FAQ – Your Questions About Varicose Vein Treatment

They may look harmless, but varicose veins can become more than just a cosmetic issue. Left untreated, they can lead to skin changes, inflammation, or even open sores (called venous ulcers).

There’s also a higher risk of thrombosis (blood clots), especially with more severe vein problems. That’s why we always recommend having varicose veins checked out early – not just for how they look, but for your health.

Most patients enjoy long-lasting results after treatment – sometimes even for life. Once a vein is treated (closed), it doesn’t come back.

However, if you’re prone to vein issues, new varicose veins can develop over time, especially with risk factors like standing a lot, pregnancy, or weak connective tissue.

We’ll give you tips on how to protect your vein health long term – from exercise to compression wear. Regular check-ups also help catch anything early.

You should avoid direct sun exposure on treated areas for about 2 to 4 weeks. The skin can be more sensitive during healing, and UV light increases the risk of staining or discoloration.

If sun can’t be avoided: wear light clothing to cover your legs or apply high-SPF sunscreen (SPF 50+). After about 4–5 weeks, the skin is usually back to normal.

Surprisingly for many: it’s not painful at all. Laser treatment and sclerotherapy are minimally invasive and very well tolerated.

We use local anaesthesia or cooling to numb the area. You might feel a little pulling or pressure – but no real pain. Most people don’t need painkillers. A walk, a cool compress, or light movement usually does the trick afterward.

Like any medical procedure, there are some risks – but with modern techniques, they’re very low.

Possible (but rare) side effects include:

This is the most important question of all. If we know the cause, we can potentially fix it. It is the only path to perfect medicine: to identify and remove the causes, and thereby prevent problems. In everyday language we call this “prevention”. Prevention is better than cure. I have been researching this topic for veins intensively for 10 years and lead an international working group. I know the field very well, probably better than anyone else — but others should say that, not me. Always stay critical!

This much is certain: varicose veins always develop on the basis of venous insufficiency. Venous insufficiency is almost always the result of random congenital venous valve defects. This has been known for 10 years, and I have given countless lectures on it. More than 50% of all children have congenital venous valve defects, and in 2% of children it is so pronounced that they develop their first varicose veins between the ages of 16 and 20. Varicose veins therefore develop silently over at least 15 years, during which something could long since have been done about them. The German term “Krampfader” derives descriptively from “krumme Ader” (crooked vein) and has nothing to do with cramps.

Everything else you tend to read — heredity (genetics), hormonal factors (pregnancy) and lack of exercise — is not the cause. These are merely accompanying factors (medically: cofactors) of venous insufficiency, which make the condition worsen more slowly or more quickly. None of it has anything to do with the cause. Varicose veins do not develop in a healthy body. They always arise from diseased veins that usually lie deeper and are therefore invisible.

Varicose veins are almost always based on congenital venous valve defects. Over the course of life, the everyday strains are added, for example from prolonged standing or sitting. During these phases blood accumulates in the leg veins due to gravity, and even in people with healthy veins minor discomfort (a feeling of congestion or heaviness) can occur. Where the common congenital valve defects are present, the veins are filled above average. As soon as the person takes a few steps or elevates their legs for the night, the venous condition normalises. This is therefore still an apparently healthy stage.

If periods of strain accumulate and recovery falls short, the stage of overload follows. Its hallmark is that one or more venous valves can no longer hold the volume of blood at all and allow it to flow backwards to a greater extent. Now it is a disease — one that can, however, only be observed for a few hours a day, and possibly only during work. If you visit the doctor early in the morning, they will find nothing. This stage is still fully reversible, though at present only through the methods developed by Dr. Ragg. Compression stockings alone are no help.

If this opportunity is not taken, the overload of the veins and their valves will lead to a reversal of flow in these regions throughout the day. Normally the muscles of the foot and leg pump venous blood upwards, and healthy valves prevent backflow. If too much blood accumulates in the veins, the valve regions overstretch and no longer close. We are then no longer dealing with strain or overload, but with venous insufficiency. Physicians call it “venous insufficiency”. It is therefore not an unfavourable predisposition, but a condition that the patient for lack of better knowledge simply allowed to develop instead of seeking treatment. Even at this stage the veins can still be saved (reversible insufficiency), though it now requires small minimally invasive procedures, for example injection venoplasty or vein laser.

