Around 50 per cent of all adults in Central Europe have dilated and tortuous superficial veins on their legs, some of which are visible and some of which are palpable. The degree of severity ranges from minor changes with at most cosmetic relevance (around half of those affected) to pronounced manifestations with massive skin changes and corresponding medical significance. Around 10 to 15 per cent of the adult population in industrialised nations are likely to be affected. Varicose veins are a venous disorder with malfunctioning venous valves which, if left untreated, can lead to non-healing ulcers ("open legs", venous leg ulcers).
One of the clinic's focal points is the clarification of the causes of wounds and wound healing disorders and their treatment. (Wound outpatient department)

State-of-the-art diagnostic and therapeutic options are available in the vein consultation.

A distinction is made between primary and secondary varicose veins.
Primary varicose veins are caused by venous valve defects due to connective tissue weakness. Older age, a family predisposition, standing work, female gender, multiple pregnancies, obesity and lack of exercise promote the development of primary varicose veins.
Secondary varicose veins develop as a late consequence of deep vein thrombosis.

Superficial truncal varicose veins (V.saphena magna and V.saphena parva)

• Lateral branch varicose veins (anterior and posterior circumflex veins) can park large amounts of venous blood due to valve damage
• Perforating varicose veins connect the superficial venous system with the deep vein system
• Reticular varices (reticular veins) and spider veins are of little functional significance due to their small calibre; they are more of aesthetic importance

In addition to the aesthetic impairment, they can also lead to serious consequential damage, such as phlebitis, deep vein thrombosis with possible pulmonary embolism, open leg (leg ulcer), overloading of the deep vein system with damage to the deep vein valves.

The most common chronic complication is chronicvenous insufficiency (CVI), which develops after many years. The most important characteristics are valve damage to the superficial, deep and connecting veins, but also occlusion of the deep veins and failure of the muscle and joint pump. The CEAP classification provides the most differentiated categorisation of CVI (chronic venous insufficiency), which takes into account anatomical and functional criteria as well as causal criteria.

Our gentle and safe examination methods:

• Bidirectional Doppler sonography (cw-DOPPLER)
• Colour-coded duplex sonography (FKDS)
• Digital photoplethysmography, light reflection rheography (d-PPG, LRR)
• Venous occlusion plethysmography (VVP)
• Venous pressure measurement (PDM)

They enable us to carry out stage-appropriate diagnostics.
The sonographic methods are procedures that work with sound waves of a certain frequency. The blood movements can be visualised acoustically and graphically and the vessels can be measured.
Imaging procedures are particularly necessary before invasive interventions; colour-coded duplex sonography has replaced contrast medium X-ray phlebography as the gold standard in most cases.
Venous occlusion plethysmography is used for the bloodless measurement of volume changes in the veins of the extremities at rest to determine the capacity of the vascular system as well as the venous outflow. Together with photoplethysmographic procedures, it can be used to determine whether a treatment has led to an improvement in the venous circulation situation.
Venous pressure measurement is used to measure the pressure conditions in the legs at rest and after activation of the muscle pump following puncture of a foot vein. This examination is very precise and the chances of success of a planned operation can be better predicted.
In rare cases, phlebography (contrast imaging of the deep vein system) is necessary to complete the findings. Phlebography is also a routine procedure that is not very stressful.

Our surgical procedures are effective, minimally invasive, aesthetic and include

• Crossectomy to close the causative venous valve defect in the groin or popliteal fossa
• Extraction (exhairesis) of the truncal vein with a probe (e.g. Babcock)
• After a stab incision, exposing, stopping and dissecting the diseased perforating veins
• In so-called incision-free surgical procedures, the side branch varicose veins are removed using small stitches and special instruments ("mini surgery", "worming").

Most of these procedures can be performed under local anaesthesia (infiltration or tumescent anaesthesia). In rare cases, general anaesthesia or spinal anaesthesia is used. Tumescent anaesthesia in particular, as a further development of conventional local anaesthesia, can achieve the greatest possible freedom from pain with very little stress for the patient. A low concentration of the local anaesthetic is dissolved in a large volume of fluid, which also reduces the rate of bruising after the operation.
Sclerotherapy (sclerotherapy ) and laser therapy for spider veins (only certain types are suitable) and brush marks (dermatological laser outpatient clinic) are established non-surgical procedures.

Special compression bandages and stockings for leg swelling and open legs are used depending on the degree of swelling.
The dermatology clinic also offers physiotherapy with targeted exercise training and the teaching of a vein-conscious lifestyle.
Depending on the clinical picture, we decide on the gentlest procedure with the best cosmetic result after completing the findings and discussing them in detail with the patient.

Varicose veins can reappear after an operation for various reasons. The following causes can be responsible for this.

At the junction of the small and large superficial trunk veins (popliteal fossa, groin) due to a "forgotten" vein branch during the first operation or due to a very rare new vessel formation (neoangiogenesis). The reappearance of branch varicose veins or perforating veins or spider veins can also occur in the case of connective tissue weakness and a corresponding tendency. Damage to the deep venous valves can also occur later, especially if superficial varicose veins have been present for too long.

*) Source: Chirurgie der Krampfadern by Stritecky-Kähler, Thieme-Verlag 1994