What are varices and which is their origin?
The main function of the veins in the circulation (of the blood), is to collect the nutrient- and oxygen-poor blood within peripheral organs like muscle, skin and bones and to transport it back to the heart. Starting at the heart, the oxygen-rich blood is being led through the arteries. The veins within the arms and legs are divided into the deep and the superficial system. The extension of a superficial vein, mainly within the legs, is called a varicose vein. The technical term for varicose veins is varices (sing. varix) and the disease varicosis.
Which kinds of varicosis exist?
Main trunk varicosis: In this form one of the so called saphenous veins is affected. There is a division between the vena saphena magna (GSV, greater saphenous vein) on the inner front side of the thigh and the vena saphena parva (LSV, lesser saphenous vein) at the back side of the lower leg. The GSV leads into the deep vein in the area of the groin, whereas through the LSV the blood flows into the deep veins above the popliteal space. At the mouth of the superficial veins are located valves, which in case of a main trunc varicosis often are not functional.
Side branches varicosis: superficial side branches bound out from the saphenous veins. It often appears in a combination with the main trunk varices.
Idiopathic telangiectases varix / reticular varix: Is a matter of minor veins within the skin. This form of the disease is only of cosmetic relevance, but may hint to an invisible main trunk varicosis.
Insufficiency of the perforating veins: perforating veins are the connecting veins between the superficial and the deep vein-system. By means of their valves, those veins usually transport the blood from the surface into the deep vein-system. An extension of the vein leads to a disorder of the valves and thereby to inversion of the blood flow from the depth into the surface, what may in turn leads to a so called distal main trunk varicosis.
What kind of complaints and complications may appear?
Varicose veins often do not cause any complaints or even pain. Though a varix may cause tumidity of the legs, which becomes noticeable by feelings of tension, the feeling of heavy legs or muscle cramps. Superficial varicose veins may bleed heavily in case of injuries. In most cases can these bleeding be stopped by applying local pressure. Varicose veins tend to inflammations, which can be extremely painful. A phlebitis often appears in connection with clot formations. (superficial venous thrombosis). The clot formation may continue from the superficial veins into the deeper ones and lead to thrombosis of the deep veins. It is possible that, the clot formation if it becomes detached wanders to the lung and causes a pulmonary embolism, which might lead to death. The yearly amount of deadly pulmonary embolisms in Germany has an expected total about 30.000 and is thereby on place three in the statistics of causes of death. A long time existing varicosis can lead to a chronic vein insufficiency, which in an advanced stage manifests itself through wounds (ulcers) at the lower leg. 140 000 Austrians do have an ulcerated leg, mostly after undergone thrombosis..
Which forms of therapy do exist?
Sclerotherapy / foam sclerotherapy: This method is suitable in case of side branch varices- and spider veins and with remaining varices after an operation. It is of low risk and almost does not strain the patient. A main trunk varicosis may also be treated by foam sclerotherapy, however the recurrences are in this case higher than with the other methods. An artificial inflammation of the vein is caused by injecting a sclerotisation- agent into the varix. The efficiency of the method is increased by blending the sclerotisation-agent with foam.
Operation: The traditional method of treatment of main trunk varicosis a is the crossectomy (ligature and transection of the diseased vein, as well as all side branches at the entrance to the deep vein) and the stripping (removal of the diseased vein, via a searcher, which is inserted from the inside) The operation is predominantly performed under spinal anesthesia. Minor side branches, may be removed in addition via stab avulsion with small cuts of the skin. The stripping may be performed from the outside (s.c. phlebectomie externe), in order to prevent minor hematomas. The diseased perforantes veins are dissected in the depth, which can be conducted minimal invasive ( without major scars) in form of an ESPD. An invasive fasciotomy is suited for an advanced stage, with ulceration.
Compression Treatment: If a surgery is no possibility, the complaints can be eased via compression stockings or elastic wraps. A temporary compression treatment is also common after an operation.
Radiofrequency-/ Lasertreatment: Those procedures provide a less invasive alternative to the vein- stripping. The diseased vein is sealed endoluminaly (from inside) and remains within the body. In case of radiofrequency ablation, is the vessel being shrunk, by heating up the vein wall, which leads to a seal inside the vein wall and thereby the blood flood is naturally redirected via healthy veins.
MOCA (Clarivein): This is an new method of less invasive, endovascular treatment of varicose veins. MOCA means mechanochemical endovenous ablation and is performed in that way, that under ultrasonography control a catheter is introduced in the sick vein and a simultaneous irritation of the inside wall of the vein and the administration of sclerotherapy is achieved. It leads to the closure of the sick vein. The adventage over the RFA or laser is that no heat is produced and at this way is eliminated the risk of nerval irritation. We prefer this treatment in suitable cases of varicosis ( http://youtu.be/-RBhpGdmH7I )
Medicinal therapy: The goal of the medicinal therapy is to stress the vein tension, though it can not replace the methods of treatment, listed up above.
Minimally invasiv (MIC) radiofrequency ablation of varicose veins
Author: Dr. Andreas Franczak