Where do veins carry blood?

Frequently asked questions - veins

Dear patients,
Experience shows that in the end it is the same questions that are asked by you in connection with diseased veins / varicose veins, also called varices or varicose veins. These questions relate to diagnostics and the various forms of therapy, behavior and also the payment of modern, so-called minimally invasive procedures by the statutory health insurance companies. We want to answer the most frequently asked questions (FAQ) at this point.

1) Where does the blood actually go when the vein / varicose vein has been switched off. Does it have to look for new ways there?

Each leg has two venous systems, one superficial and one deep. If all veins are intact, the blood is transported to the heart in both systems. The deep vein system does the main work and is essential for leg health. Both venous systems are connected to each other by transverse veins (perforating veins), so that a disease in one venous system can "infect" the other. With varicosis, which always belongs to the superficial venous system, the blood flows in the wrong direction, away from the heart. The deep venous system is now in danger because it has to take over the work of the superficial venous system. In addition to its own blood, the deep venous system must now also transport the blood of the superficial venous system to the heart. In other words: at the moment the varicose veins developed, and not through the operative elimination of the varicose veins, the blood from the varicose veins had already found the new route. The deep venous system threatens to become sick from overloading / overstretching, here too the blood would flow away from the heart, which is possible because of the risks (including tendency to swell, skin discoloration, itching, eczema, "open leg", thrombosis and pulmonary embolism) should be avoided. Only the timely elimination of the varicosis of the superficial venous system can prevent all of this.

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2) How long must the compression stocking be worn after varicose vein surgery?

A gestation period of 6 weeks has been handed down for ages. This was carried on from generation to generation by doctors, without any sense or understanding and, above all, without good studies on this problem. In our practice, a gestation period of 7 days after the operation is traditional. There are of course exceptions, e.g. a weakness of the deep venous system. See also FAQ 4 and 5. (literature about practice available).

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3) Will the varicose veins come back after an operation?

Both the genetic makeup and external influences are decisive for the development of varicose veins. There is no possibility of influencing the genetic make-up; to a certain extent, this was inherited by the parents in the cradle. In this respect it is of course possible, with the appropriate genetic makeup, that varices can come back after successful elimination, after an indefinite period of time, for a lifetime.
External factors that can be influenced are e.g. overweight, standing job, in a broader sense of course also pregnancies, lack of exercise, etc. The way in which varicose veins are removed also seems to have a very important influence. After the classic open surgery, the so-called Babcock surgery (crossectomy and stripping), the probability of recurrence in the groin after 2 years can be up to 25%. After modern radiofrequency ablation (VNUS closure fast), a pathological backflow of blood from the groin (axial reflux) can only be observed in 3% of the operated patients after 3 years. This does not seem to have changed even after 4 years. (Literature available on practice).

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4) Should one operate on varicose veins in the warm season?

The main argument of patients against having varicose veins operated on in the warm season is the common practice of having to wear a compression stocking for 6 weeks after the operation. Please also read questions 2 and 5 of the FAQ. The fact is that untreated varicose veins can lead to serious complications, please also read question 1 of the FAQ. Ultimately, the decision must be made with a sense of proportion. If, for example, there is a varicosis without symptoms (tendency to swell, heavy legs, itchy skin, eczema, brown discoloration on the lower leg) and if this is only very thin in diameter on the ultrasound, the operation can possibly be postponed to the cold season. However, if there is a varicose vein with the above If there are symptoms, this should also be operated on in the warm season. Also to avoid thromboses and pulmonary embolisms, which occur more frequently in the warm season. Pulmonary embolism is still a common cause of death.

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5) Should you wear a compression stocking in the warm season?

Basically, the answer to this question depends on the individual case.

  1. One patient had a deep vein thrombosis with remaining damage in the deep vein system: In order to avoid severe leg damage, as well as a new thrombosis, this patient should unfortunately wear the compression stocking every day and all year round.
  2. One patient has varicosis. The deep venous system is intact. However, the varicosis causes symptoms: Here a compression stocking should be worn until the operation. If the patient does not have surgery until autumn, the stocking should be worn for as long as possible, otherwise complications should be expected. In order to reduce the wearing time of the stocking, an operation would also make sense in the warm season.
  3. One patient has varicosis. The deep venous system is intact. The varicosis is only mildly pronounced and does not cause any symptoms: Here it is responsible to only have the operation carried out in the cold season and not to wear a stocking until then.

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6) Do the statutory health insurance companies pay for modern, minimally invasive catheter procedures, e.g. radio frequency ablation (VNUS closure fast) or laser?

There are currently over 40 statutory health insurance companies that pay their insured persons for these modern procedures via so-called IV contracts - fixed in the Social Code Book V of the Social Code. Numerous other statutory health insurances are now ready to subsidize these techniques, which are far superior to classic stripping, for their insured persons. Unfortunately, there are still health insurers (a few) that display incomprehensible behavior towards their policyholders in different ways. Details on this and differentiated analyzes should be clarified in a personal conversation.

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7) Can I go to the sauna with varicose veins?

The general prohibition to go to the sauna with varicose veins is just as traditional as wearing compression stockings for 6 weeks after a vein operation. Veins are also muscle tubes, among other things. Of course, these need to be trained. Sauna dilates the veins, the cold applied afterwards - in combination with elevating the legs - leads to the maximum constriction of the vein wall = muscle contraction. To the best of our knowledge, there is no exact scientific background for rejecting this venous muscle training.

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