Basically persons affected by varicose veins establish
the correct diagnosis by themselves. My task is to identify the type of
varicosity by means of ultrasound and to determine the exact location,
i.e. the upper point of insufficiency in the vein. Most frequently it
is at the groin. However, quite often the varicose vein may start in
the popliteal fossa (the inner aspect of the knee). Another unusual
site of origin is the posterior portion of the thigh – one finds a
rather impressive collection of varicose veins at this site.
If you have varicose veins - what examination should
you undergo before you come to my office?
To put it quite simply, you don’t need to undergo any
examination before you come to my office. Particularly an X-ray
investigation with contrast medium is unnecessary because the
ultrasound examination provides all the information the doctor needs.
An X-ray investigation gives no significant additional information. An
X-ray examination of the leg veins, also known as a phlebography,
should only be used to answer very rare and specific questions. One
example would be a patient who is unwell for a few days after
undergoing surgery in the abdomen or hip, and a suspected deep vein
thrombosis of the leg has to be confirmed or disproved.
What exactly are varicose veins?
"Enlarged skin veins in the legs" is by no means a
comprehensive definition, although the description is correct. What
makes a skin vein in the leg a real varicose vein is the so-called
reflux, the reversal of blood flow. Blood in a varicose vein no longer
flows upward to the heart and the lung but downward back to the leg.
The valves of the vein, which serve as flap valves, start to leak.
Currently nobody knows exactly why this happens.
|Failure of the first venous valves creates a
domino effect: increasing quantities of blood flow out of the main vein
(which is located approximately in the middle of a cross-section of the
leg) into the diseased skin vein, extend the vein in a stepwise manner
from above to below, and cause an increasing number of vein valves to
become ineffective. A dripping tap develops into a strong, flowing
cascade of venous blood which, in advanced stages, accumulates in the
region of the ankle because it does not easily reach the deep vein
|Note: No type of
varicosity remains static. It always progresses and deteriorates slowly
from one year to the next. Occasionally it may worsen in a drastic way.
The number of varicose branches of the vein may increase rapidly and
the symptoms may appear within a short period of a few weeks.
A great deal has been written about the causes of
varicose veins. Weakness of the connective tissue, which is frequently
mentioned as a cause, is no more than a catchphrase. It does not
explain anything. A genetic predisposition in the female line appears
to be a definite aspect of this condition. Nearly always it is the
mother who suffered from varicosity; occasionally it may be the
grandmother. Exceptions are rare. (Hence, a person whose mother never
had varicose veins may pursue the profession of a waiter/waitress or a
hairdresser with no qualms and need not worry about developing varicose
Obesity, which is often held responsible for varicose
veins, is not always the villain of the piece. One finds the largest
varicose veins in slim men.
Varicose veins may be regarded as escape routes for
venous blood on its way from the legs back to the heart. Blood may
escape sideways at any level and then flow downward in the leg. In
medical language this is known as a venous reflux. By far the most
frequent phenomenon is an escape route downward along the leg through
the two largest skin veins, i.e. from the groin towards the inner
malleolus (ankle) and from the popliteal fossa (the hollow of the knee)
to the outer malleolus. These two escape routes are eliminated by the
operation: venous blood bypasses the previous leakage sites and travels
upward, reaching the heart with no loss of blood. More importantly, no
further gush of blood exerts pressure on the lower portions of the
legs. Thus, the most frequent question becomes redundant: what takes
over the functions of the removed varicosities? If I lose increasing
quantities of water through an ever-increasing hole in an irrigation
canal and am then able to seal it off, I don’t worry. Rather, I
am glad my flower beds are being cared for as I wished them to be.
|Note: Removal of
varicose veins - as radical as possible - is
always for the benefit of the circulation in the leg. Worries about the
need for substitutes are unfounded.
Elimination of varicose veins by surgery:
1.) The initial examination
2.) The varicose veins are marked
before the operation
3.) The varicose veins are
removed by small incisions. The tiny sites of operation are closed with
4.) Preliminary result after 14