Varicose veins

What are varicose veins?

Varicose veins (medical terms: varices, varicosis, or varicosity) are distended veins that appear, above all on the legs, as convoluted swellings that sometimes protrude as knot-like bulges on the surface of the skin.

Symptoms of varicose veins

Varicose veins are easily visible and palpable. In contrast to the mostly harmless spider veins, varicose veins can cause massive symptoms. Furthermore, they are often a sign of deeper-lying venous disease.

• Tired legs
• Heavy legs
• Swollen legs
• Night leg cramps

People with varicose veins suffer from tired and heavy legs, mostly at night after standing or sitting all day, but also in hot weather. The ankles may also be swollen in the evenings, because water has collected in the tissues. You can relieve these symptoms by moving around or lying down. Many of those affected also suffer from calf cramp at night.

How varicose veins develop

Varicose veins develop when the veins widen and the venous valves can thus no longer close properly. Doctors call this valve regurgitation. The blood flows back to the heart too slowly, pools in the veins and gradually dilates them. Varicose veins are not only signs of aging, as they can also occur at a younger age in genetically predisposed individuals. In addition to this, risk factors include an occupation that involves standing, overweight (obesity), and heart disease. Varicose veins can also form during pregnancy.

Diagnosing varicose veins

For an exact diagnosis, the doctor examines the extent of the venous insufficiency and checks whether deeper-lying veins are jointly responsible for the varicose veins. The following medical procedures are used in the diagnostic investigation of varicose veins:

• Duplex ultrasonography (link to duplex examination)
• Ultrasonography (link to ultrasonography)
• Doppler sonography (link to Doppler sonography)

What happens if varicose veins are left untreated?

If left untreated, severe varicosity (varicose veins) can cause grave risks to health. Chronic venous insufficiency leads to growing disorders of the blood circulation and causes

• Skin changes
• Eczema
• Painful venous ulcers
• Open venous leg ulcers (ulcus cruris)

If the disease progresses further, the varicose veins may become inflamed and blood clots can form (thromboses) that may ultimately lead to a pulmonary embolism.

How are varicose veins treated?

Medical compression stockings are the disease-modifying form of treatment for varicose veins. These exert mechanical pressure on the veins, which reduces the venous diameter and allows the blood to flow more quickly. Thanks to the pressure gradient that diminishes from the ankle upwards, the blood no longer pools in the legs.

Preventive measures

You can most effectively prevent varicose veins and other venous diseases by consistently wearing medical compression garments with mild compression (e.g. compression class 1).

If you do not yet have venous disease (medical indication), you must pay the cost of the compression stockings yourself. However, this investment in your health is worth every penny, particularly since compression garments last at least six months if they are cared for properly. Your doctor can prescribe medical compression garments for you up to twice a year if they are medically necessary.

Wearing preventive compression stockings is recommended if ...

• You have hereditary lax connective tissue. This is often the case if varicose veins and other venous diseases are found in your close relatives.
• You have a job that regularly involves long periods of sitting, standing or squatting. The joint and muscle pumps can only function 100% during movement and the veins are pumped empty by muscle activity.
• You suffer from chronic constipation. The pressure on the abdominal cavity increases, this puts an added burden on the veins.
• You regularly drink (a lot of) alcohol. Alcohol acts to widen the veins.
• You are pregnant or have just given birth, or you are taking the pill or a hormone preparation for the menopause. Hormonal changes favour varicose veins.
• You have to sit or stand for long periods in special situations – for example, on long journeys (especially in aeroplanes) or when working at trade fairs. In these circumstances, even people with healthy veins are recommended to wear special (below-)knee compression socks or stockings.

Tips for everyday living

• Get as much exercise as possible. Change position more often – put your legs up every now and again.
• Stick to a light, balanced diet.
• Lose any excess weight.
• Wear loose, comfortable clothes.
• Choose comfortable flat shoes.
• Shower your feet regularly with cold water. Hot and cold showers strengthen the connective tissues.
• Plan regular 10 minute sessions of vein exercises into your daily routine.
• Wear insoles if you have flat feet or splayfoot.
• Wear medical compression stockings or socks.

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