FAQ – Your Questions About Varicose Vein Treatment

They may look harmless, but varicose veins can become more than just a cosmetic issue. Left untreated, they can lead to skin changes, inflammation, or even open sores (called venous ulcers).

There’s also a higher risk of thrombosis (blood clots), especially with more severe vein problems. That’s why we always recommend having varicose veins checked out early – not just for how they look, but for your health.

Most patients enjoy long-lasting results after treatment – sometimes even for life. Once a vein is treated (closed), it doesn’t come back.

However, if you’re prone to vein issues, new varicose veins can develop over time, especially with risk factors like standing a lot, pregnancy, or weak connective tissue.

We’ll give you tips on how to protect your vein health long term – from exercise to compression wear. Regular check-ups also help catch anything early.

You should avoid direct sun exposure on treated areas for about 2 to 4 weeks. The skin can be more sensitive during healing, and UV light increases the risk of staining or discoloration.

If sun can’t be avoided: wear light clothing to cover your legs or apply high-SPF sunscreen (SPF 50+). After about 4–5 weeks, the skin is usually back to normal.

Surprisingly for many: it’s not painful at all. Laser treatment and sclerotherapy are minimally invasive and very well tolerated.

We use local anesthesia or cooling to numb the area. You might feel a little pulling or pressure – but no real pain. Most people don’t need painkillers. A walk, a cool compress, or light movement usually does the trick afterward.

Like any medical procedure, there are some risks – but with modern techniques, they’re very low.

Possible (but rare) side effects include:

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 ofrandom 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.

Varicose veins can be seen. The cause however, is hidden and always lies deeper in the tissue. It’s clear: If the cause is not properly clarified, any therapy will only provide temporary relief!

In the past, attempts were made to understand vein function by measuring venous pressures and pumping capacity (plethysmography), and later also with Doppler probes (ultrasound without imaging). Today, these examinations only have a supplementary character. Previously, a phlebography was often performed, which is an X-ray examination with contrast medium. Today, this is only necessary in rare cases, for example, for varicose veins deep in the abdominal cavity.

The most significant role is played by

the ultrasound examination (sonography). Generally speaking, it allows one to look deep into the tissue; almost everyone is familiar with this today. All modern systems offer a “color mode” (color Doppler, color duplex), in which blood flow is displayed in color and realistically. A friendly doctor will gladly explain your venous system to you during the examination. Using ultrasound, your doctor at angioclinic Vein Center Zurichmuch more: He can tell you where your condition originates from, which veins require treatment and which can be saved, what preventive measures are recommended, and how to achieve the best aesthetic result.

The quality of an ultrasound examination is only as good as the doctor’s knowledge: For example, if the examination is only performed while lying down, the doctor can only clarify about 30% of the findings. When standing, the rate of correct findings increases to 60% (this is classic training), and if the examiner is informed about specific maneuvers to simulate your daily stresses, they will correctly diagnose up to 80% of diagnoses. The missing 20% clearly show why many treatments still do not lead to satisfaction today. A traditional surgeon will always primarily think of operating, overlooking many modern possibilities. The physics of veins is extremely complex, and every local change made by the doctor during a treatment alters the entire system. There are only a handful of ultrasound specialists in the world whose venous diagnostics are consistent in more than 95% of cases, thus leading to optimal therapy. In our Vein Center in Zurich, we have such specialists.

Diagnostics has clear goals, and every patient should know and understand them:

It’s about identifying and closing off even the small, often overlooked sources and doing so with as little bruising or later discoloration as possible. It is an “art” that requires decades of practice especially with the most modern ultrasound systems, to precisely inject an exactly dosed sclerosing foam so that all local causes of the venous disease are covered and at the same time not a single centimeter of healthy veins is lost. The angioclinic® version of microsclerotherapy is absolute high-tech and is combined as needed with laser applications (“LOVE”, “CLaCS” and other special techniques). In contrast, conventional sclerotherapy, liquid or with foam, are mostly blind injections, often painful, often imprecise. The effect is never right – either too strong with later inflammation or too weak with no effect.

Precisely injecting an exactly dosed sclerosing foam so that all local causes of venous disease are covered and at the same time not a single centimeter of healthy veins is lost, that is an art that requires decades of practice, especially with ultrasound.

Surgical removal of small varicose veins, which are still so often performed in Switzerland, should be rejected, as the veins are traumatically and uncontrollably torn off. Skin nerves can be damaged, and bleeding, wounds, and infections can occur. Also bad: The causes often remain, and the varicose veins do not disappear properly or quickly return.

