Frequently Asked Questions

A varicose ulcer, medically known as a venous ulcer, is a type of chronic wound that occurs due to the inadequate function of the veins in the legs. These wounds are usually seen in the lower part of the legs, especially around the ankle. Venous ulcers occur because of difficulties in returning blood from the legs to the heart. When the veins do not function properly, blood accumulates in the legs, leading to increased pressure inside the veins. As a result, the skin and surrounding tissues are damaged, which leads to the formation of a venous ulcer.

The main cause of venous ulcers is chronic venous insufficiency. This condition is characterized by the backflow of blood and its accumulation within the vein due to damage to the venous valves or their failure to function. The veins enlarge, swell, and exert pressure in a way that damages the surrounding tissues. Risk factors include age, obesity, a sedentary lifestyle, a history of venous thrombosis or trauma, a family history of venous disease, and prolonged standing.

The primary goal in the treatment of venous ulcers is to heal the wound and prevent recurrence. Treatment typically includes wound care, compression therapy, and interventions aimed at correcting the underlying venous insufficiency. Wound care involves cleaning the wound, protecting it with appropriate dressings, and reducing the risk of infection. Compression therapy helps reduce intravascular pressure using elastic bandages or compression stockings.

Various minimally invasive methods are available to treat the underlying venous insufficiency. These methods include laser treatment, radiofrequency ablation, Echosclerotherapy, and sclerotherapy. In addition, patients making lifestyle changes, maintaining weight control, exercising regularly, and avoiding prolonged standing are also important for treatment success.

The time to return to daily life after varicose vein treatment varies depending on the treatment method used.

With the closed, non-surgical treatments we perform, return to daily life is immediate. Hospitalization or rest is not required. On the contrary, we recommend plenty of walking and elevating the leg above heart level while resting.

Although an elastic bandage may be applied for 2–3 days after some treatments, walking is recommended. And again, bed rest is not necessary.

The treatment duration may vary from patient to patient. Factors such as each patient’s varicose intensity, type of varicose veins, depth of veins, and how many veins are impaired determine the treatment duration. This duration can be determined after examination and detailed color Doppler imaging.

Venous reflux or insufficiency is the backflow of blood due to the venous valves not functioning properly. Normally, these valves ensure one-way flow of blood and help pump blood upward against gravity. When the valves are damaged, blood flows backward and accumulates in the legs. In this case, varicose veins develop. In other words, venous insufficiency fundamentally underlies the formation of significant varicose veins.

Detection Methods

• Physical Examination: The physician evaluates signs such as swelling in the legs, discoloration, skin thinning, or ulcers.
• Doppler Ultrasonography: Sound waves are used to examine blood flow within the veins and check for reflux.
• Venography: A contrast agent is injected to visualize blood flow in the veins using X-ray.
• Color Doppler ultrasonography is a non-invasive method without side effects to detect venous insufficiency and is the method we prefer in our clinic.

What Should Be Done?

Lifestyle Changes:

• Exercising regularly
• Keeping the legs elevated
• Maintaining a healthy weight
• Avoiding prolonged standing still or sitting

Compression Therapy:

• Using compression stockings: These stockings improve blood flow by increasing pressure in the legs.

Medical Treatments:

• Laser Treatment: Varicose veins are closed with laser light.
• Radiofrequency Ablation: Varicose veins are heated and closed using radiofrequency waves.
• Medical Adhesive: An adhesive is injected into the varicose vein to close it.

Surgical Intervention:

• Stripping: Varicose veins are surgically removed.
• Phlebectomy: Varicose veins are removed through small incisions.

The appropriate treatment method for each patient varies depending on the severity of varicose veins, overall health status, and lifestyle. Therefore, it is important for individuals experiencing signs of venous insufficiency or reflux to consult a vascular surgeon or phlebology specialist.

Varicose vein surgeries are procedures performed to treat enlarged and visible veins. There are various methods of varicose vein surgery, each with its advantages and disadvantages. Here are the most common varicose vein surgery methods, how they are performed, and detailed information about when each method is preferred:

Varicose Vein Surgery Methods

• Stripping (Removal of the Varicose Vein)

The varicose vein is surgically removed from beneath the skin. The procedure is usually performed under general or spinal anesthesia. A guide wire is placed into the vein, and the vein is pulled out through this wire. Several incisions are typically made during the procedure. It is effective especially in the treatment of large varicose veins.

