Public press information on sclerotherapy: Questions and answers

Prevalence, causes, prevention and treatment options

We answer your questions about spider veins and varicose veins.

Vein problems can pose a major issue in spring and summer. Especially in warm weather, many people report swollen, painful legs and more noticeable spider veins or varicose veins. It is understandable that they wish to know how these problems develop, what helps support the appearance and health of their legs, and how sclerotherapy in particular can offer a gentle and practical option for managing certain venous changes. We address the most frequently asked questions about spider veins, varicose veins and related concerns.

How common are venous disorders?

According to a large study on vein health in Germany, some degree of venous change can be seen in around 90 percent of adults. Spider veins are the most common. The unsightly bluish-red vein networks on the legs are found in over half of all women and men, even at a young age, and can be an early indication of developing venous insufficiency. Over time, this may lead to the formation of larger varicose veins, swelling of the legs due to fluid retention and the appearance of more prominent, knot-like varicose veins. In the worst case, this can lead to damage to the surrounding skin and the development of an open leg ulcer. Approximately 60 percent of people over the age of 70 in this country are affected by advanced venous diseases and disorders.¹

How do lifestyle and working habits affect the legs?

Although vein problems and varicose veins have existed since ancient times, increasing life expectancy, modern lifestyles and working patterns have contributed to their development into a widespread condition. While our ancestors had to move frequently to obtain food or travel from one place to another, we now rely largely on means of transport such as cars, buses or trains. In addition, the share of employees working in service roles that mainly require standing or sitting has risen from 32.7 percent in the 1950s to 74.9 percent today.² This convenience comes at a price: For example, a lack of exercise causes the muscles that support vein function and blood flow in the legs to weaken. It also contributes to obesity, which places additional strain on already compromised veins.³

Why is standing and sitting harmful to the veins?

When standing, the pressure on the veins is higher than in any other body position. Studies show that normal blood flow from the legs to the heart becomes impaired after just 20 minutes.2 Certain occupational groups, such as hairdressers or salespersons, spend much of their working day standing, which increases their risk of developing varicose veins compared with the general population. However, long periods of sitting are also unhelpful and can contribute to the development of varicose veins, cardiovascular disease and back problems. When sitting for long periods, blood can pool in the legs because it is not actively pumped upward by the calf muscles as it is during walking. Prolonged sitting also increases the risk of thrombosis. People who alternate frequently between sitting and standing and those who are already a little older should consider wearing compression stockings to help prevent venous diseases or venous problems. And definitely do some exercise to balance things out.

Why should people with varicose veins exercise?

Exercise – especially walking – strengthens the calf muscles and supports blood circulation, which can help prevent venous disorders and ease discomfort. These benefits also apply to people with a hereditary tendency towards varicose veins. In fact, exercise can reduce venous symptoms such as swollen legs and may help prevent more serious conditions, including skin changes and ulcers. Ideal forms of exercise include walking, cycling, swimming or dancing. All of these activities are suitable even for people who are less athletic. Special vein exercises also offer targeted prevention, and as little as 30 minutes a day can have a positive effect. You can do vein exercises both at home and in the office (tips for a simple vein workout can be found here: www.besenreiser-krampfaderfrei.de/service/tipps-venentraining/). Wearing compression stockings during daily activities or when spending extended periods sitting or standing can be beneficial, offering extra support and protection for the veins.

What role does nutrition play in leg health?

Like exercise, a healthy diet cannot cure or prevent congenital venous insufficiency, but it can support overall leg health. Plant-based foods such as fruits, vegetables, whole-grain products, legumes, nuts and cold-pressed cooking oils provide vitamins, minerals and other beneficial substances that help strengthen connective tissue and protect cells. A balanced diet also provides plenty of fibre, which, due to its satiating properties, can help prevent excess weight and support healthy bowel function. Avoiding excess weight reduces pressure on the veins and the associated blood pooling in the legs. For healthy circulation, it is also important to drink one and a half to two litres each day, preferably water or unsweetened tea.

Why is early treatment of varicose veins important?

Varicose veins are a visible sign of a chronic venous condition that will progress if left untreated. They are commonly accompanied by various uncomfortable symptoms and can greatly reduce quality of life. Heavy, swollen legs and calf cramps are typical signs. Additional risks include skin discolouration, inflammation of the veins and, in more severe cases, leg ulcers and thrombosis. Varicose veins should therefore be checked and treated if needed, even when they are not painful. For many individuals, varicose veins and smaller spider veins on the legs are also a cosmetic issue. To avoid showing their legs, some people wear long trousers even during the warmer months and may forgo activities such as swimming pool visits or beach holidays.

How can spider veins and varicose veins be permanently removed?

While compression stockings and vein preparations for external or oral use can ease leg symptoms, they cannot make existing varicose veins or spider veins disappear. Effective health and aesthetic outcomes are achieved only through medical removal of the veins. Fortunately, modern treatment options now offer gentler alternatives to surgery. Treatments for varicose veins include laser procedures, radio wave therapy and sclerotherapy. However, some techniques may not be suitable, for example when the veins are twisted. Sclerotherapy remains the only technique capable of safely and effectively treating all types of varicose and spider veins.

What characteristics set sclerotherapy apart?

Sclerotherapy is one of the most extensively researched treatment options for varicose veins, with numerous studies confirming its safety and effectiveness. Medical guidelines identify it as the method of choice for spider veins and smaller varicose veins, achieving improvement rates of more than 90 percent. The treatment is also extremely gentle for larger varicose veins, as it does not require anaesthesia or skin incisions and involves only minor discomfort. During a short outpatient visit, the doctor uses a fine needle to inject a specially formulated medication into the affected veins, causing them to close and be naturally broken down by the body in the weeks that follow. The actual procedure lasts less than 30 minutes. Following treatment, patients are able to return to work straight away and carry on with everyday activities without needing a recovery period. Sclerotherapy is also particularly suitable for older individuals and people who are overweight.
This lower level of intervention is also reflected in its costs, which are usually less than those of alternative procedures.

Additional details on vein and leg health and on sclerotherapy are available on the website www.besenreiser-krampfaderfrei.de .

¹ Rigby KA et al. Surgery versus sclerotherapy for the treatment of varicose veins. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004980.
² Rasmussen LH et al. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg 2011;98:1079–87.
³ Rabe E et al. (2018 version). Leitlinie Sklerosierungsbehandlung der Varikose [Guideline for sclerotherapy treatment of varicose veins] (ICD 10: I83.0, I83.1, I83.2, I83.9). AWMF guideline registry number: 037–015. Development stage: S2k.