Venous blood outflow system from the lower limbs is consisted of three main networks. The superficial, which is visible under the skin, the deep, located under the muscles and the network of the vertical infiltrating veins, which binds the two previous networks. Vein disorders of the lower limbs are quite often, affecting 30% of the adult population. Chronic vein deficiency creates varices and dilated capillary vessels (spider veins) of the lower limbs.

Broken capillaries (spider veins)


Varices are the dilation of the superficial veins of the lower limbs, caused by malfunction of the venous valves, resulting to insufficient blood outflow. Normal venous valves function is one way flow, which means that they open allowing blood to return from the lower limbs to the heart and shut down if the flow is reversed, preventing that way the backflow of the blood. When these valves malfunction, blood backflows and remains inside the veins of the lower limbs, which by time widen and become malformed, causing several symptoms.

Broken capillaries (spider veins)

Broken capillaries or spider veins are dilated vessels of the skin which are easily seen under the epidermis. They represent at most an aesthetic problem, even though in some patients cause symptoms.
Symptoms caused by venous deficiency are:

  • Heavy feet and burning feeling
  • Oedema of feet and legs.
  • Itching and skin erosions.
  • Mild muscular spasms, myoclonuses and cramps.
  • Skin darkening and venous dilation.
  • Tibia ulcers, very difficult to heal.
  • Deep venous thrombosis and possible pulmonary embolism.

Diagnosis is based on the clinical findings and confirmed with the ultrasonography Doppler exam, which among other things gives us information for the situation of the deep venous network and the extend of the reflux. Treatment of venous deficiency has a wide range of potentials.

Treatment of varices and venous diseases

Conservative treatment

In mild venous deficiency, non-invasive techniques are applied, such as the special compressive socks of graduated pressure and the prescription of venotonic drugs.

Surgical treatment

In more serious cases of venous deficiency, surgical techniques are applied.

Surgical laser – Recently, in absolute harmony with the principles of minimally invasive surgery, endovascular laser treatment of the varices is applied. It is a modern, painless, minimally invasive technique which can replace the surgical excision of the major saphenous vein.

This technique is well tolerated, does not require general anaesthesia or hospital stay, it doesn’t include surgical incisions and is a method of choice for the most cases of varices.

Venous excision– It is a well-established surgical procedure for many years. It includes the excision of the major and minor saphenous veins, using very small, in fact invisible incisions. It is applied in cases where the laser technique is not applicable. In addition, using pinching incisions, every smaller remaining branches and penetrating veins are excised.

Broken capillaries, as well as very small varices can be locally treated with external laser or sclerotherapy (sclerosing agents injection), procedures not necessitating anaesthesia and performed in an outpatient fashion.

Haris D. Konstantinidis, MD – PhD

General Surgeon, Doctor of Aristotelian University Medical School

Chief Director of Robotic and Minimally Invasive General and Oncologic Surgery Department

Head of American Institute of Minimally Invasive Surgery (AIMIS) Robotic and Advanced Laparoscopic General Surgery Department

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