Only the final stages are characterised by pronounced venous insufficiency. After decades of steady deterioration, disturbances of venous metabolism and blood flow are now so significant that they are no longer reversible without major interventions. This is the beginning of chronic disease. Some sections of the veins can no longer be preserved and must be closed gently — without surgery, of course. Unfortunately, most patients only consult a doctor at this point, because symptoms are increasing, the varicose veins have become large and unsightly, or the skin is already dry, reddened or otherwise affected. The entire course of the disease could have been stopped decades earlier.

So remember:

1. Venous strain – normal
2. Venous overload – cause-related prevention now matters
3. Venous insufficiency, reversible in the early stage
4. Venous insufficiency, no longer reversible in later stages (chronic)

Since 2016, thanks to the latest ultrasound technology, we have been able to identify every process at the venous valves that leads to their long-term destruction. Early diagnostics like this has never existed before! We can see from your venous valves whether compression stockings help you, whether your vein tablets work, and whether vein exercises or 5000 steps a day really do you any good.

If you want to know what applies to you, make your appointment with us in Zurich now.

How varicose veins develop: from a scientific paper by Dr. Ragg (Progression mode of commissural gap-type e-lesions).

The most common origin of vein problems is congenital valve defects. In this example we assumed the most common type of malformation, a so-called commissural gap. The valve leaflets do not close tightly at a certain point. About 38% of the children examined have such valve defects. In this example not just one valve is defective, but three (collecting vein, great saphenous vein, right leg). The disease therefore spreads relatively quickly in this person. This is not theory: stages A, B and C were observed in a young person over 6 years. Only stage D was developed prospectively with artificial intelligence.

A: Externally unremarkable leg; ultrasound shows three venous valves in the thigh that do not close tightly. Blood flow still appears normal. The typical venous valve gap is shown below the leg sketch.

B: The venous valve gaps have become significantly larger. There is now a slight backflow of venous blood (red arrow), a first serious sign of venous insufficiency.

C: The venous valve gaps have grown larger still, and significant bulges (ectasias, pathologically enlarged diameter) have formed nearby. The pathological backflow has increased and the affected vein segment is considerably longer. In the lower leg the first small varicose veins are now appearing, at the age of 23.

D (simulation): At 40 years of age — if no therapy is finally undertaken — many and quite large varicose veins will be visible, especially on the lower leg. The origin of the disease (venous valve defect) will still be clearly recognisable. Up to this stage the damage is still curable. After that, chronic damage begins.

If you want to know what applies to you, make your appointment with us in Zurich now.

Varicose veins are superficial veins that bulge and twist, becoming tortuous. The German word ought to be “Krummader” (crooked vein), which is in fact the origin of “Krampfader”. Some people assume it has to do with leg cramps, but that is only occasionally the case, when the electrolyte balance is disturbed by long-standing venous congestion or for other reasons. The medical terms for varicose veins are “varix” or “varices”, and the presence of varices is called “varicosis”.

Varicose veins are diseased veins, whether large or small. The vein walls are damaged by structural and biochemical changes; the blood flow within the varicose vein is abnormal, running intermittently or constantly in the wrong direction; and the course of the condition is unfavourable, because without considered measures it will worsen slowly but very surely over years and decades. Every large varicose vein began as a small one.

Medical professionals distinguish between truncal varicosis, varicose veins arising from the large collecting veins (vena saphena magna or parva); branch varicosis, arising from side branches of those collecting veins; reticular varices (Lat. rete = net) for net-like, mostly smaller varicose veins; and spider vein varicosis for the finest vein dilatations at skin level with their characteristic pattern. If varicose veins reappear in the same place after treatment — usually following surgical procedures — this is referred to as recurrent varicosis.

The good news is that varicose veins no longer have to be a problem today. At our clinic in Zurich they can be removed easily, safely and with good long-term results. Just as they appeared, they can disappear again within a short time.

