Varicose veins are a vascular pathology when, against the background of connective tissue weakness, there is a stretching of the venous wall of the vein. The vein increases in diameter and its wall thins.
The large diameter of the vein leads to a decrease in blood flow velocity, venous congestion and contributes to calf pain. Against this background, varicose veins can lead to thrombophlebitis - inflammation of the affected veins, which is terrible for the development of thromboembolic complications. Visible external cones along the vessels allow you to identify varicose veins in the legs. Varicose veins of the lower extremities (ICD code I83) is a very noticeable condition that is easy to remove.
Varicose veins in the esophagus are among the symptoms of portal hypertension, and secondary varicose veins in the female perineum indicate pelvic varicose veins and difficulty in outflow of blood from the main veins.
Varicose veins of the spermatic cord (varicocele) manifest themselves clinically as secondary high blood pressure in the pelvic area and can lead to infertility in men. The etiology and pathogenesis of varicose veins are very different depending on the localization of the process. In itself, an increase in the diameter of the vein is not dangerous, but the complications of varicose veins carry a great risk to the health, and sometimes the life of the patient. The cause of the appearance of varicose veins in the legs can be heavy physical exertion, childbirth, a sedentary lifestyle of patients.
To understand what varicose veins look like, just go to the summer beach. Although many carriers of varicose veins are embarrassed to perform there, you will definitely see how varicose veins manifest themselves in both men and women. The disease is so widespread that you will definitely see it. After reading this article to the end, you will understand how easy it is to treat varicose veins of the legs. Do not be afraid to go to the phlebologist.
Can we reverse varicose veins?
Many people ask this question, hoping to cure varicose veins in the initial stages with the help of drugs or traditional medical methods. If we are talking about varicose veins in the legs, then phlebologists can unequivocally answer this question - the degenerative destruction of the vein wall cannot go away without removing or removing the affected vein from the bloodstream.
It happens that the dilated veins have not yet lost their function and increase in volume due to the overflow of blood from the overlying sections, and the muscular pump of the lower leg supports the outflow of blood into the deep veins.
Depending on the stage of varicose veins, various methods of surgical and conservative treatment can be used, which can stop the progression of varicose veins at different stages. Here the sequence applies: If the vein is irreversibly affected, it must be removed or coagulated or glued.
Why are initial varicose veins irreversible without surgical intervention? For effective treatment of varicose veins in the legs, it is necessary to identify where the pathological outflow of venous blood is coming from and remove it with minimal trauma. However, enlarged varicose veins can restore their function on their own and without surgical intervention, if the phlebologist eliminates pathological discharges that cause varicose veins and irreversibly altered veins.
Since the first varicose vein operations in men and women in the 19th century, the modern treatment of varicose veins has developed significantly. Depending on the degree of varicose veins, a classification of the disease and suitable treatment methods are created.
Innovative Vascular Center clinics know how to treat varicose veins with minimal medical, psychological and cosmetic inconveniences. We do not have to remove varicose veins according to the classic scheme. In the arsenal of phlebologists is the hemodynamic concept for treating the main causes of varicose veins, a technique in which only pathologically altered venous drainage is corrected and only affected veins are removed.
Treatment cannot be aimed at the etiology of the disease, but the pathogenesis of the problem is known, so it can be stopped. In women, the presence of varicose veins on the legs due to aesthetic problems can be an annoying symptom, but the fair sex is not ready to change the ugly appearance of neglected subcutaneous varicose veins for large scars. Therefore, the clinics offer both cosmetic and radical treatments that have the best patient reviews.
Some anatomy and physiology
The definition of varicose veins is the primary enlargement of the subcutaneous venous trunks of the lower extremities due to congenital, contributing and causative factors. 40% of adults in the world have a chance of getting varicose veins. In developed countries, signs of varicose veins are detected in half of the population.
The saphenous veins in the legs are represented by two large venous systems - the system of large and small saphenous veins. The great saphenous vein originates in the foot, runs from there along the inner surface of the leg to the groin area, where it drains from the inner side of the common femoral artery into the deep vein in the thigh.
On the way from the trunk and tributaries of the great saphenous vein, short vein trunks can be identified - perforators connecting them to the deep veins of the lower leg and thigh, causing varicose veins outside the main trunks. These perforators are designed to ease the passage of blood into the deep venous system.
The small saphenous vein is formed at the lateral malleolus, it is characterized by several bends along the posterior surface of the lower leg and empties into the popliteal vein. The large and small trunk veins are connected to each other by separate overflows. In the subcutaneous trunks there are numerous venous valves that ensure the flow of blood to the heart and prevent the backflow of blood.
