Varicose veins are a vascular pathology when, against the background of connective tissue weakness, stretching of the venous wall of the vein occurs. The diameter of the vein increases and its wall becomes thinner.
The large diameter of the vein leads to a decrease in the speed of blood flow, venous congestion and contributes to pain in the calves. Against this background, varicose veins can lead to thrombophlebitis - inflammation of the affected veins, which is dangerous for the development of thromboembolic complications. Visible external cones along the length of the vessels allow you to recognize varicose veins on the legs. Varicose veins of the lower limbs (ICD code I83) is a very noticeable disease that is easily removed.
Varicose veins of the esophagus are included in the symptoms of portal hypertension, and secondary enlarged nodes in the female perineum indicate varicose veins of the small pelvis and difficulty in outflow of blood from the main veins.
Dilated veins of the spermatic cord (varicocele) manifest through the clinic of secondary pelvic phlebohypertension and can lead to infertility in men. The etiology and pathogenesis of varicose veins are very diverse depending on the localization of the process. By itself, the increase in the diameter of the veins is not dangerous, but the complications of varicose veins carry a great risk to the health and sometimes to the life of the patient. The reason for the appearance of varicose veins on the legs can be heavy physical exertion, childbirth, sedentary lifestyle of patients.
To find out what varicose veins look like, just go to the summer beach. Although many sufferers of varicose veins are worried about appearing there, you will definitely see how varicose veins manifest themselves in men and women. The disease is so common that you are bound to see it. After reading this article to the end, you will understand how easy it is to treat varicose veins in the legs. Do not be afraid to go to a phlebologist.
Can we deal with varicose veins?
Many people ask this question, hoping to cure varicose veins in the initial stage with the help of drugs or traditional medical methods. If we are talking about varicose veins of the legs, then phlebologists can unequivocally answer this question - the degenerative destruction of the venous wall cannot disappear without excluding the affected vein from blood circulation or removing it.
It happens that varicose veins can still not lose their function and increase in volume due to the overflow of blood from the overlying areas, and the muscle pump of the lower leg helps the outflow of blood into the deep veins.
Depending on the stage of varicose veins, different methods of surgical and conservative treatment can be applied, which can stop the progression of varicose veins at different stages. The order here is this: if the vein is irreversibly affected, then it must be removed or coagulated or glued.
Why are even initial varicose veins irreversible without surgery? For effective treatment of varicose veins of the legs, it is necessary to recognize where the pathological outflow of venous blood comes from and to remove it with minimal trauma. However, dilated varicose veins can restore their function on their own and without surgical intervention, if the phlebologist eliminates the pathological secretions that cause varicose veins and irreversibly changed veins.
Modern varicose vein treatment has advanced significantly since the first varicose vein surgeries on men and women in the 19th century. Depending on the degree of varicose veins, a classification of the disease and appropriate methods of treatment are drawn up.
The clinics of the Innovative Vascular Center know how to treat varicose veins with minimal medical, psychological and cosmetic discomfort. It is not necessary to remove varicose veins according to the classic scheme. In the arsenal of phlebologists, the hemodynamic concept of treating the main causes of varicose veins, a technique that includes the correction of only pathologically altered venous outflow and the removal of only the affected veins.
Treatment cannot be directed at the etiology of the disease, but the pathogenesis of the problem is known, so it can be stopped. In women, the presence of balls of varicose veins on the legs can be an annoying symptom due to aesthetic problems, but the fairer sex is not ready to change the ugly appearance of neglected varicose veins with large scars. That is why clinics offer both cosmetic and radical treatments that have the best patient reviews.
A bit of anatomy and physiology
The definition of varicose veins is the primary dilation of the subcutaneous venous trunks of the lower extremities due to congenital, contributing, and producing factors. The probability of getting varicose veins exists in 40% of adults on the planet. In developed countries, signs of varicose veins are found in half of the population.
The saphenous veins of the legs are represented by two large venous systems - the system of the great and small saphenous veins. The great saphenous vein starts from the foot, from where it runs along the inner surface of the leg to the inguinal region, where it flows into the deep vein of the thigh, on the inside of the common femoral artery.