Varicose veins can be seen. Their cause, however, is hidden and always lies deeper in the tissue. The consequence is clear: if the cause is not properly identified, any therapy will bring only temporary relief.

In the past, attempts were made to understand vein function by measuring venous pressures and pumping capacity (plethysmography), and later with Doppler probes (ultrasound without imaging). Today these examinations play only a supporting role. Phlebography, an X-ray examination using contrast medium, was also common; today it is needed only in rare cases, for example for varicose veins deep within the abdominal cavity.

By far the most important role is played by ultrasound examination (sonography). It allows us to look deep into the tissue, and almost everyone is familiar with it today. All modern systems offer a colour mode (colour Doppler, colour duplex) in which blood flow is displayed in colour and true to life. A doctor who takes the time will gladly explain your venous system to you during the examination. Using ultrasound, your doctor at the angioclinic® Vein Center Zurich can tell you a great deal more: where your condition originates, which veins require treatment and which can be preserved, which preventive measures are advisable, and how the best aesthetic result can be achieved.

An ultrasound examination is only ever as good as the knowledge of the doctor performing it. If it is carried out with the patient lying down only, roughly 30% of findings can be clarified. Standing raises the rate of correct findings to around 60% — this is classic training. And if the examiner is versed in specific manoeuvres that simulate your everyday strain, up to 80% of findings are diagnosed correctly. The missing 20% show plainly why many treatments still fail to satisfy today. A traditional surgeon will always think of operating first and overlook many modern options. The physics of the venous system is extremely complex, and every local change a doctor makes during treatment alters the system as a whole. There are only a handful of ultrasound specialists worldwide whose venous diagnostics are consistent in more than 95% of cases and therefore lead to optimal therapy. At our Vein Center in Zurich, we have such specialists.

Diagnostics has clear objectives, and every patient should know and understand them:

It is about identifying and closing off even the small, often overlooked sources, and doing so with as little bruising or later discoloration as possible. It is an “art” that requires decades of practice, especially with the most modern ultrasound systems, to inject a precisely dosed sclerosing foam so accurately that every local cause of the venous disease is covered while not a single centimetre of healthy vein is lost. The angioclinic® version of microfoam sclerotherapy is absolute high-tech and is combined as needed with laser applications (“LOVE”, “CLaCS” and other special techniques). Conventional sclerotherapy, by contrast — whether liquid or foam — mostly consists of blind injections, often painful and often imprecise. The effect is never right: either too strong, with later inflammation, or too weak, with no effect at all.

Surgical removal of small varicose veins, still so often performed in Switzerland, should be rejected, as the veins are torn out traumatically and in an uncontrolled manner. Skin nerves can be damaged, and bleeding, wounds and infections can occur. There is another drawback: the causes often remain, so the varicose veins do not disappear properly or return quickly.

Enjoy the advances of the Dr. Ragg method:

Large varicose veins are those over 5 mm in diameter; from 10 mm they are called “very large”. But diameters of more than 20 mm are not uncommon either.

In the past it was taken for granted that such large, diseased veins had to be removed surgically. How else could they simply disappear? Today that is different, and Dr. Ragg explains how this “miracle” is achieved:

“Veins are like balloons: congested blood inflates them. They look huge, but 95% of the volume is simply blood, and that is needed more urgently elsewhere in the body. By treating the cause of the congestion we lower the venous pressure, and the varicose vein is gone. This result is stabilised with my Happy Veins strategy. We have compared every conceivable method — as shown here in the image. The result: the endovenous methods (ELVES laser, glue) are clearly better than surgery (‘ligatures’). With our techniques we provide the right impetus, and your body regulates the veins entirely on its own, as it should.”

Large varicose veins can therefore be eliminated completely without incisions, without anaesthesia, without injuries and without downtime. The only risks worth mentioning are small bruises, such as can also occur when blood is drawn, and minor discomfort during a few days of the recovery phase — not comparable to the frequent problems following conventional operations. More than 7,000 patients, including “difficult cases”, have been treated with this method since 2011.

