Every day our veins carry around 7000 liters of blood back to the heart. The leg veins do the hard work, because the blood has to be transported to the heart against gravity. At a Leopoldina online seminar, Katrin Körner, Head of Vascular Surgery at the Surgical Clinic (Professor Dr. Detlef Meyer), spoke about “Vein Disorders? Causes and Therapy”. She explained the most common diseases such as chronic venous weakness, varicose veins, inflammation of the veins (phlebitis) and deep vein thrombosis in a clear and detailed manner.
Structure of the venous system
First, Körner explained the structure and function of the venous system, which is divided into superficial and deep veins and connecting veins. The calf and ankle muscles act as pumps for blood flow towards the heart. Venous valves ensure that the blood does not fall back down again. In the case of weak, dilated venous walls and the resulting leaky venous valves, backflow occurs? chronic venous insufficiency and varicose veins can develop.
Varicose veins (varices) are defined as sac-shaped or cylindrically expanded superficial veins, circumscribed or stretch-shaped, mostly connected with a winding or tangling. Varicose veins usually appear between the ages of 20 and 35. Risk factors for their development are genetic stress, pregnancy, obesity and lack of exercise.
Treat varicose veins
Discomfort from varicose veins: feeling of heaviness and tension, pain and pulling in the legs, especially at rest. Visible skin changes, increasing swelling during the day (edema). The symptoms are aggravated by long periods of sitting, standing, warmth, even before menstruation. Cosmetic impairment due to visible tortuous varicose veins. If left untreated, varicose veins can lead to massive problems, including open legs. “But it doesn’t have to get that far,” emphasizes Katrin Körner.
Conservative treatment
Ultrasound examinations show the extent of the changes, but also the return flow through leaky valves. As therapy for varicose veins, the speaker mentions physical, medicinal or surgical options. “Consistent, long-term cooperation on the part of the patient is necessary for conservative treatment,” confirms Körner. Here she mentions compression, avoidance of tight clothing, weight loss when overweight, elevation of the legs, especially at night, lots of exercise, cold water applications.
As indications for surgical therapy, Körner names trunk and side branch varicose veins, complications such as inflammation of the varicose veins, bleeding, sore legs. Preparation for surgery always includes precise marking of the varicose veins using sonography and ensuring the patency of the deep venous system. Contraindications to invasive therapy are the presence of a circulatory disorder (must first be eliminated), occlusion of the deep venous system, general inoperability, pregnancy or lymphedema. The speaker explains the variety of surgical methods in detail, also mentions the extremely rare complications.
Special case “open leg”
The so-called open leg is a special case. First, the circulatory disorder has to be remedied, possibly an invasive therapy for the varicose veins. This is followed by wound treatment, possibly with a split-thickness skin covering for large wounds. In the case of inflammation of the veins (phlebitis), there is a coarsely reddened, tenderness to pressure sensitive cord and an inflammatory reddening of the surrounding area. It can develop in a pre-existing varicose vein, often on the arm after an infusion line. Phlebitis is rare in a normal venous system. Then a further clarification should take place.
Deep vein thrombosis
Causes of deep vein thrombosis can be: old age or obesity, too little exercise, long periods of sitting in an airplane, being confined to bed, plaster cast, operations, hormone preparations (birth control pills), pregnancy and the puerperium, tumor diseases or certain hereditary diseases. A pulmonary embolism is found in around 50 percent of patients with deep vein thrombosis.
Symptoms of a thrombosis: the leg is swollen, painful, often slightly discolored, the veins are dilated. If a blood clot is washed into the lungs and blocks a vessel there, this can be accompanied by sudden shortness of breath, chest pain and even loss of consciousness. The extensive diagnostic options include compression and color-coded duplex sonography, the D-dimer blood test, a venous occlusion and a light reflex examination, possibly a CT and a venography.
Blood thinning plus compression
Therapy consists of blood thinning (three months or more) plus compression. In the case of a first thrombosis, treatment should last three to six months; in the case of repeated thrombosis, longer, after weighing the risk and benefit. The cause should be clarified if possible. The long-term, stress-dependent, individually adapted wearing of compression stockings is also very important in order to avoid consequential damage? Katrin Körner gives her audience this important advice at the end of her presentation.
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