Varicose veins - merely a cosmetic problem Dr. Debertshäuser?

The fact is that, no matter what sort of varicose veins you have and how many, they are always caused by the same malfunction in the superficial veins on the legs. Valves that normally prevent blood that is on its way back to the heart from flowing back into the legs do not close properly. The blood then becomes trapped in the veins under the skin. These may swell up to the thickness of a thumb and appear as varicose veins. In its less serious form, only the superficial veins under the skin are affected and these are called spider veins.

Only spider veins and isolated varicose veins can be seen as a purely cosmetic problem, provided the main valves function properly and only when all the valves have been checked in an ultrasound examination. A phlebography using a contrast dye is generally no longer necessary.

All other types of varicose veins involve a malfunctioning of the main valves in the groin and  after a number of years, if not treated, frequently result in swellings, pain and discomfort after standing for a long time, infections and even badly healing open wounds on the lower legs.

The first and foremost step is to do an ultrasound examination to investigate exactly how the blood flow and valves in the legs function, so that the necessary and appropriate measures can be discussed with the patient.

In principle, virtually all varicose veins can be treated without surgery. However this would involve wearing a compression stocking permanently, which is an unreasonable expectation of anyone, especially in summer.  And because, understandably, hardly anyone manages to do this over a number of decades, the basic complaint progresses with all the consequences.

There are many products on the market to treat varicose veins, in tablet and cream form, but unfortunately none of them have proven to be very effective.

In the end the only alternatives are sclerosis or surgery, whereby the two methods are not mutually exclusive but may complement one another.

Sclerosis, in which the vein walls are stuck together, is only possible on spider veins and isolated varicose veins, provided the main valves are still in tact, or after an operation if smaller varicose veins reappear.

Surgical methods of treatment, which may all be performed under general, partial or local anaesthesia, depending on the overall picture, include stripping using the Babcock method, microsurgical phlebextraction according to Varady, the CHIVA method which targets specific veins, and the minimally invasive endoscopic dissection of perforating veins.

With stripping, the largest superficial leg vein is threaded onto a special probe and pulled out. In phlebextraction the lateral branches under the skin are mobilised and removed.

With the CHIVA method, varicose veins are interrupted at strategic points, which are determined and marked in very exact ultrasound examinations, so that the blood flow can continue on its normal course back to the heart via other intact veins. The damaged veins are not removed. After correction and regular wearing of compression stockings they should be able to be reduced to normal size.

The endoscopic method is only used when the connecting valves between the superficial and deep vein system in the lower leg are no longer in tact. In such cases patients often have open leg ulcers (ulcus cruris). With this method, too, the damaged veins are interrupted and the ulcer usually heals very quickly.

All the surgical methods are done with tiny incisions so that often stitches are not required. This is ideal from a cosmetic point of view and also means that no stitches have to be removed.

Even if the cosmetic effect of the surgery is basically of secondary importance, it is nevertheless important for the quality of life of patients.