Schedule an appointment now with Dr. Ragg at the angioclinic® Vein Center Zurich.

Even the most complicated leg can be treated fully and calmly for all vein problems — varicose veins or spider veins — in about 30 minutes at our Vein Center in Zurich, provided you have a highly trained team, as we do. Do take a look at a fine example under the telling name “Varicose veins gone in 30 minutes”.

Preparations are required, however, which can sometimes take more than a further 30 minutes. These include answering your questions before the procedure, a careful ultrasound examination with marking of important points on the skin, and hygienic preparation, so that we continue to have 0% infections.

Finally, special aftercare requests (e.g. Venartis C-Film instead of compression stockings) can take 5–15 extra minutes. So please allow 90 minutes for varicose vein treatments in Zurich, and 45 minutes for purely aesthetic procedures, and there will be no rush in your schedule.

If varicose veins are treated with modern endovenous methods instead of surgery — for example at our Vein Center in Zurich — there is virtually no stimulus for local vessel regrowth. The recurrences typical of surgery, with chaotic and hard-to-treat new formations of varices, affect about 40–65% of patients within 3 years. With modern methods, depending on their quality, recurrences after 3 years are observed in 15–58% of cases, so on average less often. Some procedures, such as the angioclinic® vein laser, which we use with great success in Zurich, show virtually no recurrences even after 12 years (< 6%). Vein problems sometimes worsen with each operation; after a good modern therapy they consistently diminish. The same applies to costs: a repeat operation is very expensive (hospital, anaesthesia), whereas a microfoam top-up is inexpensive and uncomplicated.

Dr. Ragg explains the decisive difference:

“After vein surgery the region is always more or less destroyed. Varicose veins are not embedded in tissue like spaghetti in a pot, where you simply pull them out. All connective tissue attachments, venous side branches and deep connections, small arteries, small nerves, lymphatic vessels and fascia suffer considerable damage from surgery. The region becomes scarred, the anatomy is completely altered, and new diseased veins often emerge like weeds from several sources. Operating again in a scarred area is a nightmare. It is completely different with modern procedures: there are no scars, the anatomy is unchanged, and a few drops of microfoam quickly restore the desired state.”

Every vein disease, as long as nothing is done about it, has a tendency to recur at some point – like tooth decay. Given a qualified annual check-up and, where needed, a mini-therapy with a few drops of sclerosing foam, every patient can be assured today that they will never have varicose veins again. This is not common knowledge, but Dr. Ragg’s experience from 25 years of vascular medicine in Zurich, Munich and Berlin. It corresponds to the exemplary and convincing experience you have hopefully already had with dental prophylaxis.

For purely aesthetic findings, such as spider veins, which can consist of thousands of tiny vessels, a few new ones can easily appear over time. Here the prognosis is that an aesthetic result once achieved can likewise be maintained with minimal annual effort. Compare it to a garden that is weeded regularly — it simply looks better kept.

If you want to know exactly what we can do for you, please make your appointment with Dr. Ragg now.

Early stages of venous insufficiency, with incipient varicose veins or even before they appear, receive appropriate treatment in Switzerland only in Zurich. We can say this because the necessary knowledge was developed by our teams. The early stages are where you cannot look — deep in the leg. The recognition of early venous valve changes is currently being published and taught worldwide by us. It is perhaps the most decisive discovery in the field of phlebology, because for the first time it provides a scientific basis for prevention and early therapy. We can show you the details of your veins and also find out why you personally are affected. Is it due to a congenital valve defect, to increased venous pressure, or to lack of exercise? Each cause requires a different approach.

Since there are often no or only minor visible changes, and usually no or only minor symptoms as yet, it is important to have a qualified diagnosis carried out at the slightest suspicion (spider veins, prominent blue veins, incipient varicose veins, mild swelling). Please note: only phlebologists with angioclinic® expertise in venous valve analysis should be considered, as the condition of the valves determines the type of therapy.