Due to the congenital weakness of the vein wall and its load, the failure of the internal valvular apparatus of the veins develops, blood begins to move in the opposite direction, which leads to overflow of the saphenous vein, its further stretching and the development of severe varicose veins. Therefore, it is impossible to cure chronic varicose veins without eliminating the pathological outflow of blood.
The classification of subcutaneous varicose veins on the legs is based on the name and the cause of the development of the disease, the affected venous basin and the stage of chronic venous insufficiency. Varicose veins of the lower extremities are caused by a combination of several factors:
- Congenital distensibility and weakness of the vein wall and increased intravenous pressure.
- Increased pressure on the veins due to long-term lifestyle, heavy physical exertion, pregnancy and childbirth.
- Congenital and acquired disabilities of venous outflow (compression syndromes, tumors pressing on the veins and bone formations).
- Consequences of a past deep vein thrombosis
Modern principles of treatment of varicose veins
Many patients often ask the question of what treatment is needed for varicose veins when only the first signs appear. Varicose veins on the legs is a disease that is progressive and prone to complications, so recovery cannot be expected without medical intervention. Consider the main indications for the treatment of varicose veins in the legs.
Relief of symptoms of chronic venous insufficiency
Venous hypertension is a subjectively unpleasant consequence of disturbed venous drainage, but varicose veins themselves do not hurt. Symptoms of varicose veins that require prevention and treatment include heaviness in the legs, evening swelling, increased fatigue in the legs, and even pain in the calf muscles. With the progression of the disease, stagnation in venous perforators and deep veins develops, which leads to hyperpigmentation of the skin, causes eczema in varicose veins, and a feeling of heaviness in the calves can be noted.
The most popular and publicly advertised method of treating the symptoms of varicose veins in the legs is taking various pills from varicose veins with ointments and creams, which delays contacting specialists. It is important to understand that such remedies do not affect the course of varicose veins, which is why they can only slightly relieve discomfort and symptoms in the initial stages. It is not worth counting on the fact that varicose veins will disappear after treatment with such drugs.
Treatment of complications of varicose veins (trophic ulcers, thrombophlebitis, venous bleeding)
In about 50% of cases, varicose vein disease is complicated by local inflammatory processes, which expands the indications for active surgical tactics. Most often, the patient comes to the treatment of varicose veins when complications develop - thrombophlebitis (ICD code I80), which hurts very much or a trophic ulcer appears. Sometimes disturbed by night cramps in the calf muscles, reddening of the skin, pain.
Treatment of thrombophlebitis can be carried out conservatively (heparin ointment, lyoton, compresses) or more actively - removal of the affected varicose vein or its laser coagulation. Clinical recommendations do not give an unequivocal answer to this question, but with an active approach, in addition to thrombophlebitis, the cause is eliminated, and these are varicose veins.
A trophic ulcer is an extreme manifestation of chronic venous insufficiency and a great danger. It looks like a skin defect in the area of \u200b\u200bthe inner ankle with active purulent discharge, flaccid granulations and is accompanied by constant damage to the surrounding subcutaneous tissue.
Incipient varicose ulcers tend to progress and respond very poorly to conservative management. The optimal treatment method today is the laser correction of the venous outflow (EVLK) for varicose veins of the large or small saphenous veins and the correct local treatment (special bandages, ulcer irrigation). One does not work without the other, so there is no need to count on healing a trophic ulcer only from ointments. An obligatory part of the treatment is compression therapy using special compression stockings. They significantly alleviate the discomfort of patients.
Cosmetic indications in varicose veins
Varicose veins are a disease that rarely leads to dangerous complications, but often makes you turn to specialists. Bulging varicose veins bring many aesthetic problems to their owners. Usually young patients are ashamed of these knots and hide their legs. If men are not so afraid of varicose veins and can walk in pants all the time, then women want to walk with open legs all the time.
The good news is that advanced varicose veins in the legs of women or men can now be eliminated without a trace in a single procedure of laser photocoagulation of varicose veins. Modern procedures are performed without cuts through minimal punctures, which are absolutely invisible already 3-4 weeks after the procedure. The patient is placed on the operating table under local anesthesia and the operation lasts 40-50 minutes. The laser provides an amazing cosmetic result and stable recovery from the manifestations of varicose veins, which is why EVLT is popular among doctors and young patients with varicose veins of the legs at any stage.
Prevention of the development of complications of varicose veins
The solution to these problems is possible by conservative and operative methods. The primary goal of modern phlebology is to minimize surgical trauma in the treatment of varicose veins with the longest possible therapeutic and cosmetic effect. To solve the first problem, it is necessary to block the venous vessels working in the opposite direction, through which there is a large outflow, to solve the second problem, dilated veins must be removed from the bloodstream or turned off.