Enjoy the advances of the Dr. Ragg method:

Large varicose veins are those over 5 mm in diameter; from 10 mm in diameter, they are called “very large”. But diameters of more than 20 mm are not uncommon!

Previously, it was clear that such large, diseased veins had to be surgically removed. How else could they simply disappear? Today, that’s different, and Dr. Ragg explains how to achieve this “miracle”:

“Veins are like balloons: They are inflated by congested blood. They look huge, but 95% of the volume is simply blood, and that is more urgently needed elsewhere in the body. By treating the cause of the congestion, we lower the venous pressure, and the varicose vein is gone. This result is stabilized with my Happy Veins strategy (see also krampfadern-weg-in-30-minuten). We have all

conceivable methods – as shown here in the image. Result: The endovenous methods (ELVES laser, glue) are clearly better than surgery (“ligatures”). With our techniques, we provide the right impetus, and your body regulates the veins entirely on its own, as it should be.”

Thus, large varicose veins can also be eliminated completely without incisions, without anesthesia, without injuries and without downtime. The only risks to mention are small bruises, which can also occur during blood drawing, and minor discomfort during a few days of the recovery phase, not comparable to the frequent problems after conventional operations. With this method, more than 7,000 patients and “difficult cases” have already been helped since 2011.

Schedule an appointment now with Dr. Ragg at the angioclinic Vein Center Zurich.

Even the most complicated leg can be fully and thoroughly treated in our Vein Center in Zurich in about 30 minutes for all vein problems, such as varicose veins or spider veins, provided you have a highly trained team, as we do in Zurich. Please see a great example under the telling name Varicose veins gone in 30 minutes!

However, preparations are required, which can also take more than another 30 minutes to complete. This includes answering questions before the procedure, a careful ultrasound examination with marking of important

points on the skin and hygienic preparation, so that we continue to have 0% infections.

Finally, special aftercare requests (e.g., Venartis C-Film instead of compression stockings) can take 5–15 extra minutes. So please allow 90 minutes for varicose vein treatments in Zurich, and 45 minutes for purely aesthetic procedures, to ensure there’s no rush in your schedule.

If varicose veins are treated with modern endovenous methods instead of surgery, for example, at our vein center in Zurich, there is virtually no stimulus for local vessel regrowth. The recurrences typical of surgery, with chaotic and difficult-to-treat new formations of varices, affect about 40-65% of patients within 3 years. With modern methods, depending on their quality, recurrences after 3 years are observed in 15-58% of cases, meaning they are less frequent on average. Some procedures, such as the angioclinic® vein laser, which we use with great success in Zurich, have virtually no recurrences even after 12 years (< 6%). Vein problems sometimes worsen with each surgery; after a good modern therapy, they consistently diminish. This also applies to costs. A re-operation is very expensive (hospital, anesthesia), whereas microsclerotherapy

is inexpensive and uncomplicated.

Dr. Ragg explains the decisive difference :

“After vein surgery, the region is always more or less damaged. Varicose veins are not embedded in tissue like spaghetti in a pot, where you just need to pull them out. All connective tissue connections, venous side branches and deep connections, small arteries, small nerves, lymphatic vessels, and fascia suffer significant damage from surgery. The region becomes scarred, the anatomy is completely altered, and new diseased veins often emerge like weeds from multiple sources. It’s a nightmare to operate again in the scarred area! It’s completely different with modern procedures: there are no scars, the anatomy is unchanged, and a few drops of microsclerosing foam quickly restore the desired state.”

Every vein disease, as long as nothing is done about it, has a tendency to recur at some point – like tooth decay. Under the condition of a qualified annual check-up and, if necessary, a mini-therapy with a few drops of sclerosing foam, every patient can be assured today that they will never again have varicose veins get. This is not general knowledge, but Dr. Ragg’s experience from 25 years of vascular medicine in Zurich, Munich, and Berlin. It corresponds to the exemplary and convincing experience that you have hopefully already had with dental prophylaxis!

For purely aesthetic findings, such as spider veins, which can consist of thousands of tiny veins, a few new ones can easily appear over time. Here, the prognosis is that a once-achieved aesthetic state can also be maintained with minimal annual effort. Please compare this to a garden that is regularly weeded. It simply looks more well-maintained!

If you want to know exactly what we can do for you, please make your appointment with Dr. Ragg now !

