Varicose veins is a disease that affects people both in terms of complaints such as pain and cramps that affect our daily life, and especially in female patients, in terms of cosmetic appearance and psychological. Varicose veins can be treated in any season. Warm weather is not contraindication for  treatment . Since the treatment process and recovery in capillary varicose veins is long and excellent visual results are desired in the summer months, the treatment should be started in the autumn months when the weather starts to cool. The best time for (laser and similar) treatments is the winter and spring. The varicose veins that have formed do not decrease or disappear over time or by using any medication, on the contrary, they progress slowly. Compression stockings in routine use do not have a therapeutic effect, they are only used to reduce complaints and slow the course of the disease. In order to eliminate the varicose veins, you will definitely need to be treated at some point in our lives. Therefore, the earlier the diagnosis is made and the treatment is started, the simpler the procedure will be, the easier it will be to get results, the shorter the time we will live with varicose veins, the freer from varicose veins and related worries. The most common mistake we encounter regarding timing is procrastination after a decision has been made.

Sclerotherapy is the introduction of a chemical substance into the vein which irritates the lining of the vessel and this damage causes it to collapse.

Generally, it can be done in any season. However, the legs look worse due to temporary bleeding and bruises under the skin for a few weeks after sclerotherapy. In addition, it will be necessary to wear a bandage and then compression stockings for a few weeks after the procedure. For these reasons, it is more appropriate to perform sclerotherapy outside of the summer months.

The commonly used substance is condensed brine, sodium tetradecyl sulphate, or more often polydocanol . These are all sclerosing agents so called detergents. The substance given into the vein irritates the inner surface of the vein and initiates a reaction that will eventually leads to cell death and blockage of the vein. As a result of this reaction, the vein disappears within weeks.

The required dose and amount of medicine is given by entering the determined varicose with a suitable needle. Then, the bandage is wrapped to apply pressure on the varicose veins and after for a few days, compression stockings are applied. If the vein forming the source of the varicose is deep, the vein is determined by ultrasonography or special light sources and the injection is made.

When the foam obtained by mixing the drug used in sclerotherapy with air at a certain amount, and given into the vein, less side effects and higher success are achieved with less dosage of the drug.

In rare cases, if the drug gets leaks under the skin and the skin is thin, wound may occur in the skin. The wound may close in a few weeks, but scarring is possible.

In general, this differs from person to person, but an average of 2-4 sessions are required. People with multiple varicose veins require more treatment. If there is a small number of varicose veins, 1-2 sessions are sufficient.

There will be a slight sting with each injection. The burning sensation persists for a few seconds after the injection. Often patients can tolerate this pain without any special treatment. Most of the patients state that they feel less pain after the procedure than they expected. Local anesthetic creams are beneficial before the procedure in patients with advanced sensitivity.

Almost everyone can undergo sclerotherapy, except for pregnant or breastfeeding women. However, sclerotherapy is generally not performed in patients with skin infection, fever, uncontrolled diabetes, those who use anticoagulant therapy, and those who have had deep vein thrombosis.

You may have mild pain. Therefore, you can use any pain willers at home. There will be bruising and swelling at the injection site for a few days. Putting an ice pack will alleviate them. The bruises disappear completely within a few weeks. There will be no problem while walking, there will be no restriction in your daily activities.

Except for mild pain and bruises, sclerotherapy has no obvious side effects. If sclerotherapy is applied to larger varices, a clot may form in the varicose veins. Since the clot in varicosities is basically the same as thrombophlebitis, its healing is painful and time-consuming. For this reason, in patients who have a clot in varicose veins after sclerotherapy, this clot should be removed from the holes created with a needle or a sharp scalpel. In veins thicker than 2-3 mm, there may be slight color changes in the color of coffee with milk along the vein line where sclerotherapy is performed, some of them may become permanent, although their color gradually becomes lighter.

Because of the hormones and pregnancy. Hormonal changes that occur in women during pregnancy, the increased amount of fluid and the pressure of the baby on the main vein in the abdomen during pregnancy increase the pressure in the veins and cause the formation of varicose veins. Hormones, on the other hand, are effective by loosening the connective tissue of the veins. In addition, birth control pills can cause clot formation in the veins, and this causes the destruction of the valves in the long term, thus formation of varicose veins.

