Treatment of varicose veins in Vienna

Varicose veins, also known as varices, are enlarged and dilated superficial veins primarily found in the legs. They occur when vein valves fail to efficiently transport blood to the heart, leading to blood accumulation in the veins and their subsequent expansion. Approximately three out of five Austrians experience varicose veins, with women being up to three times more affected than men. While they are often identified as blueish, winding lines or bulges beneath the skin, untreated or advanced varicose veins can pose significant health concerns.

Fortunately, nowadays we no longer need to tolerate varicose veins and the discomfort they bring. Thanks to modern advancements, varicose veins can be treated effectively and painlessly.

One of the main causes of varicose veins is the weakness of vein walls and valves. Vein valves are structural components of the veins that normally allow blood flow towards the heart and prevent backflows. When these valves don't function properly, blood can flow backward, increasing pressure in the veins, which in turn leads to their expansion and deformation. 

Gravity also plays an important role. Prolonged standing or sitting without sufficient movement can impair the blood flow in the legs, leading to increased pressure in the veins. This increased pressure can strain the vein walls and contribute to their expansion and the formation of varicose veins. 

Additionally, hormonal changes during pregnancy or the use of hormonal contraceptives can increase the risk of varicose veins. Genetic predisposition also plays a role, as certain individuals may be more susceptible to varicose veins due to their family history. Also, the natural aging process of the veins, obesity, and lack of exercise contribute to an increased likelihood of developing varicose veins.

Varicose veins are a common condition that can affect individuals of all ages and lifestyles, although they tend to be more prevalent among older adults. Women are particularly susceptible to developing varicose veins due to hormonal changes during pregnancy and menstrual cycles. Those with a family history of varicose veins or other venous disorders also face an increased risk.

Moreover, individuals who spend long hours standing or sitting, such as professionals in occupations like teaching, hairstyling, or retail, are at a heightened risk. Additionally, factors such as obesity, lack of physical activity, and other health issues that compromise blood flow can further elevate the likelihood of developing varicose veins.

Varicose veins are predominantly found in the legs, with studies indicating that signs of this venous condition can be observed in a significant portion of the population aged 18-64 years. Visible varicose veins in the legs are much more prevalent in women, affecting 20-25% of them, compared to men, where the prevalence is around 10-15%.

In my clinic, we offer various treatment options for varicose veins that often can circumvent the need for surgery. These include endothermal ablation methods such as laser or radiofrequency treatments using a catheter, foam sclerotherapy, the application of "glue," or surgical stripping. 

While varicose veins are commonly associated with twisted and bulging veins in the legs, they can theoretically occur anywhere in the body, although rarely. It's important to note that varicose veins are not confined solely to the legs, although they are most frequently observed in this region.

Varicose veins pose significant health risks, with potential negative consequences across various aspects of health. In the skin, they can disrupt proper nutrition, leading to discoloration and thickening, often appearing as a brownish hue. In more advanced stages, this can escalate to serious complications such as leg ulcers or the development of venous stasis ulcers.

Additionally, the altered blood flow within varicose veins can provoke inflammation in nearby superficial veins, a condition known as varicophlebitis. This is characterized by notable warmth, redness, and tenderness around the affected vein.

There also exists a risk of varicose vein rupture, particularly following injury, which can result in significant bleeding. In such instances, immediate intervention is necessary. A varicose vein rupture should serve as a clear warning to seek treatment for the condition and mitigate the potential for further complications.

In certain instances, more extensive surgical interventions may become necessary, particularly when the venous condition is severe or poses an elevated risk of delayed complications. Surgical treatment for varicose veins offers several options, among which stripping surgery stands out as a well-established method, particularly for addressing saphenous varicose veins. This technique, regarded as the gold standard, was developed by the American surgeon William Wayne Babcock.

During the stripping surgery, I insert a flexible specialized probe into the dilated vein and push it to the end. There, I cut the varicose vein at the top and bottom and fix it to the probe. Then, during the extraction, or stripping, the probe is guided under the skin, removing the affected vein. Subsequently, the affected varicose vein is pulled out. Additionally, smaller varicose veins can be removed through small incisions in the skin, resulting in an overall satisfactory cosmetic outcome. 

Stripping surgery can be performed under various forms of anesthesia, including general anesthesia, local anesthesia, or regional anesthesia, and can be done on an outpatient or inpatient basis, depending on the severity of the condition as well as the patient's status.

In addition to stripping surgery, other less invasive procedures are available for removing varicose veins.

Venaseal Closure System
A relatively new approach is the use of a medical adhesive to close the large saphenous veins in the leg. In this method, the affected area is first locally anesthetized. Then, through an ultrasound-guided puncture of the affected saphenous vein, I insert a catheter. Adhesive is then injected into the vein through this catheter to seal it. The pathologically altered section of the saphenous vein is glued by gradually retracting the catheter. One advantage of this technique is that it does not require compression stockings after the procedure and allows a swift return to regular activities.


