Public press release: Varicose veins – not just a cosmetic problem

Spider veins and varicose veins:

The underestimated health risk

What do Hollywood diva Angelina Jolie, tennis icon Serena Williams and reality TV star Daniela Katzenberger have in common? They, like many others worldwide, deal with vein issues. Spider veins and varicose veins affecting the legs are also widespread. But while celebrities have already undergone treatment at least once, many other affected individuals shy away from taking this step and risk the underlying chronic venous disease worsening. In fact, visibly dilated blood vessels in the legs are not just a cosmetic issue but can, over time, lead to serious consequences such as chronic wounds, dangerous bleeding and thrombosis. Sclerotherapy provides a safe and gentle outpatient option for treating all forms of varicose veins. The procedure is regarded as particularly painless and cost-effective, and is ideally carried out by vein specialists with additional training in phlebology, as well as dermatologists and surgeons with appropriate further qualifications.

Vein problems can develop even at a young age

Nobody wants them, but many are affected by visible veins on the legs. According to a large study, more than half of adults in this country are affected by the bluish-red networks of veins on the upper or lower legs known as spider veins – and these small varicose veins can even be found in some people under 20. Statistically, the prevalence of vein problems rises markedly with age. By retirement age, the majority of the population presents with spider veins, more pronounced varicose veins, water retention in the legs and skin changes – only about 2% still have unremarkable legs at this stage of life. Contrary to popular belief, venous diseases are not a typical women's ailment – the more advanced stages in particular occur just as frequently in men.¹

Swollen feet and painful legs are signs of venous insufficiency

Spider veins and varicose veins occur when blood pools in the superficial veins, causing them to stretch under sustained pressure. The venous valves, which act like one-way flaps, are made of connective tissue and may therefore no longer close properly. Consequently, more blood returns to the legs and collects there rather than being completely carried back to the heart. “At first, patients usually complain of swollen feet and ankles, along with tension and pain in the legs after prolonged standing or during warm summer weather,” says dermatologist and phlebologist Dr Karsten Hartmann, head of the Freiburg Vein Centre. “Sooner or later, many people develop their first permanently dilated blood vessels.” Spider veins, just a few millimetres in size, are situated in the skin and are therefore more visible in people with fair skin. Larger varicose veins, on the other hand, are located beneath the skin but often appear on the legs as clearly knotted or twisted veins.

If left untreated, varicose veins may result in significant complications

You do not need to be a celebrity or overly focused on appearance to regard spider veins and varicose veins as both unattractive and troublesome. At the same time, such venous changes are not merely cosmetic; they can also present a significant health risk. Even spider veins can mark the beginning of progressive venous insufficiency. In addition, larger, previously undetected varicose veins may be present and contribute to the development of spider veins. Long-term varicose vein disease can lead to issues such as skin and tissue damage, discolouration and poorly healing wounds due to impaired vein function and reduced blood flow. In rare cases, skin and vein damage can be so pronounced that even small injuries lead to varicose vein bleeding that is hard to control. The most serious complications of venous disease, however, are vascular occlusions caused by blood clots. While most thromboses develop in the deep veins of the legs, pulmonary embolisms, meaning blockages in the pulmonary arteries, can also occur.

A vein-conscious lifestyle can prevent complaints

Although genetic predisposition and age play a major role in the development of varicose veins, regular exercise and maintaining a healthy weight can help counteract discomfort and some of the associated long-term effects. To prevent swollen legs and thrombosis, phlebologists such as Dr Hartmann recommend that people in standing professions, including hairdressers and salespersons, wear support or compression stockings during the day. These apply pressure to the veins, promote the return of blood from the legs to the heart and help prevent leg swelling and vein enlargement. They are also useful in situations with limited mobility – such as after surgery or when travelling – as well as during pregnancy. Be bold: Serena Williams, the tennis champion, even wore a full-body compression suit on court for a period after a pulmonary embolism that required urgent medical attention. And nowadays, compression stockings also come in fashionable designs and a range of colours.

Vein specialists recommend treating varicose veins

The long-term attractiveness and health of the legs can be improved only by removing enlarged veins. The appropriate contact person for this is a phlebologist. Similar to Dr Hartmann, they may come from dermatology, but can equally be surgeons, angiologists or general practitioners who have received thorough specialist training in venous diseases. “Vein diseases have always played a major role in everyday dermatological practice, as they are typically accompanied by skin changes,” explains the vein specialist. “In our vein centre, we treat both aesthetically bothersome and symptomatic varicose veins that are significant for health reasons. To provide a broad range of care, we use the most modern treatment methods, with sclerotherapy proving to be particularly versatile, gentle and suitable for everyday practice.”

Sclerotherapy gently promotes healthier, better-looking legs

Sclerotherapy is the only method that can be used successfully for varicose veins of any shape and size. Its effectiveness and safety have been extensively researched. According to current guidelines, sclerotherapy is the first choice for treating spider veins, achieving improvements of over 90%. For larger varicose veins, it offers a simple and cost-effective alternative to surgery or thermal procedures such as laser and radiofrequency treatment.^2,3 Here is how sclerotherapy works: After a painless ultrasound examination, the doctor injects a special drug into the altered veins using a very fine needle. The veins then close and are broken down by the body over the following weeks and months. Appointments typically take no longer than 30 minutes. Following the procedure, patients can return straight to their usual activities, such as going back to work, walking home or doing gentle exercise. “Because sclerotherapy does not involve anaesthesia or surgery, it is very well tolerated,” Dr Hartmann explains. “There is thus no reason to be concerned about spider vein or varicose vein treatment.” The best proof of this is when Germany's best-known blonde, Daniela Katzenberger, decided to 'tackle' her spider veins with sclerotherapy, as she put it, she later published a video of the treatment. As she exited the doctor's office, her husband, Lucas Cordalis, asked whether it had hurt a lot. The answer was clear, "No!".

You can find plenty of information and tips about spider veins and varicose veins online at www.besenreiser-krampfaderfrei.de . The vein check is especially practical, as it provides insights into your own vein and leg health.

¹ Robert Koch-Institut (eds.): Venenerkrankungen der Beine [Venous diseases of the legs]. Gesundheitsberichterstattung des Bundes [Federal Health Reporting], Issue 44, May 2009.
² Rabe E et al. for the Guideline Group. European guidelines for sclerotherapy in chronic venous disorders. Phlebology. 2014;29:338–54.
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.