Are painful varicose veins dangerous

Varicose veins

Varicose veins (Varicosis, varicose veins, varices): Visible, pathologically dilated veins that run superficially under the skin, some of which are tortuous or have knotty bulges.

Varicose veins occur predominantly on the legs and are usually noticed for the first time around the age of 30. Women are three times as likely to be affected as men. Varicose veins are a widespread disease that affects more than 30% of adults.

The reason for treatment is not only the cosmetic impairment or the feeling of heavy legs: If the varicose vein progresses, it threatens to spread to the deep venous systems with chronic venous insufficiency (CVI). Varicose veins are treated with movement, compression and, depending on the extent, also surgically with vein stripping or sclerotherapy.

Leading complaints

  • Cosmetically annoying spider veins and varicose veins
  • Tired, heavy legs
  • Swelling, tingling, itching, and pain in the legs
  • Complaints increase after standing or sitting for a long time and in the heat, improvement of the complaints when raising the legs (exactly the opposite is the case with PAD)
  • Swelling of the ankles in the evening
  • Nocturnal leg cramps.

When to the doctor

In the next few weeks if

  • increasingly heavy legs, a feeling of tension and swelling of the ankles after standing for a long time.

The illness

Primary varicose veins

Varicose veins form in the vast majority of cases due to a congenital venous wall or connective tissue weakness (primary varicose veins). Age also plays a role: vessel walls degenerate and lose more and more of their elasticity over the years. The development of varicose veins is favored by increased venous pressure in the legs, triggered by known risk factors such as

  • standing or sitting for long periods of time
  • Sedentary lifestyle
  • Pregnancies
  • very overweight.

The changes in the vessel wall and the increased pressure in the leg veins mean that the venous outflow to the heart no longer functions properly and the blood sinks into the superficial veins. As a result of the congestion, the vessel walls of the veins, which are already less pronounced than those of the arteries, give way and the veins expand. Now a vicious circle begins: As the vein diameter increases, the venous valves no longer close, they become leaky. The further transport of the blood towards the heart is now even more restricted, more and more blood builds up, the veins continue to sag - and the next valve is leaking.

During these processes, the superficial veins can expand as thick as a finger, expand like a network, or develop as Spider veins Form cobweb-like flat. The varicose veins occur preferentially on the inside of the thigh and lower leg as well as on the back of the lower leg.

The difficult blood outflow, which in the course of the disease causes the feeling of tense, heavy, tired legs, is initially limited to the superficial venous system. If the perforating veins - these are the veins connecting to the deep leg veins - are also affected by the degenerative changes, blood can circulate between the superficial and deeper venous systems instead of flowing towards the heart. Oedemas often develop at the same time due to the poorer removal of blood or fluids from the legs.

Secondary varicosis

However, varicose veins also develop when the superficial veins are overwhelmed by excessive blood flow and therefore expand. This happens, for example, in the case of outflow obstacles in the deep venous system: If the deep leg vein is blocked by a deep vein thrombosis, the blood finds its way to the heart via the - still healthy - superficial venous system. Because these veins are not designed for large amounts of blood, they expand and become varicose veins. Such a varicose vein disease, which develops due to other venous diseases, the doctor calls one secondary Varicose veins.

Special form of esophageal varicose veins. A clinically significant secondary varicose veins are esophageal varicose veins (see there for details).

Complications

At an advanced stage, the disturbed venous outflow of blood leads to the deep leg veins expanding and their valves becoming leaky. There is a risk of chronic venous insufficiency, which also occurs as an end stage or consequential damage to deep vein thrombosis.

Varicose veins can also tear and cause massive bleeding. Repeated bleeding from leg varicose veins not only removes a lot of iron from the body due to the loss of blood, but also becomes the starting point for poorly healing wounds with severe infections.

Further complications are inflammation (thrombophlebitis) and, in advanced stages, wound healing disorders and open legs (leg ulcer, leg ulcer).

Diagnostic assurance

Examining the legs while standing shows the doctor which superficial vein sections are dilated. With the ultrasound (Doppler and duplex sonography) he checks the blood flow in the veins, the tightness of the venous valves and the patency of the deep venous system. He also looks for signs of advanced chronic venous insufficiency such as edema and skin changes.

An X-ray examination of the veins with contrast medium (venography) is only necessary if an additional deep vein thrombosis is suspected.

treatment

The treatment of varicose veins is not just about relieving the symptoms and treating any bleeding and inflammation. It is also important to prevent the disease from spreading to the deep venous system.

However, the varicose veins cannot be cured because no effective medication is available. This leaves only the options of eliminating the varicose veins through an operation or supporting the normal blood flow in the varicose veins through permanent pressure (compression) from the outside. In addition, the patient can use some basic measures (see below) to strengthen his veins and stop the disease from progressing.

Compression treatment

For the Compression treatment there are stockings in compression classes I (light) to IV (very strong compression). Support stockings correspond to compression class I, they are an aid for heavy, tired legs and poorly developed varicose veins. In the case of advanced varicose veins with a tendency to swell, compression stockings of compression class II are required to prevent the blood from flowing back through leaky venous valves. This prevents the progression of varicose veins as well as inflammation, bleeding and open skin areas. Even after a vein operation, the continued success of the operation is supported by wearing compression stockings. Compression stockings of compression classes III and IV are only necessary in exceptional cases with severe chronic venous insufficiency.

Treatment of bleeding varicose veins

If a varicose vein begins to bleed (variceal rupture, venous rupture), there is a risk of significant blood loss. The person concerned has to put their leg up and squeeze the bleeding vein with a pad until the bleeding stops. A subsequent pressure bandage prevents rebleeding. It must be renewed regularly until the wound has healed. If varicose veins bleed, it is time to discuss with your doctor whether surgery or obliteration of the vein is appropriate.