However, the recovery period is often longer and carries some risk of complications. Surgical scars may remain, and in some cases dimpling under the skin may occur.

• Laser Treatment (Endovenous Laser Ablation – EVLA)

A thin laser catheter is placed into the varicose vein, and the vein is heated with laser light. As a result of heating, the vein wall closes. It is a minimally invasive method performed under local anesthesia. During the procedure, a laser fiber is placed into the vein. However, some physicians may perform this procedure under spinal anesthesia or sedation anesthesia.

It is a less invasive method with a faster recovery period. The risk of complications is generally low and the cosmetic results are better. However, it may not be sufficient for large veins, and additional treatment may be required in some cases.

• Radiofrequency Ablation (RFA)

Heat is applied to the inside of the varicose vein with radio waves. The heat closes the vein by sealing the vein wall. It is performed under local anesthesia, and radiofrequency is delivered into the vein through a catheter. The procedure is minimally invasive, and the recovery period is fast. It generally carries low pain and complication risks. Compared to laser ablation, it can also be applied in some large veins.

• Medical glue or adhesive:

Varicose vein surgery with medical glue or adhesive is a minimally invasive treatment method using a special medical adhesive to close varicose veins. In this method, the adhesive is injected into the varicose vein to stick the vein walls together and stop blood flow. It does not require cutting or suturing, so the recovery time is short.

However, side effects such as allergic reactions, skin discoloration, or leakage of the adhesive outside the vein may occur. It may not be suitable for every patient, especially for very large or complex varicose veins. In large veins, reopening and the need to repeat the procedure may be a disadvantage. This method is newer compared to other traditional methods; therefore, long-term efficacy and safety data are limited.

Thanks to their minimally invasive nature, laser treatment and radiofrequency ablation generally offer faster recovery, more definitive results, and a lower risk of complications.

In conclusion, which method is more appropriate is determined based on the size and location of the varicose veins and the patient’s overall health status. A specialist vascular surgeon will perform a detailed evaluation to determine the most suitable treatment method for you.

In our clinic, Endovenous Radiofrequency or Laser treatments are applied to appropriate patients. Please contact us to make an appointment.

To provide information about varicose vein treatment fees, we must first examine you and perform a detailed color Doppler ultrasound. As a result of the ultrasound, a vein map of your leg is created and your treatment plan is determined. In addition, your varicose type identified during the examination, the intensity of varicose veins, their sizes, and any impairment in your deep veins determine the fee. Varicose vein treatment is personalized and determined specifically for each patient. For all these reasons, we first invite you for an examination and detailed color Doppler ultrasound. After this evaluation, all fees and sessions will be determined and communicated to you.

Varicose vein treatment prices are determined individually, as different methods will be applied to each patient. Prices can be determined after the initial examination and color Doppler ultrasound.

Sclerotherapy prices may vary depending on the size and extent of the varicose veins, how many sessions are needed, and the time allocated per session.
When determining foam treatment fees, the amount of medication to be used may vary depending on the patient’s age, the presence of comorbidities, and whether the patient has time constraints.

Capillary laser treatment prices may also vary depending on the density of the capillaries, how superficial or deep they are, and the presence of any other medications used.
Some capillary telangiectasias may require sclerotherapy, while others may require laser treatment. This can change the capillary vein treatment fees.

Endovenous laser and radiofrequency treatment prices vary depending on the type and quality of the catheter used, whether it is a thin or thick catheter, and how many nonfunctional veins are present in the same leg.

Not every laser or radiofrequency catheter has the same price. And this is determined according to the patient. For all these reasons, you should first make an appointment for an examination and detailed color Doppler ultrasound.

The price of the examination and detailed color Doppler ultrasound may vary in each clinic or hospital. The reason is the difference in the time allocated to the patient and the duration of the color Doppler ultrasound.

In our clinic, the examination and color Doppler ultrasound can take approximately 45–60 minutes. Therefore, after obtaining some information by phone from the patient, we can share this fee. Of course, we have standard fees, but even this fee may vary from patient to patient. Please contact us to learn this fee.

