FAQ varicose veins & spider veins

"What causes varicose veins?" or
"Do varicose veins always require an operation?"
You can find the answer to this and other questions here.


Do patients with varicose veins have muscle cramps more frequently?

Das Wort „Krampfader“ stammt aus dem Altdeutschen „Krumpe Ader“, also krumme Ader, und beschreibt lediglich den von aussen sichtbaren Venenverlauf einer erkrankten Vene.

Sometimes patients with varicose veins complain of increased calf cramps, but these are not due to the varicose veins.

What causes varicose veins?

Veins are soft structures and are mainly made from connective tissue. If a familial weakness of the connective tissue is present, veins can expand and deform. The sealing capacity of the venous valves reduces over time and can result in a retention of blood in the veins.

Is prolonged standing the cause of my varicose veins?

The main cause for the development of varicose veins is a genetic, familial disposition. Naturally there are certain risk factors that favour the development of varicose veins. These are excessive weight, or activities that involve prolonged standing or sitting and a lack of movement.

Where does the blood flow if a diseased vein is removed?

The healthy veins, especially the deep veins that are protected by the muscle layer, take over this task. Sometimes a mild swelling remains temporarily after treatment until the return flow has normalised.

Don't varicose veins always return after treatment?

The disposition as a cause of the development of varicose veins cannot be treated. There is a risk of approximately 25-30 % that patients who undergo treatment will develop new varicose veins over time, independent of the treatment method.

I am pregnant and I have varicose veins, is this dangerous?

New varicose veins can develop during pregnancy or existing varicose veins can increase in magnitude. In particular, symptoms such as a feeling of heaviness increase in the last trimester. Compression stockings should be worn during pregnancy, especially as treatment is only allowed in the case of complications. A majority of varicose veins due to pregnancy recede after approximately 4-6 months after childbirth. However, examination by a specialist doctor should always be undertaken.

I have varicose veins and must undertake a long journey by air, what should I bear in mind?

Patients with healthy veins that undergo a long journey by air or road have a slightly increased risk of thomboses. This risk is additionally increased in the case of varicose veins, so a suitable compression stocking should always be worn. A corresponding anti-thrombosis prophylaxis must even be considered (haemodilution) in certain cases.

I have varicose veins and take haemodilution medication, is this dangerous?

The haemodilution protects from thromboses and is indicated in the case of many other disorders (artificial heart valves, stents, auricular fibrillation, etc.). If large varicose veins are visible under the skin and if one injures oneself in such a place, heavy bleeding can occur. Immediate compression (towel, belt) can reduce bleeding but cannot usually stop it. After the bleeding has undergone medical treatment the varicose veins should be examined and treated by a specialist.

Today, many treatments can be performed on an outpatient basis without having to interrupt haemodilution.

I have varicose veins but no symptoms. Do I still need to consult a doctor?

Varicose veins do not always cause symptoms and cannot always be seen from outside. The so-called "saphenous veins" that extend between the muscle layer and the skin can exhibit a backflow due to failure of the valves to seal, and can hence represent a risk of complications without necessarily causing symptoms. An ultrasonic examination will rapidly provide clarification.

Must one abstain from power training if one already has varicose veins?

No, negative consequences are not to be expected if heavy breathing is avoided and training is undertaken with low weights. Nevertheless, the varicose veins should be examined by a specialist doctor.

How long does a consultation take?

Clinical examination of the legs plus duplex sonography and subsequent consultancy usually takes 30-45 minutes. Ultrasonic examination is absolutely painless and the costs are borne by the basic insurance provider. More time is usually reserved for specific issues.

Who bears the costs?

The costs of initial consultancy, medically required treatments and follow-up examinations are borne by the healthcare insurance provider in Switzerland. Cosmetic treatments without relevant pathological significance such as e.g. sclerotherapy of spider veins are not reimbursed.

What does the doctor look for during the ultrasonic treatment?

Ultrasound is used to detect and document diameter, venous trajectory, valve function, direction of bloodflow, wall changes and flow disturbances in the venous system. Substantially, healthy veins are differentiated from diseased veins in this way. In addition, ultrasound can be used to safely and painlessly check vein sealing (thromboses), genetically-predisposed anomalies and results of treatment.

Can compression stockings eliminate varicose veins?

Compression stockings do not eliminate existing varicose veins, nor can they influence the genetic predisposition for development of varicose veins. However, compression treatment can temporarily normalise the backflow of blood and reduce congestion so that symptoms such as a feeling of heaviness and swelling are significantly reduced.


Classical operation or endovenous procedure, which is better?

Both methods have proven their worth in the treatment of varicose veins, and demonstrably lead to normalisation of the backflow. An operation removes the diseased vein but requires the patient to be under full or local anaesthetic and to undergo skin incision; the recovery phase usually lasts about 7-10 days. Endovenous thermal ablation seals the vein and disables it without requiring its removal. The treatment takes place on an outpatient basis under local anaesthetic, this usually only requires small needle pricks and the patient can resume their normal activities more quickly.

Is sclerotherapy painful?

Both the sclerotherapy of spider veins and foam sclerotherapy of larger veins cause a slight burning sensation that abates again within a few minutes. In sensitive areas, for example the inner ankle or the hollow of the knee, and anaesthetic cream (Emla cream) can be applied beforehand.

Is it true that spider veins never go away or rapidly return?

The results after spider vein sclerotherapy are usually good. However, there are also findings where several treatments are required or where the patient even proves to be resistant to therapy. The often-heard statement, according to which treated spider veins "always come back", is incorrect. But naturally, if affected individuals have a disposition for the development of such results they will remain.

What must I bear in mind after spider vein treatment?

Sclerotherapy of spider veins causes local reddening and sometimes minor bruising. The treated skin area will be sensitive for a few days and should be protected from direct sunlight. Bathing and showering can be undertaken directly after therapy, sport and normal physical activity are not restricted. Special compression is only necessary in exceptional cases.

What complications are there after spider vein sclerotherapy?

Complications are very rare. An undesired effect, especially after foam sclerotherapy, is the occurrence of unsightly discoloration – so-called pigmentation marks. These occur in 15-20 % of patients and spontaneously disappear after several months. In general, the cosmetic effect of the treatment can be seen 6-8 weeks after sclerotherapy.

Can heavily-twisted veins also be treated with thermal ablation?

Endovenous thermal ablation is intended for insufficient saphenous veins. These usually extend in very straight lines. Superficial, twisted lateral branch varices cannot be treated using a heated catheter and are generally removed using a fine hook.

Does thermal ablation also work with heavily enlarged saphenous veins?

Yes. Even very large veins can be successfully and permanently sealed using endovenous thermal ablation.

Is there a risk of skin burning with thermal ablation?

With the endovenous procedure, sterile saline solution is injected with ultrasound guidance around the vein from the outside (tumescence anaesthesia). This insulating liquid layer is sufficient to distribute the heat emanated by the catheter to just the venous wall and not to the skin. This type of complication is an absolute rarity.

Why do some alternative procedures not require local anaesthetic?

Wherever heat leads to the sealing of diseased veins, an insulating, protective liquid layer must first be applied. This so-called tumescence anaesthesia is not required if veins are adhered (VenaSeal® Sapheon Closure System) or atrophied using foam.

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