Thermal Ablation
Thermal ablation is a minimally invasive treatment method that includes endovenous laser therapy (EVLT) and radiofrequency ablation (RFA). Conducted on an outpatient basis under local anesthesia, these techniques provide an effective alternative to conventional surgery.


Radiofrequency Ablation (RFA)
In radiofrequency ablation, a thin catheter is inserted into the affected vein. This catheter emits radio waves, generating heat that seals the vein from the inside.


Endovenous Laser Therapy (EVLT)
In contrast, endovenous laser therapy (EVLT) uses laser beams to seal the vein from the inside. A catheter containing a laser fiber is inserted into the vein targeted for treatment, and the vein is treated under the guidance of ultrasound.
These minimally invasive procedures offer quick recovery, minimal side effects, and excellent cosmetic results. These procedures can both be performed in a single session to treat both small and large saphenous veins simultaneously. Following the treatment, the treated vein gradually diminishes over time, and patients can typically return home soon afterward.


Foam Sclerotherapy
Foam sclerotherapy, also known as foam sclerotherapy, is a gentle method for treating larger varicose vein branches. In this procedure, I inject a sclerosing foam into the vein to be treated. This foam leads to a shrinking closure of the varicose vein without requiring skin incisions to remove the vein.

After the treatment, I recommend wearing compression stockings for a short period to optimize the treatment outcome. These stockings support healing by controlling pressure on the treated vein and reducing swelling, minimizing the risk of complications and improving the long-term result. Foam sclerotherapy is an effective and gentle method for treating varicose veins and allows for a quick return to normalcy.

After undergoing vein glue treatment, you can typically resume normal activities the day after the procedure. One advantage of this method is that compression stockings are usually unnecessary. For thermal procedures like EVLT or RFA, you can typically return to work and other activities relatively quickly after the procedure. Following sclerotherapy, I recommend wearing compression stockings for a brief period to optimize the treatment's effectiveness.

If varicose veins have been surgically removed, it's recommended to undergo compression therapy using elastic bandages or compression stockings for three to six weeks to prevent swelling. Additionally, a multi-day anticoagulant treatment may be prescribed to prevent thrombosis and embolism.
It's important to take it easy for a while after the treatment. Avoid strenuous physical activities and elevate your legs when possible. If you experience any pain or unusual symptoms, don't hesitate to contact me immediately. Your health is my priority, and I'm always available to help you with any potential complications.

In general, a well-performed treatment for varicose veins carries relatively low-risk. However, there is a chance of varicose veins recurring even after surgery. Moreover, complications such as lymphedema may arise due to potential injury to the lymphatic vessels near the treated veins during the procedure.

Although there are creams, ointments, and medications available over the counter that contain herbal ingredients and heparin, offering some relief from symptoms, they do not offer a permanent cure. Their effectiveness in preventing or treating varicose veins lacks scientific evidence. Hence, they should be regarded solely as supportive measures and must not replace medical treatment.

There are several steps you can take to combat the development of spider veins and varicose veins while supporting your venous system. Engaging in regular exercise like cycling, running, or swimming keeps your leg muscles active and enhances blood circulation. This boosts the muscle pump, vital for maintaining healthy venous return. Alternating between warm and cold showers or leg baths can also aid venous function by promoting circulation. Additionally, participating in venous-friendly sports and targeted leg muscle exercises is advisable.

Maintaining a healthy body weight and consuming a diet rich in fiber further also contributes to venous health. Cutting down on sugar, fats, alcohol, and nicotine helps minimize the risk of varicose veins and other venous conditions. Avoiding high temperatures, whether from sun exposure, hot baths, or sauna sessions, is crucial as they can dilate blood vessels and impede blood flow, heightening the risk of vein issues. If prolonged standing or sitting is unavoidable, compression stockings provide support to the veins and reduce swelling. Elevating your legs regularly can also alleviate strain on the venous system. Choose flat shoes in your daily activities as high heels may impair venous function. Loose-fitting clothing, especially around the legs and ankles, prevents excessive pressure on the veins.

If you notice the initial signs of varicose veins, don’t hesitate to schedule an appointment in my practice. Early intervention facilitates the removal of varicose veins and lowers the risk of complications such as edema or skin ulcers. Your well-being is important to me, and I am here to assist you in preventing and treating vein-related issues at any time.

For varicose veins deemed medically significant and treated with the stripping method, health insurance typically covers the costs. However, for an accurate cost estimate and to address all your inquiries comprehensively, I extend an invitation to a personal consultation.

During our conversation, you'll have the chance to share all your concerns regarding pain. My aim is to collaborate with you in devising an optimal treatment strategy and delivering best possible medical care and treatment. I'll take time to address your concerns and questions and provide support throughout the entire treatment journey.

Say goodbye to your discomfort and take the first step toward effective varicose vein treatment. Schedule an appointment today so we can discuss your situation in more detail.