We are preparing our patient, whom we have previously diagnosed with Doppler ultrasonography and marked 1 day before the operation, for the operation with a slight stupor, which we call local anesthesia and sedation. advanced throughout. If the vein we intervene is the great saphenous vein, that is, the great superficial vein on the inner face of our leg, our laser catheter is advanced from a region below the knee to the region where our superficial vein flows into the main deep vein in the groin region. From here, it is pulled back 1-2 cm, which is the safe zone, and placed. If the vein to be ablated is the small saphenous vein, that is, the small superficial vein on our calf, on the back of the leg, the same procedures will be repeated, but this time the catheter will be placed in the appropriate place in the back of the knee, accompanied by ultrasonography. Following these procedures, that is, after the laser catheter is placed in the appropriate place, cold serum containing appropriate doses of adrenaline, bicarbonate, and local anesthetic, so called tumescent anesthesia, will be injected under the outer sheath of the vessel through the catheter. The purpose of this liquid application is to increase the effect of the laser by shrinking the vein with cold serum and to protect the surrounding tissue from the effects of thermal injury generated by the laser. 2- To limit possible bleeding with adrenaline 3- With local anesthetics, it is to ensure that you spend the hours following the surgery more painlessly and comfortably.

EVLT, i.e. Laser vein treatment, can be applied to patients with 3nd or 4th degree venous insufficiency, whose vessel diameter has exceeded 5.5 mm as a result of Doppler ultrasonography. Another point that should be considered is that EVLT treatment is guaranteed up to 12 mm in diameter. Although we can successfully close the vessels of higher diameter literature with additional measures and techniques, it should be kept in mind that the safe range is 12 mm and it should not be postponed too long.

• EVLT treatment; to those who are pregnant,
• Those with advanced arterial disease,
• Immobile patients,
• Patients with poor general condition,
• Patients with a life expectancy of less than 6 months,
• For patients with bleeding tendency.

It is not preferred to be applied, but the main topic that needs attention is the patients with deep vein thrombosis. Patients with a history of deep vein thrombosis, advanced venous insufficiency or even open wounds should be approached very carefully.

Although it is very rare compared to open surgery, which is the old method, there are minor side effects in EVLT, as in every interventional procedure.

• Feeling of withdrawal: After the procedure, some of the patients will have a feeling of pulling along the vein trace, which is burned with laser, and this will disappear within a few months when the leg and that area regain their elasticity. 
• Neurological complaints: Some of our patients may have symptoms such as drowsiness, electrification, hypoesthesia, or hyperesthesia. Since the vascular nerve bundle in our arms and legs is adjacent to each other, minor damage to our sensory nerves due to the heat of the laser may cause these complaints. It will disappear on its own within 3 to 6 months. Only patients with very advanced complaints can be supplemented with vitamin B.
• Phlebitis: A picture that can be seen with redness, tenderness, pain and temperature increase in the treated area can be seen in rare cases. It heals within a week with cold dressing, painkillers and antibiotics. 
• Bruising: Although rarely, bruises may occur in the treatment area along the vein. As with any bruise, it heals spontaneously within 1-2 weeks. 
• Deep vein thrombosis and pulmonary embolism: DVT and PE, a rare but feared complication after EVLT covid be life-threatening. Early mobilization and compression stockings are the best ways for protection. Rarely, elderly and lead a sedentary life or who will travel long distances in the early postoperative period may be prescribed anticoagulants
• Skin burns: Although it is a rare complication after EVLT, it is an annoying complication because it will not go away and will leave a scar. It can be easily avoided with a good tumescent anesthesia application and the use of high quality lasers.