Of course, it can give us an idea. However, let us explain why you should prefer us to perform your ultrasound. In many hospitals, color Doppler is performed by a separate specialist, while your treatment is carried out by another specialist. This may cause some disadvantages. It is a natural process for the doctor who will undertake your treatment to review the color Doppler they performed themselves. It is not right to present you with treatment options, fee information, and number of sessions without examining you and performing your color Doppler ultrasound. In some hospitals, due to workload, color Doppler may take 5–10 minutes. In our clinic, this examination is performed in detail and takes between 25–45 minutes. Radiology departments in hospitals may be engaged in various ultrasound and other imaging methods.

Varicose veins usually occur due to the enlargement and swelling of the veins in the legs. However, symptoms of varicose vein disease can vary from person to person; in some individuals, symptoms may be mild, while in others they may be more pronounced. Some common symptoms that may indicate varicose vein disease are as follows:

• Visible Spider Veins: Thin veins in purple, blue, or red may be seen on the legs, especially behind the knees and on the back of the legs.
• Swelling: Swelling in the legs may occur, especially at the end of the day or after prolonged standing.
• Pain and Heaviness: There may be pain, a feeling of fullness, or heaviness in the legs. These symptoms usually increase during the day.
• Itching and Burning: The skin around varicose veins may feel itchy, burning, or tingling.
• Skin Discoloration: There may be discoloration of the skin around varicose veins.
• Night Cramps: Nighttime cramps in the legs are common.
• Tenderness and Pain: The skin around varicose veins may be sensitive and painful.

These symptoms are possible signs of varicose vein disease, but not everyone with these symptoms necessarily has varicose disease. If you experience one or more of these symptoms, it is important to consult a healthcare professional and evaluate your condition. A specialist doctor can diagnose varicose vein disease by performing imaging tests (e.g., ultrasound) if necessary and can help you by recommending appropriate treatment options.

No, the treatment of every varicose vein patient may not be the same. Varicose vein treatment requires a personalized approach based on the patient’s symptoms, venous structure, health status, and other individual factors. Methods used in varicose vein treatment may include:

• Compression Stockings (Support Stockings): Used to improve circulation and reduce symptoms in the legs.
• Sclerotherapy: The vein is closed by damaging its inner surface with an injected substance.
• Laser and Radiofrequency Ablation: Energy sources are used to burn or help close the vein.
• Surgical Interventions: In severe cases, surgical procedures may be required to remove large varicose veins.
• Phlebectomy: A surgical procedure to remove varicose veins through small incisions on the skin surface.

The treatment plan is usually determined by a phlebologist or vascular surgeon. The condition of the veins and the type of varicose veins are evaluated using a patient examination and, when necessary, imaging tests (e.g., ultrasound). Treatment may vary depending on the severity of symptoms and the size of the varicose veins.

Since every patient is different, personalizing the treatment plan is important. In some patients, symptoms can be controlled with lifestyle changes and the use of compression stockings alone, while others may require more intensive treatments. It is important to consult a specialist to make the best decision regarding treatment options.

One of the treatments recommended for varicose vein patients is the use of compression stockings or support stockings. However, this may not be the same for every patient. Compression stockings can help the blood accumulated in the legs return to the heart more effectively, which can alleviate varicose symptoms.

Compression stockings may provide the following advantages:

• Increasing circulation: Compression stockings can increase circulation in the legs and reduce the dilation and swelling of veins.
• Reducing swelling and pain: Compression stockings can reduce swelling and pain in the legs.
• Supporting venous structure: Compression stockings can support the structure of the veins and promote better blood flow.

However, wearing compression stockings is not always mandatory. This may vary depending on the patient’s condition and symptoms. A healthcare professional will decide whether to recommend compression stockings after evaluating the patient’s condition. In addition, it is important to determine the correct size and pressure level when selecting compression stockings.

It is important to discuss recommendations and decisions about wearing compression stockings with your doctor to create a treatment plan appropriate to your individual situation.

