Varicose veins:
Diagnosis and treatment

Today, early treatment of varicose veins is recommended before symptoms occur. Doppler procedures are now mostly used to assess the reflux and detect flow obstructions. Color-coded duplex sonography, an ultrasound examination, has largely replaced phlebography, an X-ray examination with contrast medium. It can be used to precisely localize thromboses or valve leaks.
There are various options for treating the veins: Removal (by classic crossectomy and stripping), closure (with endoluminal procedures) or adhesion (sclerotherapy).

Stripping procedure

Open crossectomy was considered the gold standard of phlebology for over 100 years and is covered by all health insurance companies. Depending on the location of the vein to be treated, an incision is made in the groin or knee. The so-called crosse, the crossing point between superficial and deep veins, is sought. The superficial vein is then cut off as close as possible to where it joins the deep vein, severed and pulled out. As the legs have to be wrapped for several weeks, the treatment is only recommended in the winter months. It can also lead to bruising, infections, sensitive nerve damage or thrombosis.

Endoluminal procedures

In endoluminal procedures, the varicose vein wall is damaged from the inside by delivering energy to the vessel wall, causing the varicose vein to close. The aim is for the treated vein to be broken down by the body. The energy can be applied using a laser (endovenous laser ablation, ELVT) or steam (endovenous vapor ablation, EVSA).

Endovenous laser ablation (ELVT) is comparable to radiofrequency therapy in terms of the procedure. Different lasers with wavelengths from 810 to 1470 nm are used for ELVT. This results in temperatures of up to 700 °C. In endovenous vapor ablation (EVSA), steam is used to close the vein. A catheter releases the steam at temperatures of up to 120 °C in two directions.

Sclerotherapy

As with the treatment of spider veins, ethoxysclerol is also injected into the vessels to be treated for sclerotherapy of varicose veins – however, the veins involved are larger and the concentrations are correspondingly higher. Sclerotherapy is performed on an outpatient basis and does not require anesthesia. However, as the closure rates are rather low, the method is only used if the procedures described above are not possible.

Continue reading:
Vein problems: Options for prevention
Venous medicine

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