Varicose veins (medical term: varices) are dilated and nodular veins. Patients with varicose veins therefore suffer from varicosis.
How do varicose veins develop?
Varicose veins are caused by a congenital weakness of the connective tissue or vein wall. Previous thrombosis of the deep leg veins can also lead to an overload of the superficial venous system. This favors the development of varicose veins.
Due to natural ageing, the vascular walls of the veins slowly give way and venous valves can become leaky. As a result, varicose veins tend to develop gradually over the years.
Women in particular suffer from varicose veins. They are around three times more likely to be affected by the troublesome vein change than men. Many women develop varicose veins during pregnancy in particular.
What are the risk factors?
Typical risk factors are
What different types of varicose veins arethere?
Varicose veins are particularly common in the legs, for example in the greatsaphenous vein (Vena saphena magna). This runs from the inner ankle to the groin and is therefore the longest superficial leg vein in the body.
The smallsaphenous vein (Vena saphena parva) runs from the outer ankle on the back of the lower leg to the back of the knee.
The veins on the arm or in the abdomen are affected much less frequently.
A distinction is made between the following forms depending on the type of development:
- In truncal varicosis, the main veins below the surface of the skin are affected, i.e. the saphenous vein parva and the great saphenous vein (small and large rose vein). The vein stripping procedure is preferably used for these types of varicose veins.
- In the case of side branch varicosis, the side branches of the venous system are affected by blood congestion in the main veins.
- If there is a leak in the connecting veins between the superficial and deep venous system, this is referred to as perforator insufficiency
- In spider vein varicosis, small veins of a reddish-bluish color can be seen. These are often the first sign of vein disease.
Stripping is an effective surgical method for treating varicose veins © Solarisys | AdobeStock
Varicose veins do not disappear on their own. If they are not just a cosmetic problem but also cause discomfort, health insurance companies will cover the costs of the necessary treatment.
There are three possible forms of treatment:
Conservative therapy
Conservative therapy involves compression stockings. These are designed to exert pressure on the vein walls and thus support them.
The compression stockings are produced in different pressure levels and should be worn permanently during the day. Also
- gymnastic exercises,
- Kneipp treatments or
- lymphatic drainage
can also lead to an improvement in symptoms.
Sclerotherapy and catheter therapy (endoluminal therapy)
If conservative therapy is not sufficiently successful, sclerotherapy with liquid or foam may be indicated.
It is also possible to use catheters to seal the vein from the inside by applying heat (laser or radiofrequency therapy). These procedures are usually possible under local anesthesia, but there is a certain risk of skin burns due to the application of heat.
Surgical therapy (stripping)
In classic varicose vein stripping, the varicose vein is removed
- at the point where it opens into the deep vein system (groin or back of the knee) and
- at the lowest point of the dilatation
is severed. A thick wire (probe) is then inserted through this, the vein is knotted to this wire and then pulled out ("stripped").
Sclerotherapy, laser therapy and stripping can all be carried out under outpatient conditions. The costs for surgical varicose vein stripping are generally covered if medically indicated.
The costs for sclerotherapy and laser therapy are only covered by certain health insurance companies.
Stripping is a minor operation that can often be performed on an outpatient basis and under local anesthetic. However, depending on the severity of the condition, a general anesthetic may also be necessary. Your doctor will decide which form of anesthesia is best in your case.
In the classic procedure of vein stripping (Babcock operation), the surgeon removes the damaged segments of the great saphenous vein. However, the prerequisite for this is that the deep vein system is still pervious. This can be checked using a contrast agent examination or ultrasound.
As part of the Babcock operation, the doctor first makes an incision in the groin. This allows the so-called "crosse", i.e. the junction of the femoral vein and the great saphenous vein, to be exposed. The doctor then cuts off all lateral branches that lead into the femoral vein. The next step is to cut off the main vein.
A further incision is made below the varicose section of the vein. If the vein is completely permeated by varicose veins, this incision is made just above the inner ankle. The lower section of the truncal vein is then cut off. Finally, the vein stripper (Babcock probe) is inserted and advanced to the groin. The head of the probe is then unscrewed in the groin. The doctor can now pull the vein out of the incision site from top to bottom.
