Varicose veins are a common condition, currently affecting 45-55% of the population. The issue of varicose veins affects both women and men across all age groups. If left untreated, there is a risk of further complications, with the most serious being the development of leg ulcers, thromboembolism, and bleeding.
The cause of varicose veins is damage to the superficial venous system, where the one-way valves in the surface veins of the legs stop closing properly and allow blood to flow backward. This leads to gradual enlargement of the veins, resulting in the formation of varicose veins as we know them. Heredity plays a role in valve damage, as some individuals are born with reduced strength and elasticity in their vein walls. Another contributing factor is being overweight, which puts more strain on the venous system. The higher incidence among women is linked to pregnancy, as the growing uterus increases venous pressure in the lower limbs during this time. A sedentary lifestyle or prolonged standing also plays a significant role. Blood flow is supported by the so-called muscle pump, where muscle movement compresses the veins, accelerating venous circulation. A sedentary job, long periods of standing, and lack of physical activity slow down blood flow, leading to typical swelling and fatigue in the lower limbs. Therefore, office workers, salespeople, hairdressers, teachers, and similar professions are most commonly affected.
The first symptoms of the condition include frequent feelings of fatigue in the limbs, temporary swelling, usually during the summer months, and resting pain in the limbs, most commonly at night. In addition, spider veins may appear on the lower limbs, followed by the characteristic bulging, twisted varicose veins. The most serious condition involves changes in the color and quality of the skin, particularly darkening and hardening of the swelling around the ankles.
Several therapeutic approaches are used in the treatment of varicose veins. One option is conservative treatment, which involves a combination of medications that increase venous wall tension and compression therapy using compression stockings. While conservative treatment can alleviate the patient’s symptoms, it never leads to a reduction or removal of the veins. The removal of varicose veins is only possible through surgery. Damage to the venous valves and the subsequent enlargement of the venous trunk with blood reflux (known as reflux) is an irreversible condition that progressively worsens. Varicose veins enlarge, causing limb swelling, and often lead to eczema due to impaired metabolism, thinning of the skin and subcutaneous tissue. The final stage is the formation of a leg ulcer, which severely limits the patient’s health. Surgery for varicose veins is currently a very common procedure. In addition to the traditional radical surgery performed under general anesthesia, our medical facility also offers and prefers new, less invasive methods that are increasingly popular among patients, such as sclerotherapy, endovenous laser therapy, and ClariVein. These less invasive methods do not require hospitalization, and the procedure is usually performed under local anesthesia.
Each method for removing varicose veins has its advantages and disadvantages, and the appropriate method can only be determined by a doctor who will assess your health and conduct the necessary diagnostic examinations. This often involves the use of color duplex ultrasound, where color mapping is used to precisely identify the extent of venous damage and propose a treatment method. In many cases, two or three methods are combined for the patient, depending on their health condition and the extent of the procedure needed. The most common complementary method for varicose vein removal is sclerotherapy, which is used to make small adjustments that complete the procedure.
Sclerotherapy is a very gentle method. Doctors close the affected smaller vein by injecting a special sclerosing agent into it. Afterward, the lower limb is compressed with a compression stocking or bandage, which the patient should wear for at least two weeks. The closed vein will eventually be absorbed by the body over time.
The procedure is performed on an outpatient basis, is time-efficient, and lasts approximately 20 minutes. The treatment is painless and does not require any subsequent restrictions on physical activities. It can be performed year-round, with the only limitation being the wearing of compression stockings during high temperatures.
Sclerotherapy can also be used as a complement to other methods of varicose vein removal.
The health insurance company covers the treatment of three areas of varicose veins in the lower limbs using one ampoule of sclerosing agent during sclerotherapy. For larger areas, any additional treatment that exceeds the coverage provided by the health insurance must be paid for directly by the patient.
One of the options is classic surgery, which involves the surgical removal of the entire affected and damaged vein. This method is more demanding and less gentle for the patient, as it also causes injury to surrounding tissues, leading to subsequent pain and the formation of large bruises. For this reason, the use of anesthesia is necessary, along with subsequent hospitalization. The duration of hospitalization is approximately three days, and the following recovery period in sick leave is typically four to six weeks.
This method is covered by health insurance.
This is a minimally invasive method for treating varicose veins that is gaining popularity. It is usually performed under local anesthesia (tumescent anesthesia) alone or in combination with sedation. A laser fiber is inserted into the damaged varicose vein, and the vein is closed (sealed) in the affected section. The entire procedure, including patient preparation, takes about 30 to 40 minutes. Doctors perform the entire operation under the guidance of an ultrasound machine.
This procedure is currently one of the most rapidly developing treatments in terms of gentleness and cosmetic results. After this procedure, only minimal bruising remains, which disappears within a month, and no scars are left. Patients only need to wear compression stockings for about two weeks. After the procedure, they can practically walk immediately and are not restricted in their regular physical and work activities; the procedure does not require sick leave.
The method is particularly suitable for patients who, due to work or other time constraints, cannot undergo the classic method, or for patients who are concerned about general anesthesia, the pain following the classic method, or do not accept its cosmetic effect.
The additional charge for the use of the laser device and the disposable laser fiber is not covered by health insurance.
The ClariVein method is the latest and gentlest surgical approach for minimally invasive treatment of varicose veins in the lower limbs, including the great and small saphenous veins, perforating veins, and other affected vessels. Under ultrasound guidance, a catheter is inserted into the treated vein, where its tip rotates rapidly, causing the vessel to constrict. Simultaneously, a sclerosing solution is injected into the tip. The rotation of the tip ensures even contact of the solution with the inner wall of the vein, leading to its sclerosis and subsequent closure along its entire length. The treated vein collapses, and its walls stick together, transforming into fibrous tissue after several weeks. This effectively addresses the cause of varicose veins, while the administered sclerosing agent also closes the branches that create visible varicose veins, eliminating the need for surgical removal. During the procedure, patients only feel a slight tingling sensation along the treated vein. Ultrasound monitoring is maintained throughout the operation. Post-operative recovery is also very quick, with minimal subjective issues for the patient. After the procedure, it is recommended to take regular walks. A compression stocking is worn post-operatively for just two weeks, with continuous wear for the first week. There are minimal bruises after the operation, and there is virtually no need for physical restrictions. Regular daily activities can resume immediately, while sports and heavier physical exertion can be resumed after one week post-operation.
Therefore, both limbs can be treated using the rotating loop method in a single procedure. The risk of damage to accompanying nerves, skin, subcutaneous tissue, and the occurrence of pain due to heat is completely eliminated. The procedure is quick, elegant, and safe.
This method is not covered by health insurance.
VenaSeal is the newest method in which a small amount of certified medical adhesive is injected into the varicose vein. This adhesive seals the damaged vein, redirecting blood flow to adjacent healthy veins. The procedure is performed through a single incision using a special catheter and under ultrasound guidance, allowing for precise placement of the adhesive material. After the procedure, there is no need to wear compression stockings. The risk of peripheral nerve damage is completely eliminated. A small percentage of patients may experience an allergic reaction to the treatment. The cost of the procedure is 35,000 CZK for the treatment of one limb.
Schedule appointment with: MUDr. Khaled El Samman
This method is not payed by health insurance.
