How Do Varicose Veins Develop?

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

This is certain knowledge: Varicose veins develop always on the basis of a vein weakness. A vein weakness 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 already develop their first varicose veins between the ages of 16 and 20. Varicose veins thus develop silently and secretly over at least 15 years, during which something could have been done about them long ago. The term “Krampfader” (varicose vein) descriptively comes from “krumme Ader” (crooked vein) and initially has nothing to do with cramps.

Everything else you read, e.g. heredity (genetics), hormonal factors (pregnancy) and lack of exercise, is not the cause. These are merely accompanying factors (medically: cofactors) of vein weakness that cause the disease to worsen more slowly or quickly. However, none of this has anything to do with the cause. Varicose veins do not develop in a healthy body. Varicose veins always arise from diseased, usually deeper-lying and therefore invisible veins.

Varicose veins are almost always based on congenital venous valve defects. Over the course of life, the daily stresses 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 (feeling of congestion or heaviness) can occur. In the case of common congenital venous valve defects, the veins are overfilled. As soon as the person takes a few steps or elevates their legs for rest at night, the venous condition normalizes. Therefore, this is still a seemingly healthy stage.

If periods of stress accumulate and regeneration is too short, the stage of overload follows. The characteristic is that one or more venous valves can no longer hold the blood volume at all, but allow it to flow backward to a greater extent. Now it is a disease, which, however, can only be observed for a few hours a day and possibly only during work. If you go to the doctor early in the morning, they will find nothing. This stage is still fully reversible, but currently 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 venous valves prevent backflow. If too much blood accumulates in the veins, the valve regions overstretch and no longer close. Now we are no longer dealing with stress or overload, but with a vein weakness. The physician calls it “venous insufficiency” or “vein insufficiency”. So, a vein weakness is not an unfavorable 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), but now it will require small minimally invasive procedures, e.g. injection venoplasty or vein laser.

Only the last stages are characterized by a pronounced vein weakness After decades of steady deterioration, disturbances in venous metabolism and blood flow are now so significant that they are no longer reversible without major interventions. It is the beginning of chronic disease. Some sections of the veins can no longer be preserved, and we must gently close them, of course without surgery. Most patients unfortunately only seek a doctor at this point because the symptoms are increasing, the varicose veins have become larger and unsightly, or the skin is already dry, reddened, or otherwise affected. The entire disease development could have been stopped decades earlier.

So remember:

1. Venous stress – normal

2. Venous overload – cause-related prevention is now important

3. Venous weakness, reversible in early stages

4. Venous weakness, no longer reversible in later stages (chronic)

Since 2016, we have been able to identify all processes at the venous valves that lead to their long-term destruction, thanks to the latest ultrasound technology! Such early diagnostics have never existed before! We can see from your venous valves whether compression stockings help you, whether your vein tablet works, 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 only one valve is defective, but three (collecting vein, great saphenous vein, right leg). Therefore, the disease spreads relatively quickly in this person. It’s not a theory! All stages A, B, and C were observed in a young person over 6 years. Only stage D was prospectively developed 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 vein weakness.

C: Now the venous valve gaps have become even larger, and significant bulges (ectasias, pathologically enlarged diameter) have already formed nearby. The pathological blood 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 recognizable. 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.