Varicose veins: Diagnosis and treatment

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

Stripping procedure

Open crossectomy has been considered the gold standard of phlebology for over 100 years and is paid for 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 the junction with the deep vein, separated and torn out. Since the legs have to be wrapped for several weeks, the treatment is only advisable in the winter months. Bruising, infections, sensitive nerve damage or thrombosis may occur.

Endoluminal procedures

In endoluminal procedures, the varicose vein wall is damaged from the inside by delivering energy to the vessel wall, whereupon the varicose vein closes. The aim is for the treated vein to be broken down by the body. The energy can be delivered by radiofrequency (radiofrequency ablation RFA such as Venefit®), laser (endovenous laser ablation ELVT) or steam (endovenous steam ablation EVSA).

The Venefit^® (VNUS ClosureFast) RFA method RFA procedure is a minimally invasive varicose vein therapy. The treatment can be performed on an outpatient basis under local anesthesia and has a lower risk of infection. With the help of a highly precisely placed radiofrequency catheter, the broken truncal vein is treated. Only a very small incision is necessary. Under ultrasound guidance, the vein is then heated to approximately 120 degrees and sealed with a high-frequency current (radiofrequency). As a result, it breaks down completely. Work and sports are then possible without any problems.

Endovenous laser ablation (ELVT) is similar in procedure to radiofrequency therapy. Different lasers with a wavelength of 810 to 1470 nm are used for EVLT. This results in average temperatures of up to 700 degrees C. In endovenous steam ablation (EVSA), the vein is closed with steam. A catheter delivers the steam at temperatures of up to 120 degrees in two directions.

Sclerotherapy

As in the treatment of spider veins, ethoxysclerol is injected into the vessels to be treated for the sclerotherapy of varicose veins. However, it involves larger veins and correspondingly higher concentrations. Sclerotherapy is performed on an outpatient basis and does not require anesthesia. However, since occlusion rates tend to be low, the method is only used when the procedures described above are not possible.

Learn more:
Venefit^®: The most modern treatment