Small congenital valve defects and localised pressure overloads are optimally corrected by vein shaping with hyaluronic acid — a small injection, nothing more. A medically proven biogel surrounds the overloaded vein segment like an internal compression stocking, stabilising and normalising its diameter. The procedure is still young (first international competition win in 2013 in Boston, USA), but it uses extremely well-researched media (e.g. hyaluronic acid as used for wrinkle injections), and it is very successful, safe and very well tolerated. In Switzerland it is offered exclusively at our angioclinic® Vein Center Zurich.

For chronically reduced venous circulation (“congestion”, especially in standing and sitting occupations), targeted activation programmes according to Dr. Ragg are used: precisely those muscles are trained whose activity relieves the veins. The exercises require little time and can be integrated almost imperceptibly into daily life, yet they are highly effective. For people in sitting and standing occupations, light and fashionable compression stockings will also be recommended. What is special is that we can demonstrate the effectiveness with ultrasound. Patients only have to do what demonstrably helps them. Nobody needs to wear compression stockings “on suspicion” any more.

Compression stockings were prescribed to every vein patient in the past. Switzerland has a long and commendable tradition in the knowledge of compression treatment. Several powerful and globally renowned manufacturers of compression garments (e.g. Sigvaris and Salzmann-Medico) also come from Switzerland and produce there.

With modern knowledge about the development of venous insufficiency, varicose veins and spider veins (see Dr. Ragg’s ultrasound analyses), it becomes clear that every person has very different needs regarding their vein condition — depending on predisposition, muscle condition, the type of past and current physical activity, training status, metabolic factors and further influences.

Only on the basis of Dr. Ragg’s sonographic valve and tissue analysis can truly individual advice be given on the sense or futility of compression stockings. Good news: thanks to a patent by Dr. Ragg, all vein treatments at the angioclinic® Vein Centers can now be carried out without compression stockings. You can shower, bathe, swim or exercise immediately.

In Switzerland this is available only at the angioclinic® Vein Center Zurich. Vein patients today are active, well-informed and determined people, who can be coached on the prevention of vein problems just as successfully as dentists have achieved with tooth preservation. The rule: anyone who moves little and sits or stands a lot needs more support from compression garments than someone who moves a great deal in everyday life and above all walks a lot.

Compression stockings come in countless colours and materials, including special versions for rest periods, sport and air travel; most products no longer look medical at all. They are “functional stockings”. Tip: have Dr. Ragg and his team examine and advise you.

Vein treatments are offered in vein practices (specialties: vascular surgery, phlebology, dermatology, angiology) as well as in hospitals and vein clinics. I personally like one vein clinic very much, because its chief physicians are excellent vascular surgeons (I am happy to reveal the name in person). Standard care is guaranteed everywhere in Switzerland. The big BUT is that classic surgery — the more or less forceful tearing out of veins — is usually what is offered, typically under general anaesthesia, and that is simply no longer good enough today. Nobody wants cuts, wounds, injuries, bleeding or nerve damage if it is not absolutely necessary. Nobody wants to suffer pain or be absent from work unnecessarily. A very clear no to surgery: it is not necessary in a single case. And a no to general anaesthesia: it endangers the person even if they “come through” it. One more thing: we observe that simple sclerotherapy or “modern methods” are increasingly performed by very inexperienced practitioners, or that modern methods are carried out under general anaesthesia or combined with injurious, bloody and traumatising procedures (vein stripping, phlebectomy). So be careful with plain “radio waves”, “lasers”, “foam sclerotherapy” or “vein gluing” — the risk of wrong concepts, incomplete care and complications is high. In my opinion the best solution is our angioclinic® methodology in Zurich, because we can solve every vein problem with high-tech catheters or micro-instruments, under small local anaesthesia, pain-free and without complications. People go home with happy faces, gently treated legs and exemplary aesthetics. These are the most successful procedures worldwide, with assured quality and long-term experience, backed by the entire know-how of the largest clinic for endovenous vein therapy in Europe. I recommend informing yourself about all the options.