The pain and complication rate of EVLT itself is extremely low. The main cause of pain in patients who have surgery is the process of removing the vessels that are cosmetically disturbing to you through the small holes so called miniphlebectomy after EVLT. Yes, these areas will be painful. And the complaints that bother you after the surgery will originate from these areas. However, you will have a very comfortable period after EVLT. Your hospital discharge will be with elastic bandages. The next morning, after removing your elastic bandage and showering, I will ask you to wear compression stockings for 20 days. Since early mobilization, absence of pain, pain and bleeding are among the biggest advantages of this treatment, you can go to work even the next morning if you wish. We can operate on Friday evenings or Saturdays for our patients who cannot take working leave, and then send them to their workplaces very comfortably on Monday. So you have no restrictions.

EVLT treatment is the most applied and most successful treatment method in the world for the last 20 years. Success rates of 94% and 98.5% are reported in the results published from different centers. With increasing experience and developing technology, success rates are increasing gradually.

In addition to its many advantages, the prominent advantages of EVLT treatment are: * No need for general anesthesia * No pain * No bleeding, no bruises * No scars * No stitches * The procedure is around 30-90 minutes depending on the number of vessels * There is almost no risk of infection.

Since there is an average of 100,00-150,000 km of vessels in our body, closing a diseased vessel will not do you any harm. The circulation will be diverted to new pathways outside the closed vessel, and even if there is a temporary edema, this will resolve itself within a few weeks. One of the most frequently asked questions in this topic is that this vein should be saved for a future coronary bypass surgery, which is why we don’t use sick veins for this purpose, so you don't need this vein.

Since the patients remained immobile after classical, (open) surgeries, and the risk of deep vein thrombosis and pulmonary embolism is high, it is not preferred to perform open surgeries on both legs. However, since early mobilization is possible with the EVLT method, both legs can be operated easily in the some session and there will be no problems.

There is no significant preparation before EVLT. As with any patient entering the operating room, an anesthetic examination and a small blood test panel are required. Apart from this, the most important point to be considered is hunger and thirst for 8 hours, as in every patient, before entering the operating room. For male patients, it is also necessary to shave from the navel region down.

After EVLT treatment, which has a success rate of over 94% and 98,5%, repetition is almost non-existent with the developing technology and our increasing experience. Recurrence is actually very rare in venous diseases. However, due to your genetic predisposition, our blood vessels that are healthy today are more likely to get sick over time.

Since EVLT treatment is classified as inpatient treatment in the guidelines, YES is fully covered by private insurances.

Although EVLT is a very successful treatment method with a very low complication rate, although there is a rare risk of deep vein thrombosis, when there is an unexpected redness, temperature increase, tenderness in your leg, or a sudden swelling, exaggerated pain, tension feeling in the leg or When you have shortness of breath, you should contact your doctor immediately.

Like the EVLT treatment itself, the post-operative period will be very comfortable and enjoyable. You can continue your normal life without any restrictions. I recommend antibiotics and anti-inflammatory for 3 days. Apart from this, you will use compression stockings for 20 days.

Unlike classical, open surgery, EVLT treatment is an outpatient treatment. There is no hospitalization. The total time you will spend in the hospital will be around 5-6 hours, after this surgery we performed with local anesthesia and sedation, you will be at home within 2-3 hours after you go to your room.

Compression stockings, known as they are known, are aids developed to apply pressure to your legs. The pressure created will help regulate your circulation, thereby reducing your pain and edema. In general, the pressure, which is at the highest level around the ankle, decreases gradually as you go up. The good news is it's no longer in the thick brown nylon canvas form your grandmother used to use. With the developing technology, thin, beautiful, even fashionable socks are available. The stockings on the market are available in different forms and colors as below the knee, above the knee, crotch and pantyhose.

As we explained in the formation of varicose veins, unfortunately, the venous system lacks a heart and has to move passively upwards towards the heart against gravity. For this reason, there are valves in our veins. The blood will not return to the heart at a sufficient level in vein and valve dysfunctions that occur in cases of insufficiency. Instead, it will be pooled in the leg, wrist and foot. Compression stockings will support your leg health by providing a suitable, constant and continuous pressure at this stage. Thanks to the applied external pressure, the blood will move more easily in the vein, the circulation will be improved and the ponding in the legs will be prevented. In this way, ponding and the edema it causes, heaviness in the legs, fatigue and pain will disappear.

