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Procedure of varicose sclerotherapy

Varicose vein disease, also known as varicosis, is defined by pathologically dilated superficial veins, also called varices. Most often, the lower extremities are affected.

Anatomy of the leg veins

A distinction is made between the superficial (suprafacial) and deep (subfascial) leg veins. The superficial truncal veins include the great saphenous vein and the parval saphenous vein. Deep veins, on the other hand, are the femoral vein and the popliteal vein.

At this point, it should be mentioned that perforating veins connect the deep and superficial venous systems, perforating the fasciae. The superficial truncal veins, on the other hand, are connected by lateral branches.

Veins function

Veins are responsible for transporting deoxygenated blood to the heart. The blood pressure of veins is significantly lower than that in arteries. The natural pump for the blood flow of veins is the skeletal muscles, which pump the blood against the force of gravity in the direction of the heart. The valves in the veins act like check valves so that the blood does not flow back when the muscles relax.

How do varices develop?

Varicose veins form due to a venous outflow disorder caused by insufficient venous valves. Superficial varices are easily visible, as they usually meander along in the subcutaneous fat tissue. Varices of the deep venous system can only be seen on ultrasound or phlebography.

Since cardiac-directed blood flow is no longer possible in varices, the hydrostatic pressure acting on the vessels in the lower part of the body increases. This increased pressure in the venous system compared to the surrounding tissue (transmural pressure), causes water to seep through the vein wall and spread through the tissue, causing oedema.

Causes of varicose veins

Varicose veins usually develop primarily as a result of idiopathic insufficiency of the venous valves due to genetic predisposition. Secondary forms are acquired outflow obstructions of the deep veins, mostly due to leg vein thrombosis.

Risk factors

Risk factors for varicose veins are weakened connective tissue, which often occurs in women or during pregnancy. Increased venous pressure is also a risk factor, which is promoted by increased sitting or by being overweight.

How can varices be treated?

The preferred method for the treatment of reticular varices and spider vein varices, the so-called C1 varices, is sclerotherapy. However, insufficient truncal veins, side branch varices, perforator varices or recurrent varices can also be treated with the help of sclerotherapy.

Procedure of varicose vein sclerotherapy

A sclerosing agent is injected into the varicose vein. In Germany, Aethoxysklerol®155 with the active ingredient polidocanol (lauromacrogol 400) is approved. The liquid sclerosant causes targeted chemical ablation of the varicose vein, resulting in artificial inflammation of the inner vessel wall, which ultimately leads to occlusion of the vein.

After treatment

This results in the transformation of the varicose vein into a connective tissue strand that no longer allows blood flow. Immediately after the treatment, a tight compression bandage or compression stocking is applied for 24 hours. These should also be worn for up to 8 hours a day for the next three weeks after treatment.

Complications

Possible complications of varicose sclerotherapy include allergies to the sclerosant, tissue necrosis, venous thrombosis, and hyperpigmentation due to intravascular blood clotting. A dangerous complication of therapy is accidental injection of the sclerosant into an artery. Fast action is required here, which consists of anticoagulation therapy.

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Bibliography

  1. Herold et al.: Innere Medizin. Eigenverlag 2012, ISBN: 978-3-981-46602-7 .
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  3. S3-Leitlinie Ulcus cruris venosum. Stand: 1. August 2008. Abgerufen am: 16. August 2016.
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