.
The subsequent scarring closes the vein. The reflux of blood stops after a few days. A few months after the treatment, the body breaks down the closed vein or converts it into connective tissue.
Laser therapy can also be performed without general anesthesia. However, it is also necessary to inject fluid around the vein (tumescent solution = saline solution with local anesthetic).
Laser therapy is performed on an outpatient basis. The patient can go home after the treatment. To minimize pain and speed up the closure of the vein, compression stockings are recommended for around 2-4 weeks. The attending physician can provide further details and recommendations.
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Laser technology makes it possible to treat large varicose veins on the leg in a minimally invasive, outpatient procedure under local anesthesia without anesthesia @ Rabizo Anatolii /AdobeStock
In mechano-chemical ablation, doctors also puncture the vein, insert a probe and push it upwards.
The special feature is that the probe has a curved tip that rotates at up to 3500 revolutions per minute.
This causes damage to the vein wall from the inside. Doctors then inject a sclerosing foam or adhesive and then withdraw the probe.
The internally injured vein then closes due to the injected foam. However, the vein is not closed by heat, but mechanically and chemically.
The advantage of this procedure is that no further anaesthetic is required apart from the local anaesthetic at the punctured site. The tumescent solution, which is necessary for heat applications, does not require infiltration.
Endovenous procedures offer several advantages over classic vein stripping :
Wearing compression stockings is recommended for both procedures in order to reduce pain:
However, you should be aware that endovenous procedures can cause skin burns, which are very painful.
There are also reports of permanent skin discoloration along the course of the treated vein, which is often considered cosmetically unpleasant.
Studies report that recurrences in the groin area are higher with endovenous procedures than with surgical methods.
This should be taken into consideration, particularly in the case of multiple procedures, and taken into account when selecting the treatment method.
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