If the pressure on the nerve fibers in the ankle area is to be reduced, the procedure can also be performed in the opposite direction.
In some cases, related procedures are used in conjunction with classic vein stripping:
- Conventional stripping of the saphenous vein is similar. Here, only the saphenous vein on the lower leg is treated.
- Invasive stripping is considered a particularly gentle procedure because the surgical trauma is extremely low. A pin stripper according to Oesch is used here, which causes the vein stump to be inverted during extraction.
- Cryptostripping is also a particularly gentle procedure. It can be used for almost all types of varicose veins. A metallic probe is inserted, which can be cooled down to minus 80 degrees. This almost completely prevents bleeding. The vein can then be easily removed.
- Side branch varicose veins are best treated by miniphlebectomy. In this procedure, the affected veins are pulled out of the body using small hooks.
- The perforator ligation procedure is used if other blood vessels are affected in addition to the great saphenous vein.
Whether the stripping operation is performed on an outpatient or inpatient basis depends on the complexity of the procedure and the extent of the varicose veins. If necessary, the procedure can also be performed in several sessions.
Before the stripping operation, a thorough medical history must be taken by the doctor. On this occasion, the doctor will also explain exactly how the stripping procedure works and what risks are associated with the procedure.
Do not take any blood-thinning medication in the two weeks before the procedure. This also includes painkillers containing acetylsalicylic acid - i.e. ASA. Otherwise there is an increased risk of bleeding during the procedure. You should also avoid alcohol during this time.
Smokers should start massively reducing their nicotine consumption one month before the procedure. This will prevent any disruption to wound healing.
Stripping is the standard procedure for treating varicose veins, partly because it has a much higher chance of success than other methods: Laser treatment has a recurrence rate of 18 percent. After stripping, varicose veins recur in only 1.3 percent of patients.
The operation itself involves small incisions, so there are no large scars. However, despite all caution, tissue is always damaged, for example
- Lymphatic vessels,
- nerve fibers or
- tiny side branches of the vein.
Large bruises and swelling in the surgical tissue are a common consequence. However, these usually disappear on their own. Compression stockings support the healing process.
Patients are usually on sick leave for one to three weeks after stripping. You should then wear compression stockings for several weeks or even months. You should also avoid sitting for long periods and get plenty of exercise.
To prevent new varicose veins from appearing in other areas (after all, the basic tendency to develop varicose veins remains), the following are recommended
are recommended.
In general, varicose vein stripping is a routine procedure that only very rarely causes serious side effects.
Possible complications are
- bruising,
- feelings of pressure,
- swelling,
- feelings of tension in the legs,
- a feeling of numbness caused by injury to skin nerves,
- severe pain indicating a circulatory disorder - a check-up is necessary in this case,
- in rare cases, wound healing disorders and infections may occur,
- Injuries to the artery in the groin area,
Blood clots may form after the procedure. Thrombosis prophylaxis should therefore be carried out: In the worst case, a life-threatening pulmonary embolism can otherwise occur.
If electrical devices are used, leakage currents can occur, which can lead to tissue and skin damage.
Lying on the operating table can lead to pressure points on the soft tissue and nerves. This can lead to sensory disturbances and, in the worst case, paralysis.
In the event of an allergy or hypersensitivity to the agents used, the following can occur
- Skin rashes,
- itching,
- swelling,
- vomiting,
- dizziness or
- watery eyes
may occur.
Infections affecting the respiratory system, heart or circulation are extremely rare.
Whether stripping is a suitable method for treating your varicose veins must of course be decided by a doctor on an individual basis. In general, however:
- Stripping is an option if truncal veins are affected because they are less tortuous. If a varicose vein is too tortuous, the wire with the probe can only be passed through with difficulty.
- Other treatment methods are usually carried out first, for example compression in conjunction with gymnastics and other accompanying therapies. Only if these therapies do not (or no longer) lead to success is stripping performed.
- For patients with an increased risk of surgery or anesthesia, other minimally invasive methods are attempted. These can include laser treatments and sclerotherapy, for example.