Early stages of venous insufficiency, with incipient varicose veins or even before their appearance, receive treatment in Switzerland only in Zurich for appropriate treatment. We can say this because the necessary knowledge was developed by our teams. The early stages are where you cannot look – deep in the leg! The recognition of early venous valve changes is currently being published and taught worldwide by us. It is perhaps the most crucial discovery in the field of phlebology because it provides a scientific basis for prevention and early therapy for the first time. We can show you the details of your veins and also find out why you are personally affected. Is it due to a congenital valve defect, to increased venous pressure or to lack of exercise? Each cause requires a different approach.

Since there are often no or only minor visible changes and usually no or only minor symptoms yet, it is important to have a qualified diagnosis performed at the slightest suspicion (spider veins, prominent blue veins, incipient varicose veins, mild swelling). Caution: Only phlebologists with angioclinic® expertise are eligible for venous valve analysis, as the valve condition determines the type of therapy.

Small congenital valve defects and localized pressure overloads are optimally corrected by vein shaping with hyaluronic acid – a small injection, nothing more. A medically proven biogel surrounds an overloaded vein segment like an internal compression stocking, stabilizing and normalizing its diameter. This procedure is still new (first international competition win in 2013 in Boston/USA), but it uses extremely well-researched media (e.g., hyaluronic acid as used for wrinkle injections), is very successful, safe, and very well tolerated. It is offered exclusively in Switzerland at our angioclinic® Vein Center Zurich.

For chronically reduced venous circulation (“congestion”, especially in standing and sitting professions), targeted activation programs according to Dr. Ragg are used: Precisely those muscles are promoted whose activity leads to venous relief. The exercises require little time and can be integrated almost imperceptibly into daily life. Nevertheless, they are highly effective. For those in sitting and standing professions, light and fashionable compression stockings will also be recommended. The special thing is that we can prove the effectiveness with ultrasound. The patient only has to do what demonstrably helps them. No one needs to wear compression stockings “on suspicion” anymore.

Compression Stockings were prescribed to every vein patient in the past. Switzerland has a long and commendable tradition in the knowledge of compression treatments. Some powerful and globally renowned manufacturers of compression garments (e.g., Sigvaris and Salzmann-Medico) also originate from Switzerland and produce there.

With modern knowledge about the development of venous insufficiency, varicose veins, and spider veins (cf. Dr. Ragg’s ultrasound analyses!), it becomes clear that every person, due to their predisposition, muscle condition, type of past and current physical activities, training status, metabolic factors, and other influences, has very different needs regarding their vein condition.

Only after Dr. Ragg’s sonographic valve and tissue analysis can truly individual advice be given regarding the usefulness or futility of compression stockings. Good news: All vein treatments at angioclinic – Vein Centers can now be performed without compression stockings, thanks to a patent by Dr. Ragg. This means you can shower, bathe, swim, or exercise immediately.

This offer is available in Switzerland only at the angioclinic Vein Center Zurich. Today, vein patients are active, well-informed, and determined people who can be trained just as successfully on the prevention of vein problems as dentists have achieved with tooth preservation. Rule: Anyone who moves little, sits and stands a lot, needs more support from compression garments than someone who moves a lot in everyday life and especially walks a lot.

There are compression stockings in countless colors and materials, especially for rest periods, sports, and flights; most products no longer look medical. They are “functional stockings”. Tip: Let Dr. Ragg and his team examine and advise you.

Vein treatments are offered in vein clinics (specialties: vascular surgery, phlebology, dermatology, angiology) as well as in hospitals and vein clinics offered. I personally really like a vein clinic because the chief physicians are excellent vascular surgeons (I’d be happy to reveal the name in person). Standard care is guaranteed everywhere in Switzerland. The large BUT is that classic surgery (the more or less forceful tearing out of veins) is usually offered, typically under general anesthesia, and that is simply no longer good enough today. Nobody wants cuts, wounds, injuries, bleeding, or nerve damage if it’s not absolutely necessary. Nobody wants to suffer pain or be unnecessarily absent from work. A very clear No to surgery, it is not necessary in a single case. And a No to anesthesia, it endangers the person even if they “survive” it. One more thing: We observe that simple sclerotherapy or “modern methods” are increasingly being performed by very inexperienced practitioners, or modern methods are performed under anesthesia or combined with injurious, bloody, and traumatizing procedures (vein stripping, phlebectomy). So be careful with simple “radio waves”, “lasers”, “foam sclerotherapy”, or “vein gluing” – the risk of wrong concepts, incomplete care, and complications is high. In my opinion, the best solution is our angioclinic – methodology in Zurich, because we every vein problem can be solved with high-tech catheters or micro-instruments, under local anesthesia, pain-free and without complications. People go home with happy faces, gently treated legs, and exemplary aesthetics. These are the most successful procedures worldwide with assured quality and long-term experience, with the entire know-how of the largest clinic for endovenous vein therapy in Europe. I recommend learning about all options.

