Last Updated: 2023-07-07

Author(s): Anzengruber F., Navarini A.

ICD11: BD74.1Z

Varicose veins, spider veins, varicosis, varicose veins, reticular varicose veins, varicose veins.

Due to degenerative disease of the vein walls, pathologically dilated epifascial veins occur, mostly in the course of the great and parietal veins.

  • Women > men
  • There are different data regarding the incidence. It can be assumed that about 1/3 of the population suffers from relevant varicose veins. There is a marked increase with age. The first symptoms can already occur from the age of 20.

  • Primary varicosis: degeneration of the vessel wall
  • Secondary varicosis: vessel wall caused by another disease.
    • Valvular agenesis
    • AV fistulas
    • Klippel-Trénaunay syndrome
  • Teleangiectasias: Dilatations of the subpapillary intradermal venous plexus caused by localised venous hypertension or primary vascular wall weakness.
  • Reticular varicosities: Reticular areas with broom tears appearing on the lateral upper or lower thigh and in the popliteal fossa.
  • Trunk varicosities: Varicose change of the great saphenous vein. saphena magna (80–85%) or V. saphena parva (15–20%).
  • Side branch varices: arising from the branches of the Vv.saphenae.
  • Perforan veins:  Insufficiency of the Boyd or Dodd perforan vein can lead to varicosis.
  • Pregnancy varicosis: Mostly reversible, occurring during pregnancy (in approx. 1/3 of first-time mothers, in 2/3 of multiparous women.

Severity according to Widmer/Partsch

Varices Subjective complaints (pruritus, feeling of heaviness, dysaethesias, swellings) Hypostatic eczema, hyperpigmentation,  Atrophies Ulcers
Grade 1 + - - -
Grade 2 + -. -
Grade 3 + + -
Grade 4 + + + +


  • Due to remodelling processes, there is a decrease in contractile capabilities, vasodilation and eventually valvular regurgitation.
  • Predisposing factors
    • Genetics
    • Increasing age
    • Stagnation
    • Pregnancy
    • Adiposity
    • Familial disposition (genetic factors)
    • Hormones

  • Depending on the clinic, telangiectasia to dilated vessels may be visible
  • Division according to Hach
    • V. saphena magna
      • Grade I: Insufficiency of the crosse (reflux up to approx. hand width below the groin)
      • Grade II: Insufficiency of the crosse (reflux up to hand width  above the knee)
      • Grade III: Insufficiency of the crosse (reflux up to below the knee)
      • Grade IV: Insufficiency of the crosse (reflux up to the ankle)
    • V. saphena parva
      • Grade I: Insufficiency of the crosse at the sluice valve/incision site.
      • Grade II: Insufficiency of crosse to mid US.
      • Grade III: Insufficiency of crosse to lat. ankle.

  • Anamnesis
  • Phlebological examination
  • Doppler sonography
  • Duplex sonography
  • Light reflection rheography