Diagnosis of varicose veins
Correct diagnosis of superficial vein disease requires an examination by an experienced specialist and an ultrasound scan of the saphenous veins and deep veins from the abdomen to the feet. Information from these research methods is enough to correctly identify this diagnosis in the vast majority of patients. The main signs of varicose veins on the legs can be seen with the naked eye, and the causes can be determined using ultrasound.
In some cases, doctors perform invasive tests at the level of phlebography on an angiography unit. After treatment, patients need regular monitoring of the condition of the operated veins, which doctors conduct using ultrasound diagnostics. If at the diagnostic stage the doctor has questions about the condition of the deep veins, then MRI diagnostics or CT with a contrast agent will accurately determine their patency.
Methods of treating varicose veins in the vascular center
A vascular surgeon can cure varicose veins of the lower extremities only by eliminating the causes of its occurrence. It is necessary to fight the cause of the development of varicose veins and the progression of the disease. Consider the key technologies with proven effectiveness.
Laser Treatment of Varicose Veins (EVLT)
Endovenous laser coagulation is based on heating the vein wall with a coherent beam of light. Varicose veins can be effectively treated without incisions and general anesthesia. An optical fiber is inserted into a vein through a puncture under ultrasound control. Laser energy of a certain wavelength is absorbed by the vein wall at the moment of its occurrence, which leads to its heating and destruction of connective tissue. As a result, the vein wall turns into scar tissue and blood flow through the affected vein stops completely. It achieves the same effect as surgically removing a vein, but without the incisions, general anesthesia, and pain.
The EVLK surpasses the open operation of phlebectomy in its effectiveness. 98% of all operated patients recover from varicose veins, regardless of the degree of development of the nodes. Rare side effects include numbness of the skin around the coagulated vein, inflammation and blood clots in the coagulated veins. The total incidence of such complications does not exceed 1%. In the Innovative Vascular Center, EVLK is the "gold standard", it can cure all varicose veins, both in the initial and advanced stages. Patients leave the best reviews immediately after laser treatment.
Radiofrequency Obliteration of Varicose Veins (RFO)
RFO is referred to in its effect and effect as the laser as a thermal method for the treatment of varicose veins, but a different physical principle is used there. The radiosonde is also inserted into the vein through a puncture. The procedure is performed under local anesthesia. The RFO principle is based on the generation of thermal energy in the probe head, which is then transferred to the vessel walls. Heating the wall leads to thermal destruction of its structural elements, followed by scarring of the vein.
Both methods (EVLK and RFA) relate to thermoablative (thermal) technologies. They are similar in effectiveness, however, the laser heats the vein wall itself, while RFO heats the working surface of the probe and the heat is transferred to the wall through the liquid part of the blood.
According to experts, EVLT more radically destroys the structure of the affected vein, therefore the frequency of recurrences after the laser is lower than with radiofrequency obliteration. Doctors found that 98% of varicose veins did not return after EVLK and 86% after RFO. Based on the experience of 20 years of work, phlebologists came to the conclusion that thermal methods treat varicose veins more effectively than traditional vein removal operations.
Non-thermal methods of obliterating varicose veins
In the 1970's, surgeons showed increasing interest in minimally invasive types of surgical treatment of varicose veins and began using electrocoagulators. Good idea, but poorly implemented in practice. Patients had skin burns, which is why doctors for a long time were afraid of thermal methods for varicose veins. Chemical methods of venous obliteration have proven to be safe and quite effective. These include sclerotherapy in various forms and adhesive obliteration.
sclerotherapy
Sclerotherapy is the intravenous administration of special drugs that cause damage to the vein wall, followed by obliteration (overgrowth) of the lumen of the varicose vein. The history of this method began in the 19th century and has an interesting development path. In the vascular center, specialists use the most advanced technology - a foam form of sclerotherapy. Prolonged treatment for six months allows you to get rid of varicose veins of the lower extremities for a long time. Although the recurrence rate in 5 years is about 50%. With sclerotherapy, the treatment is not aimed exactly at the causes of the varicose veins, but eliminates the venous knots themselves and can therefore be used in combination with other minimally invasive procedures (EVLK, RFO). A feature of sclerotherapy is the appearance of dense cones - coagulus at the site of sclerotic veins, which dissolve up to six months.
Glue veins with varicose veins with special glue
Venaseal technology is the name of a non-thermal method of obliterating varicose veins of the trunk veins, in which a special adhesive is introduced into the vein lumen, which polymerizes in the vein lumen and causes its blockage. The idea looks interesting and has been developed over the past decade, but there are several pitfalls. First, the glue remains in the affected veins as a foreign body, it does not dissolve. Secondly, there is a risk of periphlebitis around a sealed vein as a reaction of the body to a foreign body. Third, it is an expensive treatment method.