With a few questions, you can roughly assess the quality of vein treatments, measured against international standards of modern vein medicine:

Actually, the prevention of varicose veins should be particularly easy in Switzerland, as the Swiss are much closer to nature than others. Simple rule: Lots of walking protects your veins from venous insufficiency. If you don't have venous insufficiency, you won't get varicose veins. Walking uphill or on flat ground is better than downhill. Walk barefoot in the garden. Use shoes that give you a feel for the ground and promote a natural roll-off. Do 3 sets of 30 calf raises daily. Avoid conventional chairs that make you immobile. If your job requires a lot of sitting or standing, protect yourself with light compression stockings. But – who needs exactly what? Dr. Ragg will take the time for you in Zurich and give you a completely individual recommendation, the success of which can be monitored with ultrasound measurements.

If you already have vein damage training and compression stockings only help as much as brushing your teeth helps with cavities – only the healthy parts are protected; the diseased parts inevitably get worse over time. Unfortunately, vein defects can exist for decades without external signs or symptoms – which is why an early diagnosis is so important! If you want to prevent them, you need to get examined while you still feel 100% vein-healthy!

The regular vein coaching is as important as an annual dental visit. The good news is that prevention is indeed very possible. Many people, including many doctors, do not know that varicose veins today are completely preventable are. Dr. Ragg will gladly show you how to prevent venous insufficiency. Some patients avoid any intervention by changing their exercise habits. Others protect themselves from a relapse after treatment through cleverly chosen measures. For each individual, prevention brings joy of life, vitality, and a better future for their veins.

You can recognize a good vein clinic or practice, even in Switzerland, by whether they offer reliable concepts to prevent varicose veins and venous disorders. Treatment offers that are solely about “repairs” should be avoided.

Good advice is not simple: The doctor must recognize to what extent heredity and congenital defects, strain, overexertion, daily habits, and other factors lead to varicose veins or venous insufficiency in an individual. Only then can they create an individual plan create. It's always about how to achieve the best effect with the least and most pleasant effort.

At our vein center in Zurich, we possess this knowledge, and with Dr. Ragg, we have a proven expert in the early detection of vein diseases.

Dr. Ragg: “I have studied thousands of venous valves until it dawned on me that each one tells a story about its past. Some have gaps, some are too small, some have inflammation, some deposits, some are stuck together. Each story holds a key to remedy. Now we are studying the benefits of preventive measures. This is completely new! If someone has symptoms, they can know whether a measure alleviates them or not. But prevention concerns symptom-free stages, and until now, one had to believe in the effect of stockings, pills, or creams to go through with it. Today, we can see and measure important effects with ultrasound, and people can learn how to prevent effectively.”

The cost of varicose vein treatment vary greatly depending on the stage of the disease, the task, and the provider. A varicose vein operation in a hospital costs CHF 4,500 – 8,000 or even much more if both legs are affected. This is not only overpriced but also fundamentally the wrong approach, with unnecessary risks of anesthesia, body incision, and tissue destruction (bleeding, nerve damage, thrombosis). Outpatient operations are cheaper, but equally nonsensical and not without risk, especially since emergency care is worse than in a hospital. Modern procedures using laser or radiofrequency cost CHF 1,600 – 3,200 per leg, depending on the effort involved. Although we offer you the most modern and safest varicose vein treatment at our vein center in Zurich, you receive these services at the same price. Only special requests, such as vein glue or aesthetic procedures, require an additional charge,

which we will discuss with you in advance.

NEW: In Switzerland, basic insurance generally covers the costs of laser or radiofrequency treatment since 2016! After your examination, you will receive a binding cost estimate to submit to your insurance company.

We often receive inquiries about how much a spider vein treatment costs. Providing a price quote without knowing you and without an examination is not serious. It could be a one-time 10-minute treatment costing CHF 120 for a small finding, or two or three sessions lasting up to an hour for legs covered with spider veins with deep sources, costing more than CHF 800 each. The costs depend on the number of areas to be treated, the anatomical complexity, and the time and material expenditure. The safest way: Show us your spider veins and varicose veins, and we can give you a tailored and binding cost estimate.

In treatment, there are enormous differences in quality. We will explain what is important for you.

Feel free to schedule an appointment now with us in Zurich.