With a few questions you can roughly assess the quality of vein treatments, measured against international standards of modern vein medicine:

The prevention of varicose veins ought to be particularly easy in Switzerland, as the Swiss are much closer to nature than others. Simple rule: plenty of walking protects your veins from venous insufficiency. If you do not have venous insufficiency, you will not get varicose veins. Walking uphill or on level ground is better than downhill. Walk barefoot in the garden. Wear shoes that give you a feel for the ground and encourage a natural roll-off. Do 3 sets of 30 calf raises daily. Avoid conventional chairs that keep you immobile. If your job involves a lot of sitting or standing, protect yourself with lightly compressing stockings. But who needs exactly what? Dr. Ragg takes the time for you in Zurich and gives you an entirely individual recommendation whose success can be monitored with ultrasound measurements.

If you already have vein damage, training and compression stockings help only as much as brushing your teeth helps with tooth decay — only the healthy parts are protected, while the diseased parts inevitably get worse over time. Unfortunately, vein defects can exist for decades without external signs or symptoms, which is why early diagnosis is so important. If you want to prevent them, you need to be examined while you still feel 100% vein-healthy.

Regular vein coaching is as important as the annual dental visit. The good news is that prevention really is possible. Many people, including many doctors, do not know that varicose veins today are completely preventable. Dr. Ragg will gladly show you how to prevent venous insufficiency. Some patients avoid any intervention by changing their movement habits. Others protect themselves against a relapse after treatment through cleverly chosen measures. For every individual, prevention brings joy of life, vitality and a better future for their veins.

You can recognise a good vein clinic or practice, in Switzerland too, by whether it offers reliable concepts for preventing varicose veins and venous disorders. Treatment offers that are only about “repairs” should be avoided.

Good advice is not simple: the doctor must recognise to what extent heredity and congenital defects, strain, overload, daily habits and other factors lead to varicose veins or venous insufficiency in a given individual. Only then can an individual plan be drawn up. It is always about achieving the best effect with the least and most agreeable effort.

At our Vein Center in Zurich we have this knowledge, and in Dr. Ragg a proven expert in the early detection of vein disease.

Dr. Ragg: “I studied thousands of venous valves until it dawned on me that each one tells a story about its past. Some have gaps, some are too small, some show inflammation, some deposits, some are stuck together. Every story holds a key to the remedy. Now we are studying the benefit of preventive measures. This is entirely new. If someone has symptoms, they can know whether a measure relieves them or not. But prevention concerns the symptom-free stages, and until now one had to believe in the effect of stockings, pills or creams in order to keep it up. Today we can see and measure important effects with ultrasound, and people can learn how to prevent effectively.”

The cost of varicose vein treatment varies greatly depending on the stage of the disease, the task and the provider. A varicose vein operation in a hospital costs CHF 4,500 – 8,000, or even considerably more if both legs are affected. This is not only overpriced but fundamentally the wrong approach, with the unnecessary risks of anaesthesia, surgical opening of the body and tissue destruction (bleeding, nerve damage, thrombosis). Outpatient operations are cheaper, but equally pointless and not without risk, especially as emergency care is poorer than in a hospital. Modern procedures using laser or radiofrequency cost CHF 1,600 – 3,200 per leg, depending on the effort involved. Although we offer you the most modern and safest varicose vein treatment at our Vein Center in Zurich, you receive these services at the same price. Only special requests, such as vein glue or aesthetic procedures, involve a surcharge, which we discuss with you in advance.

NEW: In Switzerland, basic insurance has generally covered the costs of laser or radiofrequency treatment since 2016. After your examination you will receive a binding cost estimate to submit to your insurance company.

We often receive enquiries about how much a spider vein treatment costs. Quoting a price without knowing you and without an examination would not be serious. It could be a single 10-minute treatment costing CHF 120 for a small finding, or two or three sessions lasting up to an hour for legs covered with spider veins fed by deep sources, costing more than CHF 800 each. The cost depends on the number of areas to be treated, the anatomical complexity, and the time and material required. The safest way: show us your spider veins and varicose veins, and we can give you a tailored and binding cost estimate.

There are enormous differences in quality between treatments. We will explain what matters for you.

Feel free to schedule an appointment with us in Zurich now.