The cost of treating varicose veins with this method is about twice that of laser photocoagulation. There are no long-term studies on the long-term results of such treatment. The advantages of this technology have not yet been identified, but active research is being carried out, and it is possible that varicose veins will become a disease in which the entire treatment regimen will become a "magic" injection. It is characteristic that this method is used in the latest clinicalguidelines has not yet been taken into account, but is already being actively offered by some phlebological centers.
Surgical methods of treating varicose veins of the lower extremities
Since the middle of the 19th century, doctors have been dealing with the question of how to get rid of large varicose veins in the superficial veins of the legs and how to prevent complications. The history of the struggle with enlarged veins makes it clear how the operation went from early large incisions disfiguring the legs to micropunctures, which allow you to treat varicose veins without cosmetic defects.
Advanced phlebologists use elements of classic surgery in the form of microphlebectomy through puncture to remove individual varicose veins and side branches. This is possibly the most cosmetic way to remove varicose veins in thin skin. A month after such an operation, the skin is not even reddened.
Other thermal methods
When deciding how to treat varicose veins, phlebologists have often used exotic methods. Varicose veins were treated with thermal stress using superheated steam and bipolar electrocoagulation. However, modern thermal methods are more effective and allow the doctor to prevent the further development of varicose veins and treat the patient on an outpatient basis without disturbing his lifestyle. In the hands of a novice phlebologist, thermal ablation methods can cause unpleasant complications: decreased sensitivity, burns, seals. The effectiveness of this method in the hands of an experienced phlebologist is more than 98%, and using the laser method and RFO, you can eliminate not only the original form, but also very pronounced varicose veins on the legs without incisions.
Use special glue
Since its introduction, this method has aroused great interest among phlebologists. The trunk of the saphenous vein is glued with a special cyanoacrylate glue. In the lumen of the vessel, this glue polymerizes and fills the lumen of the dilated vessel. According to the ideas of the developers, this method does not require anesthesia, and a "plug" is formed in the vessel, which reliably blocks the flow of blood. Considering this, half an hour for the procedure is enough to get rid of varicose veins in the legs. Venasil is the only oneTechnology to treat varicose veins without wearing compression stockings.
Most women can return to normal activities immediately. Symptoms of chronic venous insufficiency are relieved soon after the procedure. The process of actively promoting this glue on the phlebological market should begin in the near future. However, there are certain disadvantages: The presence of a foreign body in the human body. Ruffled glue remains in the jar forever and can provoke chronic allergies, sometimes there is inflammation of the vascular wall or rejection of the polymer with suppuration. Acute thrombophlebitis of the glued vessel can occur.
The use of glue in the trunk of the saphenous vein does not eliminate the need to deal with the elimination of varicose veins, which is why doctors have to remove signs of subcutaneous varicose veins with sclerotherapy or miniphlebectomy. The visible effect of using glue is revealed only when combined with other methods of getting rid of varicose veins. The patient has to pay more. The unreasonably high cost of the gluing kit makes this procedure much more expensive than the modern laser or radio frequency method.
Thermal methods are preferred in the clinic. Phlebologists believe that it is better to do good local anesthesia than to treat varicose veins in the legs with an expensive and untested method. Also, the result is at best the same. If there is a relapse, the patient has to operate on the sealed vessel, which is a laborious operation, since other methods can no longer be used.
The modern method of combined reflux treatment along the subcutaneous vein trunks gives additional weight to conventional sclerotherapy. Mechanochemical procedures are a combination of mechanical damage to the inner surface of the vein wall and the introduction of a sclerosing agent. A catheter is inserted into the trunk vein through a puncture under ultrasound control. After installing the catheter in the right place, the device is connected. The rotating sharp head of the catheter makes up to 3. 5 thousand revolutions per minute, causing severe damage to the inner layer of the vein wall. In parallel, a sclerosing agent is injected through the catheter, which "mixes" in the lumen of the vessel and, with the help of the rotating part of the catheter, acts on the vessel wall, causing its inflammation and adhesions.
This is a modern microsurgical aesthetic method of removing varicose veins. It involves a delicate technique of puncturing and pulling varicose veins with the help of special tools. This operation is not for a novice phlebologist, you need to master the skills of the delicate operation. Miniphlebectomy is an operation without the use of a scalpel and is performed under local anesthesia. The punctures are made in the direction of the skin lines, so they are almost invisible after 2 months.