Operative treatment

Surgical measures can eliminate varicose veins or close them permanently. The doctor treats small varicose veins with laser therapy or Desolation (Sclerotherapy). In this case, the inner wall of the vessel is destroyed by heat or vein sclerosing agent injected into the vein, thus provoking an artificial inflammation. The vein closes and a connective tissue remodeling follows. Unfortunately, this method does not lead to long-term success with larger veins. It is also associated with the risk that the sclerosing agent will flow into the deep venous system and trigger a thrombosis there. In this case, the enlarged veins are better partially or completely surgically removed (stripping) and the perforating veins are tied off so that no more blood can get from the deep into the superficial venous system.

Stripping

The most common surgery done to remove varicose veins is that Stripping, in which the vascular surgeon pulls out the affected sections of the damaged vein. This procedure is usually carried out on an outpatient basis and under local anesthesia and takes 30 minutes to 1 hour. If the varicose veins are not just a cosmetic problem, the health insurance companies will cover the costs for their removal.

At the beginning of the procedure, the surgeon ties off the vein above the damaged area near the junction between the superficial and deep leg veins. This point is in the groin on the thigh and in the hollow of the knee on the lower leg. He then cuts through the vessel below the varicose vein.

To pull the vessel out of the leg, he now pushes a wire with a probe through the loosened section from below. Once at the top, he attaches a metal button to the end of the classic stripping and then pulls the probe and the vein out of the leg. In the past few years, a large number of gentler procedures have been developed in which mostly smaller incisions and improved probes are used. In invaginating mini-stripping, for example, the upper section of the vein is tied to the probe head so that the vein turns inward when it is pulled out, and a particularly fine probe is used in pin-stripping. Cryo-stripping is a very gentle process. The doctor uses a cold probe to freeze the affected piece of vein.

The surgeon leaves healthy vein segments in place so that material is still available for any later bypass operation. Finally, he knots the now functionless or also affected perforating veins (they are - medically speaking - tied).

After the operation

Despite all caution, stripping always damages small side branches of the vein, lymph vessels and fine nerve fibers. Large bruises often form as well. Exercise therapy, which makes a decisive contribution to healing, begins the day after the operation. The patient remains on sick leave for the first 1-2 weeks after the operation. To accelerate healing and prevent bleeding, he must also wear class II compression stockings for about 3 months.

forecast

After surgery, varicose veins develop again in ~ 5% of cases. One of the reasons for this is that the congenital predisposition to the formation of varicose veins persists.

Your pharmacy recommends

What you can do yourself

Footwear. Wear flat, comfortable shoes that allow the natural rolling motion when walking and thereby activate the muscle vein pump. Wear insoles and orthopedic aids if you have arches splayfoot. Prefer open-toe shoes and sandals that let air into your feet. You should change lined winter shoes at work, because they too promote heavy legs in the evening.

Training. In addition to compression treatment (self-help tips can be found under chronic venous insufficiency), a lot of movement and little sitting or standing is good for the veins. Take time for daily vein gymnastics, for example, 10 minutes by putting your legs up against the wall, lifting, lowering and clawing your toes, circling and rocking your toes, alternating toe and heel stand while standing. Many of these exercises are also possible during the day while at work or while sitting at a desk. It is unfavorable to cross or let the legs dangle and to exert a great deal of force with high pressure, e.g. B. heavy lifting. Take every opportunity to put your legs up. If you have to sit for a long time (long-haul flight, long journeys by car, etc.), use the muscle pump again and again (pull toes to your nose, bob on your heels) or if possible take a few steps in between. Activities such as running, hiking, swimming, cycling, dancing, and cross-country skiing are inexpensive. Veins depend on well-trained leg muscles.

Sleep. With nightly calf cramps, the targeted withdrawal of heat often works wonders. In winter, it is sometimes enough to lay the duvets sideways so that the legs are open (if your toes are cold, socks can help). In midsummer, a wet bath towel that has been wrung out again and placed on the mattress at lower leg height helps. A short cold shower in the legs can also stop leg cramps, as can a glass of mineral water containing magnesium.

Complementary medicine

Kneipp treatments: Kneipp treading water and alternating showers of the legs with cold and warm water from the foot to the groin alleviate the discomfort, with cold water at the end. Then rub your feet and legs with a skin care cream.

Heat is poison for the veins. Avoid solariums, sunbathing, hot full baths and tropical heat. You don't have to go without a sauna if you don't forget your legs during the cold phases after the sauna - cold showers are good for the veins, and many people also find ice-cold footbaths that last for minutes refreshing. Alternatively, you can try foot change baths. Fill one vat with very cold water and one with as hot as possible. Place your feet alternately in a tub. You should always put your feet up in the sauna.

Herbal medicine. Horse chestnut seed extracts of the over-the-counter vein remedies were able to show a certain effect on complaints of leg vein diseases in studies. Daily doses of 200 mg aescin (about 300 mg extract in retarded form) were examined. It is important, however, that plant medicine is only one additional Represents treatment and must in no way replace basic therapy with movement and compression.

Further information

  • www.venenliga.de - website of the Deutsche Venen-Liga e. V., Bad Bertrich: Comprehensive information and help on venous disorders.
  • H. Höfer: Healthy veins, beautiful legs. The vascular training for everyday life. Recommended by the German Vein League. Schlütersche, 2015.
  • E. Mendoza: Guide to varicose veins, leg swelling, thrombosis. Springer, 2016.

Authors

Dr. med. Dieter Simon, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 20:18


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.