Sports suitable for varicose vein patients are generally low-impact activities that do not excessively strain the legs. Here are suitable sports for varicose vein patients:

• Walking: Regular walking strengthens the leg muscles and can increase circulation. However, it should not be overly strenuous.
• Swimming: Water provides gentle resistance to the body, which works the muscles without putting too much pressure on the joints and veins.
• Cycling: Riding a bicycle on low resistance and flat ground can strengthen the leg muscles and increase circulation.
• Yoga: Some yoga poses can increase blood flow in the legs and strengthen the leg muscles. However, overexertion should be avoided.
• Exercise bike: Using an exercise bike at low resistance can strengthen the legs and support cardiovascular health.
• Exercise in water, yoga, and massage: Gentle water movements can relax muscles and increase circulation.

Varicose vein patients should avoid overly strenuous sports, weightlifting, prolonged standing, and extremely hot environments, as these factors can exacerbate varicose symptoms. Also, it is always a good idea to talk to a healthcare professional before starting any exercise program.

Varicose veins are a condition that usually occurs in the legs and is often considered a cosmetic issue. However, if varicose veins are not treated, the condition may progress and symptoms may worsen over time. Possible problems that may arise if varicose veins are left untreated include:

• Pain and Discomfort: Varicose veins often cause symptoms such as pain, heaviness, and discomfort in the legs. If left untreated, these symptoms may increase. This can negatively affect the quality of daily life.
• Swelling: Varicose veins can cause swelling in the legs due to the dilation of the veins. If left untreated, the swelling may become more pronounced.
• Skin Problems: Circulatory problems caused by varicose veins can lead to changes in the skin. These changes include discoloration, itching, and dryness. Varicose veins can cause swelling and color changes under the skin. This can lead to itching, dryness, skin ulcers, and even infections.
• Ulcers: In advanced cases, varicose veins in the legs can damage the tissues under the skin and cause venous ulcers (wounds). These ulcers can be difficult to heal.
• Thrombophlebitis: Varicose veins can weaken the vein walls in the legs and lead to the formation of clots inside the vein called thrombophlebitis.
• Dermatitis: Changes in the skin due to varicose veins can sometimes cause inflammatory skin diseases called dermatitis.
• Venous ulcer wound: In untreated patients who develop dermatitis, skin integrity may deteriorate over time, leading to ulcerative wounds.
• Clot and Embolism: In patients who develop deep venous insufficiency and do not receive treatment, clots may form within the vein and pulmonary embolism may develop. This can be fatal. The slowing and pooling of blood in varicose veins increase the risk of blood clot formation. These clots can lead to a serious condition known as deep vein thrombosis (DVT). DVT can be life-threatening if the clot reaches the lungs.
• Bleeding: Superficial bleeding that occurs in varicose veins may recur if left untreated and lead to blood loss.

If left untreated, the likelihood of varicose veins leading to these complications increases. Therefore, it is important for individuals experiencing symptoms of varicose veins to contact a healthcare professional and evaluate appropriate treatment options. Treatment not only alleviates symptoms but also helps prevent potential complications.

Whether varicose vein treatment is performed during pregnancy may vary depending on the severity of the condition, symptoms, and the stage of pregnancy. Due to hormonal changes in the body during pregnancy and increased blood volume, vein dilation and varicose veins may be more common. However, treatment options should be evaluated carefully.

The following methods may be considered for varicose vein treatment during pregnancy:

• Compression Stockings: These stockings can alleviate varicose symptoms by increasing circulation in the legs. Their use during pregnancy is generally safe.
• Regular Exercise: Regular, low-impact exercise during pregnancy can strengthen the leg muscles and support the circulatory system.
• Balanced Nutrition: A healthy diet can prevent fluid retention in the body and reduce varicose symptoms.

However, some invasive treatment methods (for example, sclerotherapy or surgical intervention) may not be recommended during pregnancy, especially in the early stages. The risks and benefits of such treatments should be considered, and it should be discussed with a specialist whether they should be performed during pregnancy.

Women experiencing varicose symptoms during pregnancy should maintain open communication with their doctors about treatment options and determine the safest and most effective approach together.

Even if treatment is not started immediately in pregnant patients, treatment can be started 2 months after delivery. We still recommend examination and color Doppler ultrasound during pregnancy. Because if advanced deep venous insufficiency is detected, the mother may need protection, including against embolism-related death risk, due to the risk of clot and embolism. Pregnant women with varicose veins may be at risk throughout pregnancy and up to 1 month after delivery.

