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The truth is in the legs



Heaviness, swelling, pain in the legs… The symptoms of varicose veins are familiar to many of us. Today, every third woman and tenth man suffers from them. Moreover, many people have already encountered this condition at the fairly young age of 30–40 years old.

Varicose disease can be – and has to be – treated. Today, there are quick and painless treatment methods available. Swiss doctors know how to rid us of varicose veins for a long time, if not forever. Providing more details in this interview is Dr. Thomas Meier, head of the Interdisciplinary Center of Venous Diseases, University Hospital Zurich.

– Dr. Meier, tell us about the first signs of varicose veins. What do we need to pay attention to in order to begin treatment in time?

– As soon as you notice pain, swelling and heaviness in the legs, you should consult a specialist. Do not wait for the first external signs, such as brown skin coloring (hyperpigmentation) and small tortuous veins in the foot (corona phlebectatica paraplantaris). These indicate the progress of the disease.

The next stage of the disease’s development is called «chronic venous insufficiency». This means that skin alterations have developed. Besides the so-called hyperpigmentation and dermatitis (inflammation of the skin), cutaneous ulceration can be present.

These alterations are usually located on the inner side of the calf.

Without appropriate treatment of the varicose veins, the patient faces complications such as chronic venous insufficiency, bleeding veins and inflammation of the superficial varicose veins with formation of blood clots, the so-called varicophlebitis. If the blood clots are not treated, they can, while progressing, go into the deep vein system. In this case, there is an elevated risk of pulmonary embolism.

– In your experience, who are more likely to suffer from varicose veins – men or women?

– Women, although the difference is not so great. Perhaps this is because women are much more attentive to their health, and more often go to the doctor if they notice the initial signs. A risk factor for women is pregnancy.

– And for men?

– Generally, the risk factors include professions which require a lot of standing, and the most common and probably the most important risk factor is age. 60-80% of people suffer from varicose veins after sixty years of age.

– Tell us about modern methods of treatment. What new developments in this area of medicine have appeared in recent years?

– Over the last 15 years, endovenous therapies have become available. These treatments are minimally invasive, are performed on an outpatient basis and take only one or two hours, depending on the extent of the disease. The patient can immediately return to his usual routine. There are two types of endovenous treatments: thermal ablation by laser or radiofrequency and chemical ablation by sclerosant agent or glue.

The most recent endovenous method is vein occlusion by intravenous injection of cyanoacrylate, which acts as an instant glue. The result of this treatment is comparable to laser ablation. The advantage of the glue is that no local anesthesia and compression therapy are necessary.

A relatively new method of treatment is ultrasound guided foam sclerotherapy. The veins are cannulated under sonographical control and the sclerosant agent, polidocanol, for example, is injected intravenously as foam. This occludes the vein by shrinking and constricting it. Foam sclerotherapy is the ideal method to treat recurrent varicose veins after traditional vein surgery.

A novel laser method with a radial emitting dual ring laser-tip makes it possible to treat any kind of varicose veins, regardless of the size of the veins. But in this case, a special local anethesia is necessary.

What all of these methods have in common is that, over time, the treated, «lifeless» vein-tissue is absorbed or converted into connective tissue by the body. As you can see, we can abandon conventional surgery on account of these new methods.



– Tell us, what are the stages of treatment? How long can it take?

– The examination of the patient will take about one hour. The treatment options are discussed with the patient and together we choose the most suitable one. Thanks to the infrastructure of the clinic and the qualifications of the doctors, it is possible to treat both legs in one appointment, even in the most severe cases.

It is necessary to consider that you should not fly for about one week after treatment, in order to avoid possible complications such as thrombosis and pulmonary embolism.

– How will the leg look after treatment, aesthetically speaking? This issue concerns many women.

– Skin browning (hyperpigmentation) in the area of the treated vein can occur only if sclerotherapy is performed on large veins, located close to the skin, and if the skin itself is very bright. But it will resolve itself in six months to two years.

– How long does the effect of the treatment last?

– 3 months after the treatment, laser ablation and ablation with cyanoacrylate show the same excellent results as traditional stripping and crossectomy: in more than 95% of patients, the treatment is effective. Accessory varicose veins can be treated by foam sclerosant in the same session.

– Dr. Meier, a frivolous attitude towards the treatment of varicose veins can lead to a more serious problem, namely thrombosis. Tell us more about this disease.

– Major risk factors for deep vein thrombosis are age, cancer and immobilization (bed rest, long flights, casts). However, the treatment of varicose veins is also a risk factor for developing thrombosis, but this is rare and patients at risk

are treated with anticoagulation for a few days after the intervention.

– What are the first signs of the disease?

– First of all, pain and swelling of the leg. The skin can take on an unusual purple color.

– Is thrombosis prevention possible? What can be done to minimize the risks?

– There are two main means of prevention: activity and compression therapy by wearing compression stockings. But these are not those tight and uncomfortable rubber stockings worn by our grandparents. Modern models are much softer and more pleasant.



– What is the treatment for thrombosis?

– Venous thrombosis is treated with anticoagulation drugs («blood thinner») for at least 3 months, and sometimes for years depending on the cause of the thrombosis. Usually, at least at the beginning, patients should wear compression stockings to reduce swelling. In the case of vein thrombosis of the pelvis, catheter directed thrombolysis must be considered as a treatment in addition to blood thinners, compression and mobilization. Studies show, in selected patients, a significant reduction of vascular complications even years after the acute event.

– For which patients do you consider thrombolysis for the treatment of deep vein thrombosis?

– If the patient has severe swelling and pain and large veins are occluded, we perform catheter-directed lysis, with very good results.

In some cases it is necessary to place a stent into the affected vein.

– What are the consequences of deep vein thrombosis?

– The most severe complication of deep vein thrombosis is pulmonary embolism in the acute phase. It is therefore very important to begin immediately with anticoagulation therapy. In the long term, post-thrombotic syndrome can occur. This is characterized by leg swelling, pain and heaviness and finally leg ulcers, the most feared complication.

– We are talking mainly about leg diseases. Can it also affect the upper extremities?

– Varicose veins don’t usually develop in the upper extremities. Deep vein thrombosis can occur, especially in the region of the shoulders, in the subclavian vein. Here thrombosis can occur as a complication resulting from vigorous exercise of shoulder/arm muscles, particularly if the subclavian vein is compressed by abnormal bone structures, ligaments or hypertrophic muscles in the area of the first rib and the clavicle. This can cause thrombosis.



Thomas Meier

Doctor of Medicine, graduated from the Department of Medicine at the University of Zurich in 1991. He worked at the Institute of Clinical Pathology and the Institute of Anaesthesiology at the University Hospital in Zurich for more than five years. From 1997 until 1999 he served as a doctor in the Department of Internal Medicine at the Cantonal Hospital of Winterthur and at the University Hospital of Zurich. After a year of residence in the Intensive Care Unit at the University Hospital of Zurich, he worked as a senior physician in the Internal Medicine department at the Cantonal Hospital of St. Gallen for two years.

Since 2002, he has been a senior doctor at the Angiology Clinic at the University Hospital of Zurich. In 2007-2008, he received additional education in the treatment of varicose veins. He is the author of scientific publications related to diseases of the veins and microcirculation disorders, a member of the Swiss Society of Phlebology (SGP), the Union of Vascular Societies of Switzerland (USGG), the Swiss Society for Emergency and Rescue Medicine (SGNOR) and the European Society for Vascular Medicine (ESMV).


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