  • Chronic venous insufficiency
  • Variceal haemorrhage
  • Thromboses

  1. Agu, O., et al., Endothelin Receptors in the Aetiology and Pathophysiology of Varicose Veins. European Journal of Vascular and Endovascular Surgery, 2002. 23(2): p. 165-171.
  2. Baccaglini, U., et al., Consensus Conference on Sclerotherapy of Varicose Veins of the Lower Limbs, in Phlebology ’95. 1995, Springer Science + Business Media. p. 604-605.
  3. Barrett, J.M., et al., Microfoam Ultrasound-Guided Sclerotherapy of Varicose Veins in 100 Legs. Dermatologic Surgery, 2004. 30(1): p. 6-12.
  4. Beebe-Dimmer, J.L., et al., The Epidemiology of Chronic Venous Insufficiency and Varicose Veins. Annals of Epidemiology, 2005. 15(3): p. 175-184.
  5. Bergan, J.J., Ambulatory phlebectomy: A practical guide for treating varicose veins. Journal of Vascular Surgery, 1995. 22(4): p. 510-511.
  6. Bradbury, A., et al., What are the symptoms of varicose veins? Edinburgh vein study cross sectional population survey. BMJ, 1999. 318(7180): p. 353-356.
  7. Butie, A., Clinical Examination of Varicose Veins. Dermatologic Surgery, 1995. 21(1): p. 52-56.
  8. Darke, S.G. and S.J.A. Baker, Ultrasound-guided foam sclerotherapy for the treatment of varicose veins. British Journal of Surgery, 2006. 93(8): p. 969-974.
  9. Darvall, K.A.L., et al., Higher prevalence of thrombophilia in patients with varicose veins and venous ulcers than controls. Journal of Vascular Surgery, 2009. 49(5): p. 1235-1241.
  10. Garde, C., Cryosurgery of Varicose Veins. The Journal of Dermatologic Surgery and Oncology, 1994. 20(1): p. 56-58.
  11. Goldman, M.P., Intravascular lasers in the treatment of varicose veins. J Cosmet Dermat, 2004. 3(3): p. 162-166.
  12. Goldman, M.P., R.A. Weiss, and J.J. Bergan, Diagnosis and treatment of varicose veins: A review. Journal of the American Academy of Dermatology, 1994. 31(3): p. 393-413.
  13. Guex, J.-J., Sclerofoam for Treatment of Varicose Veins, in The Vein Book. 2007, Elsevier BV. p. 201-207.
  14. Jukkola, T.M., et al., The effects of parity, oral contraceptive use and hormone replacement therapy on the incidence of varicose veins. Journal of Obstetrics and Gynaecology, 2006. 26(5): p. 448-451.
  15. London, N.J.M., ABC of arterial and venous disease: Varicose veins. BMJ, 2000. 320(7246): p. 1391-1394.
  16. Marley, W., Fading Rate of Pigmentation Induced by Sotradecol for Sclerotherapy of Varicose Veins, in Phlebology ’95. 1995, Springer Science + Business Media. p. 618-618.
  17. Nishibe, T., Stripping operation with preservation of the calf saphenous veins for primary varicose veins: hemodynamic evaluation. Cardiovascular Surgery, 2003. 11(5): p. 341-345.
  18. Orbach, E.J., Sclerotherapy of varicose veins. The American Journal of Surgery, 1944. 66(3): p. 362-366.
  19. Pfisterer, L., et al., Pathogenesis of varicose veins - lessons from biomechanics. Vasa, 2014. 43(2): p. 88-99.
  20. Raju, S. and P. Neglén, Chronic Venous Insufficiency and Varicose Veins. New England Journal of Medicine, 2009. 360(22): p. 2319-2327.
  21. Rautio, T., et al., Endovenous obliteration versus conventional stripping operation in the treatment of primary varicose veins: A randomized controlled trial with comparison of the costs. Journal of Vascular Surgery, 2002. 35(5): p. 958-965.
  22. Raymond-Martimbeau, P., Technical Feasibility and Early Results of Radiologic-Guided Foam Sclerotherapy for Treatment of Varicose Veins. Dermatologic Surgery, 2011. 37(8): p. 1196-1197.
  23. Ruckley, C.V., Varicose Veins and Telangiectasias — Diagnosis and Treatment. J. J. Bergan and M. P. Goldman (eds). 261 × 185 mm. Pp. 448. Illustrated. 1993. St Louis, Missouri: Quality Medical Publishing. £104. British Journal of Surgery, 1994. 81(3): p. 477-477.
  24. Sadick, N.S., Treatment of Varicose and Telangiectatic Leg Veins with Hypertonic Saline: A Comparative Study of Heparin and Saline. The Journal of Dermatologic Surgery and Oncology, 1990. 16(1): p. 24-28.
  25. Sadick, N.S., Sclerotherapy of Varicose and Telangiectatic Leg Veins: Minimal Sclerosant Concentration of Hypertonic Saline and Its Relationship to Vessel Diameter. The Journal of Dermatologic Surgery and Oncology, 1991. 17(1): p. 65-70.
  26. Sadick, N.S. and H. Schanzer, Combined High Ligation and Stab Avulsion for Varicose Veins in an Outpatient Setting. Dermatologic Surgery, 1998. 24(4): p. 475-479.
  27. Stansby, G., Women, pregnancy, and varicose veins. The Lancet, 2000. 355(9210): p. 1117-1118.
  28. van der Velden, S.K., et al., Management Strategies for Patients with Varicose Veins (C2–C6): Results of a Worldwide Survey. European Journal of Vascular and Endovascular Surgery, 2015. 49(2): p. 213-220.
  29. Weiss, M.A., Sclerotherapy: Treatment of Varicose and Telangiectatic Leg Veins. Arch Dermatol, 1997. 133(1): p. 117.
  30. Weiss, R.A. and M.P. Goldman, Endovenous Ablation Techniques with Ambulatory Phlebectomy for Varicose Veins, in Surgery of the Skin. 2010, Elsevier BV. p. 589-600.
  31. Weiss, R.A. and M.A. Weiss, Continuous Wave Venous Doppler Examination for Pretreatment Diagnosis of Varicose and Telangiectatic Veins. Dermatologic Surgery, 1995. 21(1): p. 58-62.
  32. Weiss, R.A. and M.A. Weiss, Controlled Radiofrequency Endovenous Occlusion Using a Unique Radiofrequency Catheter Under Duplex Guidance to Eliminate Saphenous Varicose Vein Reflux. Dermatologic Surgery, 2002. 28(1): p. 38-42.
  33. Wolf, M.A.X., LICHEN AMYLOIDOSUS ASSOCIATED WITH VARICOSE VEINS. Arch Dermatol, 1953. 67(4): p. 407.
  34. Kahle, B. and M. Stücker, Diagnostik und Therapie der Varikosis. Aktuelle Dermatologie, 2009. 35(06): p. 243-255.
  35. Lorenz, M.B., P. Gkogkolou, and T. Goerge, Sklerotherapie der Varikosis in der Dermatologie. JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2014. 12(5): p. 391-394.
  36. Nüllen, H., T. Noppeney, and W. Lang, Chirurgie der Perforans-Varikosis, in Diagnostik und Therapie der Varikose. 2010, Springer Science + Business Media. p. 329-342.
  37. Schultz-Ehrenburg, U., G. Gallenkemper, and A. Miller, Diagnostik der chronischen venösen Insuffizienz und Therapie der Varikosis, in Dermatologie an der Schwelle zum neuen Jahrtausend. 2000, Springer Science + Business Media. p. 613-615.