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At a glance
Record your leg complaints, compression wearing times and appointments in brite and go to your vein check with a clear overview. Free of charge.
A suddenly one-sided swollen, overheated and painful leg is not a normal course of varicose veins but rather a suspected deep vein thrombosis — here the leg needs prompt medical examination.
Varicose veins (medically varices or varicosis) are dilated, twisted superficial veins that appear above all on the legs. Incidentally, the German name has nothing to do with muscle cramps — it derives from the old word "Krummader", meaning a crookedly running vein. They become visible as bluish, translucent, protruding cords, often on the calf or the inner side of the lower leg.
To understand why they develop, it helps to look at the job of the leg veins. They have to transport the blood upwards against gravity back to the heart. For this to succeed, three things work together: the muscle pump of the calf, which pushes the blood upwards with every step, elastic vein walls and above all the vein valves. These valves work like non-return valves: they only let the blood through towards the heart and prevent it from sinking back down.
With varicose veins these valves no longer close properly. The blood partly flows back and pools in the superficial veins — experts call this reflux. The permanently raised pressure widens the veins further and further, they become longer and twist. This creates a cycle that reinforces itself: leaky valves lead to congestion, the congestion widens the vein, and the widened vein makes the valves even more leaky. This is why varicose veins do not recede on their own.
Not all varicose veins are the same. There are harmless cosmetic forms and pronounced varicose veins that cause complaints. An overview of the most important forms:
To describe the severity of a venous disease uniformly, experts use the CEAP classification. The C in it stands for the visible clinical findings and ranges from C0 to C6. You don't need to memorise the abbreviations — here is an easy-to-understand translation:
| Stage | What you see | Meaning |
|---|---|---|
| C0 | No visible signs, but complaints | Heavy legs without visible varices |
| C1 | Spider veins, fine net veins | Mostly purely cosmetic |
| C2 | Distinct varicose veins | Treatment sensible depending on complaints |
| C3 | Additional swelling (oedema) | Beginning chronic venous insufficiency |
| C4 | Skin changes, discolouration, hardening | Advanced — treat |
| C5 | Healed open leg (ulcer) | Late consequence, risk of recurrence |
| C6 | Active open leg (leg ulcer) | Most severe form — treat urgently |
Most people are in the range of C1 to C3. Important to know: the stages are not a one-way street with a fixed pace — with good treatment the progression can be halted in the vast majority of cases, and the severe stages C4 to C6 are rare with timely therapy.
Besides the visible findings, varicose veins cause typical complaints that change over the course of the day. Characteristically, the legs feel heavier in the evening than in the morning and get worse with prolonged standing or sitting, and better with movement and elevation.
Interestingly, the intensity of the complaints does not necessarily match the size of the varicose veins. Some people have thick varices and hardly any complaints, others suffer from heavy legs even with small veins. This is why appearance alone does not decide the treatment, but rather the overall picture of complaints, ultrasound findings and course.
The actual cause of most varicose veins is a weakness of the vein valves: the valves in the superficial leg veins no longer close tightly, the blood flows back and congests. Why the valves and vein walls weaken is an interplay of predisposition and strain. This is then referred to as primary varicosis — it makes up the large majority.¹
Less often another cause is behind it (secondary varicosis). The most important trigger is a previously experienced deep vein thrombosis: if a deep vein has become blocked or its valves damaged, the blood has to divert via the superficial veins, which are thereby overloaded and dilate into varicose veins. This is why the question of a previous thrombosis is always part of the assessment.
Varicose veins can often be seen at first glance. For treatment, however, appearance alone is not enough — what is decisive is which veins and valves are affected and whether the deep veins are involved. This is clarified above all by ultrasound.¹,²
Particularly important is distinguishing it from deep vein thrombosis. Varicose veins themselves are not a thrombosis — they develop slowly over years and affect the superficial veins. A deep vein thrombosis, by contrast, is a blood clot in the deep leg veins that occurs suddenly and can become dangerous, because part of it can break loose and reach the lungs as a pulmonary embolism.
Not every varicose vein has to be operated on. At the start, and accompanying every procedure, comes conservative treatment — that is, measures without surgery. It does not remove existing varicose veins, but it reliably relieves complaints, slows progression and prevents complications. For mild forms it is often sufficient.¹
The two supporting pillars are compression and exercise. Both aim to improve the return transport of the blood and to lower the pressure in the superficial veins.
So-called vein preparations (herbal products, for example with red vine leaves or horse chestnut) can somewhat ease the feeling of heaviness and the swelling. However, they replace neither the compression nor a necessary treatment of the leaky veins — they are a supplement, not a substitute.
If complaints persist, the varicose veins progress or complications threaten, procedures come into question that specifically switch off the diseased vein. The principle is the same for all of them: the leaky vein is closed or removed so that the blood drains via healthy veins. The body copes well without the shut-down superficial vein. Which procedure is suitable depends on the location, size and course of the vein as well as on the ultrasound findings.¹,²
After every procedure, wearing compression stockings for a certain time is part of it, as is getting up and moving early. The exact duration and aftercare are determined by the treating practice. Important to know: whether and which procedure the health insurance covers depends on the findings — purely cosmetic treatments such as the sclerosing of spider veins are usually paid for out of pocket.
brite reminds you to wear your compression stockings and documents complaints and appointments seamlessly — ready for your next vein consultation.
Varicose veins are a chronic condition that usually slowly worsens without treatment. With the right habits, however, the course can be strongly influenced — and anyone with a familial risk can actively prevent them from developing. The most effective levers lie in everyday life:
Left untreated, a pronounced varicosis can lead to chronic venous insufficiency: first with swelling and water retention, later with skin discolouration, hardening and, in the worst case, an open leg (leg ulcer) that heals poorly. A possible complication is also an inflammation of a vein in a varicose vein (superficial vein thrombosis), which shows itself as a reddened, hardened and painful cord. It is usually less dangerous than a deep thrombosis but needs medical assessment. All of this is a reason not to dismiss varicose veins as purely cosmetic, but to do something in good time.
Record in brite how swelling, the feeling of heaviness and compression wearing times develop — ideal for your next doctor's consultation.
Most varicose vein complaints develop slowly and are not an emergency. There are, however, situations in which you should not wait:
Varicose veins are not treated in weeks but over years — with compression, exercise and regular checks. The therapy only works if it runs reliably and the complaints stay in view. This is exactly where brite supports you.