There is a risk of recurrence after varicose vein treatment, but this risk can be reduced with proper treatment and lifestyle changes. After treatment, it is important to take measures to support the circulatory system, maintain the elasticity of the veins, and prevent venous dilation. There are many veins in your leg. This does not indicate recurrence of the same varicose veins but the formation of new varicose veins.

The following steps can be taken after treatment:

• Compression Stockings: Compression stockings used as recommended by your doctor can support blood circulation in the legs and reduce the formation of varicose veins.
• Regular Exercise: Regular exercise strengthens the leg muscles and supports the circulatory system. Low-impact exercises such as walking, cycling, or swimming may be recommended.
• Healthy Diet: Adequate fiber intake and a healthy diet improve overall health and support vascular health.
• Weight Control: Excess weight can put extra pressure on the veins in the legs. Maintaining a healthy weight can reduce the risk of varicose veins.
• Regular Check-ups: Regular doctor check-ups are important after treatment. If symptoms reappear, early intervention can increase treatment success.

Varicose vein treatment can be effective in relieving symptoms and improving appearance, but it cannot completely prevent the formation of new varicose veins. Every patient is different, so it is important to work with your doctor to manage the post-treatment process.

The purpose of color Doppler ultrasound is to determine this. If there is a problem inside, other varicose veins may form. Therefore, we first solve the internal problem and then apply cosmetic treatment. The visible veins are the impaired ones, and we treat these impaired ones. Other veins may of course deteriorate in the future. However, if these are not treated, new ones will be added on top. Just as another tooth can decay even though you have treated a decayed tooth, the same situation applies.

Not every varicose vein patient needs surgery. Varicose veins are generally treated considering factors such as cosmetic concerns or the severity of symptoms. Non-surgical interventions used for varicose vein treatment include surgery, sclerotherapy, radiofrequency ablation, and endovenous laser ablation.

Surgery is usually considered in more advanced varicose veins or in cases that do not respond to other treatments. However, today many patients are offered effective and less invasive treatment options with non-surgical methods. Therefore, if varicose vein treatment is being considered, it is important to consult a specialist doctor and evaluate the condition. Every patient is different, and the treatment plan should be determined individually.

You can consult a cardiovascular surgery specialist at every stage of varicose vein treatment. However, not every cardiovascular surgery specialist may be specialized in varicose vein treatments. In addition to surgeons interested in cardiac surgery and peripheral arterial surgery, there are also physicians who have received special training in phlebology and varicose vein treatment and who provide treatment in this field.

However, most of these physicians unfortunately do not perform the color Doppler ultrasound themselves or conduct a detailed evaluation. Therefore, they refer their patients to a radiologist for color Doppler ultrasound and apply treatment based on the results obtained. At this stage, some problems may arise. Due to insufficient time allocated to color Doppler ultrasound, incomplete imaging due to workload, or errors in the imaging method, even if your surgeon has high manual skill, treatment may be incomplete or even incorrect.

In addition, some general surgery specialists can also perform varicose surgery, and similar problems may arise for these reasons. An even more serious situation is the surgical removal of varicose veins or the performance of sclerotherapy (foam treatment) without performing color Doppler ultrasound.

Some radiologists also perform varicose vein treatments. They perform the Doppler ultrasound themselves and apply laser, radiofrequency, and sclerotherapy treatments in patients who do not require surgery. However, there is another problem here. Considering that surgical intervention may be required in case of a rare complication, and that radiologists cannot perform this, delays in reaching a cardiovascular surgeon and situations such as bleeding and hematoma may lead to more serious complications.

In addition, some dermatologists, plastic surgeons, and even beauty centers can apply sclerotherapy or capillary laser to small capillaries without color Doppler ultrasound. However, this is a very critical mistake, and even if a result is achieved, the satisfaction will be very short-lived. Because if an underlying defective vein is causing these, they will recur in a very short time.

Op. Dr. İlker Zan is a vascular surgeon who has developed himself in the field of phlebology, has been performing only vascular treatments for many years, and can perform detailed color Doppler ultrasound himself. He is an experienced physician who can intervene even in very low-risk situations and can apply all incisionless and sutureless varicose treatment procedures under local anesthesia.

