Varicose veins

Varicose veins (from Old High German krimpfan, curve '; plural varices, from Latin varix ) are knotty - Advanced (superficial ) veins. The disease in the presence of varicose veins is called in the jargon varicose veins or varicose veins as well.

It relates to the superficial veins of the legs, including their main tribes, the great saphenous vein and saphenous vein.

Classification and frequency

Depending on the emergence of the disease is divided as follows:

• Primary idiopathic varicose veins, caused by genetic susceptibility to venous wall weakness (about 95 % of cases)
• Secondary varicose veins due to other diseases such as deep vein thrombosis, with formation of a bypass circuit on the superficial venous system (about 5 % of cases)

Vein damage is very common to find. According to estimates, a third of the adult population should have unsymptomatische damage in at least one segment of vein. In > 80 % are small varicose veins ( spider veins ) occur and up to 30 % have a varicosis. The disease frequency ( prevalence) increases with age and women are three times more likely than men affected. The first damage may show up with 30 years.

Causes

The cause of idiopathic varicose veins is a congenital vein wall or connective tissue. Play no part sun, heat, crossing your ( interleaving ) of the legs. The blood is transported to the heart by the muscle pump against gravity. In motion, such as the Walking shorten the leg muscles and pump the blood back to the heart. A back flow is prevented by the venous valves.

When the vein walls are weak by assessment, the surrounding tissue little pressure builds up and the movement of the legs is missing, for example through activities that require prolonged standing or sitting, more blood remains in the legs. The veins are stretched until they are so far, that the venous valves no longer close - comparable to a gate with a large frame. At this point it comes to the flow reversal or blow out, called the blood of the gravity flows following the direction of the foot, rather than to the heart. The phenomenon continues over years towards walking away. Faster and faster, as with any leaking flap is more blood in the leg veins. The varicose veins are caused by an outflow of blood through the superficial leg veins that are filled at a varicose vein. The wires themselves are dangerous signs of venous congestion, which point to worse: a chronic venous insufficiency with the symptoms described below.

A secondary varicose veins occurs when the blood in the deep leg veins can not drain away freely. This is caused by a thrombus (blood clot ) or a space-occupying tumor in Ausstrombereich a deep Leitvene. To compensate for the disturbed blood flow, a bypass circuit via the superficial veins that are being broadened developed.

Complications of varicose veins

Varicose veins are not just a " flaw ", but have important clinical significance. With the disease progresses, it comes as a result of problems with drainage of the blood and the resulting increased peripheral venous pressure cause serious damage in the leg, especially in the area of the distal lower leg. The lesion usually manifests itself initially only in discrete and non-specific symptoms, such as ( one side reinforced) leg swelling, heaviness, itching or nocturnal leg cramps. Provide varicose ulcers ( " open leg " ) Scarring of the skin, subcutaneous tissue and fascia ( dermato- lipo- Fascio Sclerosis ) as well as the deposition of hemosiderin in the context of stasis ( stasis dermatitis ), inflammation of the superficial veins ( thrombophlebitis ) to the ulcer then serious, some not repairable diseases, already constitute the risk of thrombosis with subsequent pulmonary embolism is relatively low. In old age, the advanced skin damage often leads to life-threatening variceal bleeding after minor injury.

Symptoms

Varicose veins do often initially only with a discrete voltage or heaviness in the legs felt - leg flat storage helps then equal. Also itching of the skin over a larger varicose veins and nocturnal leg cramps may occur. During warm weather, because of the increased arterial blood inflow at comparatively worse efflux in an upright posture, the complaints usually worse (typically not in the beach holiday ). Women complain of different clinical pictures in the course of their monthly cycle. In the advanced stage, the thickened veins are characterized in its typical wavy and branching form from through the skin. Water is stored in the tissues, and there are edema. The skin may turn brown and parchment-like harden, occasionally there is a fungal infection of the skin ( tinea pedis), or toenails (onychomycosis ), whose relationship is misunderstood by many varicosities. Rarely prepare varicose veins localized pain, even though they are already very advanced and complications may be prone - so many patients come too late in the medical consultation.

Depending on which veins are affected in the legs, to distinguish different forms:

• Varicosis: dysfunction of the large and the small superficial saphenous vein ( great saphenous vein, vena saphena parva )
• Seitenastvarikose: dysfunctional side branches of the great saphenous veins
• Perforansvarikose: dysfunctional connecting veins between the superficial and deep venous system
• Reticular varicose veins: dysfunctional small veins just beneath the skin (1-3 mm diameter)
• Spider veins varicose veins: dysfunctional smallest veins in the skin

Diagnostics

Noninvasive color-coded duplex sonography is preferred phlebography in the context of imaging techniques, it is now the gold standard. More applied research methods form hemodynamic processes such as

• Photoplethysmography (PPG ) and light reflection rheography ( LRR)
• Venous occlusion plethysmography ( VOP )
• Phlebodynamometry (PD )

The main requirement of surgical rehabilitation of varicose veins is the proven consistency and functionality of the deep venous system.

Therapy

The focus of the therapy today are minimally invasive surgical procedures, and between methods of ligation, removal and sclerotherapy ( bonding ) can be distinguished from veins.

Surgical therapies such as "stripping " - the " pull " of the varicose vein - including crossectomy are the world's still most widely used forms of therapy. However, there is now much gentler instruments as a few years ago. The affected veins are removed surgically. When cryostripping the distance with the help of a cold probe is done. This method is, however, very little spread.

In endovenous laser treatment, radiofrequency endovenous and sclerotherapy the inner lining of the affected veins ( the endothelium ) thermally or chemically damaged, so that the blood flow is prevented. The veins themselves are not removed. There are three basic methods substantially. Once the endoluminal procedure with laser (there are several providers, all working with a similar system ), and then the so-called VNUS Closure Fast procedure in which a tube-like filament into the vein is heated with electricity and thus in direct contact the vein walls thermally damaged. The third method is the Celon FITT radio frequency method ( RFITT = radiofrequency -induced thermal therapy). This radio -frequency energy is coupled into the vein walls, which, in other words the varicose vein leads directly there to the desolation, the welding and the permanent closure of the abnormal vein.

In the less common CHIVA method veins are tied off targeted at individual points, so that those responsible for the varicose abnormal returns are avoided. Pre-existing varicose veins can be so formed back within a few weeks.

Ideally, several or all of the above procedures are in specialized facilities offered to send a possible tailored to his form of varicose ideal therapy to the patient, because not every method can be applied in any patient in the same way.

With the exception of operative technique ( stripping ) is in all treatment methods today wearing compression stockings only a few days to a few weeks necessary. Mainly responsible for the minimum vulnerability and the selectivity of the individual techniques, in which case the shortest times of 2-3 days to a few weeks be achieved in the RFITT radiofrequency procedures in the endovenous laser therapy.

Preventive and soothing effect, the use of compression or support stockings and medication. From Naturopathy cold water showers Kneipp, various ointments, teas and envelopes are known, for example. The leech therapy can be used when clots have formed in superficial veins, the causes of varicose veins may be unable, however, be eliminated.