If you are in a risk group, that is, if you have one or more of the following, we recommend that you consult your cardiovascular surgeon and use compression stockings.

• If you have a family history
• Female gender
• Fertility
• Obesity
• Over 60 years old
• Pregnancy
• Lack of physical activity
• Sitting for long periods of time
• Working for long periods of time.

It is recommended not only for those in the risk group, but also for leg swelling, long journeys, athletes to protect or reduce pain.

Compression stockings are the simplest protective method that can be easily found everywhere and affordable for the risk group or diagnosed patients. However, one of the important points is that they should be properly pressurized and used consciously. For this purpose, I will seek answers to a few frequently asked questions.

Your doctor will give you the most suitable socks. The socks you receive should wrap the foot, ankle and leg well. It should not be wrinkled, it should be folded. Especially below the knee, above the knee and in the crotch type socks, as the folds from the upper elastic area are very common, they should definitely be avoided. Because such curls disrupt your circulation and harm you as well as removing the socks from its purpose. Unless your doctor recommends otherwise, compression stockings are normally worn before getting out of bed in the morning, after your legs are lifted to the wall and emptied in the direction of gravity for a few minutes, they stay on the leg all day and are removed when we lie down.

Compression stockings are measured with pressure, ie mmHg. Low numbers indicate low pressures and high numbers indicate high pressures. Your doctor will determine the socks that are suitable for you for your intended use. If your intended use is a previous deep vein thrombosis or a high risk of deep vein thrombosis, a high pressure stocking will be recommended to you. Antiembolic stockings with the highest pressure will be recommended after long hospital stays and major surgeries. If our intended use is varicose veins, that is, chronic venous insufficiency, the socks we will prefer will be medium pressure socks. Socks, which we call resting or low pressure, will be given to patients who do not have a diagnosed disease and have symptoms similar to venous insufficiency.

Stockings according to pressure degrees:

• Low grade (8-15 mmHg) is recommended for those who stand for a long time, pregnant women, and those with mild leg edema.
• Medium stockings (15-20 mmHg) are suitable for the relief or prevention of complaints in this group, patients with venous insufficiency. It is recommended for long-term travel, patients at risk of DVT and after venous surgeries.
• High-pressure stockings (20-30 mmHg) are recommended for patients with orthostatic hypotension, as well as for patients with severe edema or DVT after some venous surgeries.
• Extra tight stockings (30-40 mmHg) can also be used for severe venous insufficiency, edema, DVT risk, orthostatic hypotension.
   

The answer to this question is definitely NO. Compression stockings are not curative for venous insufficiency. Its main purpose is to relieve complaints, slow down the course of the disease and increase the quality of daily life. Compression stockings have absolutely no therapeutic effect.

The answer to the question is also NO. If you have one of the following diseases or complaints, you should definitely consult your doctor.

• Congestive heart failure
• Septic phlebitis
• Advanced arterial disease and circulatory disorders in the legs
• Skin infections
• Peripheral neuropathy
• Allergies
• Dermatitis

The most preferred type of socks is below the knee. Studies have shown that knee-high socks are sufficient for protective purposes. However, if you have a widespread insufficiency diagnosed by ultrasonography along the entire leg, it is also beneficial to wear crotch type or pantyhose. Take your socks in line with the recommendations of our doctors.

The answer to this question is definitely YES for patients in the risk group and with ultrasonography-proven venous insufficiency. In the worst case scenario, you can wear your daily socks recommended by your doctor, as there are compression stockings specially manufactured for sports purposes.

Do not forget, compression stockings are a medical product and are adjusted for pressures that decrease from the ankle upwards. For this reason, they should be washed carefully and with care. When I tell these to my patients, I say you should wash them like you would a sweater. In other words, it should be washed in warm water with gentle movements without rubbing it, and it should be dried at room temperature, without wringing it too much, by laying it on a towel as if drying a sweater. It should never be dried in a dryer, heater or under the sun. In applications made in this way, the compression stocking will immediately lose its feature and its life will be shortened, so you will not be able to notice it, since nothing appears to have changed. Regardless of the conditions used, I recommend my patients to buy 2 socks for washing and to change them every 6 months.