In our clinic, we apply up-to-date treatment methods without incisions, without sutures, under local anesthesia, and without requiring hospitalization. All of these reduce the risk of procedural complications and enable you to return to your daily life in a very short time.

Which method will be performed is determined after an examination and detailed color Doppler ultrasound. And a patient-specific choice is made. Every patient is different. According to the results obtained, the following treatment methods can be preferred:

• Sclerotherapy: A special drug (sclerosant) is injected into the varicose vein to close the veins. This method is generally suitable for small varicose veins and capillary networks. After treatment, the veins are gradually absorbed by the body.
• Laser Treatment: High-energy laser light is applied to the vein walls to heat and close the veins. Laser treatment is generally used for small capillaries. It is an effective option for superficial veins.
• Endovenous Radiofrequency and Laser Ablation (EVRF, EVLT, Endovenous Procedures): Heat is applied inside the vein using radio waves or laser to close the vein wall. This method helps close the veins by heating their interior and helps normalize blood flow. It is generally used for medium and large varicose veins. It can be performed under local anesthesia. There are no surgical sutures or incisions.
• Phlebectomy or Mini-Phlebectomy: Varicose veins are surgically removed through small incisions. It is generally used for large varicose veins and is performed under local anesthesia. The recovery period is generally fast. Sometimes sutures may be required.
• Foam Sclerotherapy: Sclerotherapy drugs are prepared in foam form and injected into the vein. The foam spreads over a wider area within the vein and provides more effective treatment.
• Complementary Treatment: In varicose vein treatment, supportive treatments such as compression stockings and lifestyle changes (e.g., regular exercise, weight control) are used. Compression stockings regulate blood flow in the veins and alleviate symptoms. They reduce the risk of complications.

Each treatment method has advantages and disadvantages, and the most appropriate treatment option is determined according to the type of varicose veins and the patient’s health status. A vascular surgery & phlebology specialist will carry out the necessary evaluations to create the most appropriate treatment plan.

All treatments in our clinic are applied without incisions and sutures, without hospitalization, and without anesthesia risks. Contact us for your first examination and detailed color Doppler ultrasound appointment.

• Using Compression Stockings

These are special stockings that increase blood flow in varicose areas and reduce swelling and pain. They should be worn daily, usually when you wake up in the morning, and in some cases even while still in bed. Compression stockings have various pressure levels; you can choose the one suitable for you by consulting your doctor.

• Exercising Regularly

Exercise increases blood circulation and reduces pressure on the veins in the legs.

Low-impact exercises such as walking, swimming, and cycling are recommended. These activities work the leg muscles and support the venous pump function.

• Keeping the Legs Elevated

Raising the legs above heart level facilitates the return of blood from the legs and reduces swelling. Keep your legs elevated on a pillow or similar support several times a day. Also, you can keep your legs slightly elevated while sleeping at night.

• Healthy Nutrition and Weight Control

A balanced diet helps with weight control and reduces pressure on the veins in your legs. You should consume fiber-rich foods, fresh fruits and vegetables, and whole grains. In addition, avoid excessive salt and processed foods.

• Cold Applications

Cold compresses can relieve discomfort in the legs. Washing the legs with cool water or applying a cold compress can increase blood flow and reduce swelling. Avoid hot baths and staying in hot environments for long periods.

• Choosing the Right Shoes

High-heeled shoes can adversely affect blood circulation in the legs. Comfortable shoes with supportive soles should be preferred. Wear shoes that are comfortable and suitable for your feet.

• Avoiding Inactivity

Prolonged standing still or sitting can worsen varicose veins. Avoid staying in the same position for long periods. Change position and move at intervals.

Important Notes

Regular Check-ups: See a healthcare professional regularly to monitor your varicose veins and evaluate changes in your symptoms.
Early Intervention: If your symptoms worsen or new symptoms appear, it is important to seek professional medical help.
These methods can help alleviate the symptoms of varicose veins, but professional medical intervention is required for serious varicose problems.

If you wait, the severity of your varicose veins and your complaints may progress, and undesirable complications (bleeding, clot, embolism, non-healing wounds) may develop. These recommendations are the ones you should pay attention to until you consult us and also after treatment. They do not replace treatment.