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Varicose Veins

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 system.  
Click: Varicose Veins
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 veins!).

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:

Click: Varicose Veins Surgery 1
Click: Varicose Veins Surgery 2
Click: Varicose Veins Surgery 3
Click: Varicose Veins Surgery 4
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 adhesive tape
4.) Preliminary result after 14 days

Complications of varicose veins

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