On the way from the trunk and tributaries of the great saphenous vein, short venous trunks can be identified - perforators that connect it to the deep veins of the lower leg and thigh, which causes varicose veins away from the main trunks. These perforators are designed to facilitate the passage of blood into the deep venous system.
The small saphenous vein is formed on the external malleolus, is characterized by several turns on the back surface of the lower leg and merges with the popliteal vein. The great and small saphenous veins are connected to each other by separate overflows. In the subcutaneous trunks there are numerous venous valves that ensure the movement of blood to the heart and prevent the reverse flow of blood.
Due to the congenital weakness of the venous wall and the load on it, damage to the internal valvular apparatus of the veins develops, the blood begins to move in the opposite direction, which leads to the overflow of the saphenous vein, its further stretching and the development of severe varicose veins. Therefore, without eliminating the pathological discharge of blood, it is impossible to achieve treatment of chronic varicose veins.
The classification of subcutaneous varicose veins of the legs is formed by the name and cause of the development of the disease, the affected venous pool and the stage of chronic venous insufficiency. Varicose veins of the lower extremities are formed by a combination of several factors:
- Congenital extensibility and weakness of the venous wall and increased venous pressure.
- Increased pressure on the veins due to a long lifestyle, heavy physical exertion, pregnancy and childbirth.
- Congenital and acquired obstructions of the venous outflow (compression syndromes, tumors and bone formations pressing on the veins.
- Consequences of past deep vein thrombosis
Modern principles of treatment of varicose veins
Many patients often ask the question - what treatment is needed for varicose veins if only its first signs appear. Varicose veins of the legs are a disease that constantly progresses and is prone to complications, therefore, without medical intervention, you cannot count on recovery. Consider the main indications for the treatment of varicose veins of the legs.
Relief of symptoms of chronic venous insufficiency
Venous hypertension is a subjectively unpleasant consequence of impaired venous outflow, but varicose veins themselves do not hurt. Symptoms of varicose veins that require prevention and treatment include a feeling of heaviness in the legs, swelling in the evening, increased leg fatigue and even pain in the calf muscles. As the disease progresses, stagnation develops in venous perforators and deep veins, which can lead to hyperpigmentation of the skin, cause eczema in varicose veins and heaviness in the calves.
The most popular and publicly advertised method of treating the symptoms of varicose veins in the legs is taking various pills for varicose veins, using ointments and creams, which makes contact with specialists late. It is important to understand that such means do not affect the course of varicose veins, therefore they can only slightly relieve complaints and symptoms in the early stages. It is not worth relying on the fact that varicose veins will disappear after treatment with such drugs.
Treatment of complications from varicose veins (trophic ulcers, thrombophlebitis, venous bleeding)
In about 50% of cases, varicose veins are complicated by local inflammatory processes, which expands the indications for active surgical tactics. Most often, the patient comes for treatment of varicose veins when its complications develop - thrombophlebitis (ICD code I80), which hurts a lot or a trophic ulcer appears. Sometimes it is disturbed by night cramps in the calf muscles, redness 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, together with thrombophlebitis, its cause is also removed, which is varicose veins.
Trophic ulcer is an extreme manifestation of chronic venous insufficiency and represents a great danger. It appears as a skin defect in the area of the medial malleolus with active purulent discharge, loose granules, and is accompanied by permanent damage to the surrounding subcutaneous tissue.
Incipient varicose ulcers tend to progress and respond very poorly to conservative treatment. The optimal treatment method today is laser venous outflow correction (EVLK) for varicose veins of the great or small saphenous veins and the correct local treatment (special dressings, washing the ulcer). One does not work without the other, so you do not need to rely on the healing of a trophic ulcer on ointments alone. A mandatory component of treatment is compression therapy using special compression stockings. They significantly alleviate patients' complaints.
Cosmetic indications for varicose veins
Varicose veins are a disease that rarely leads to dangerous complications, but often makes you turn to specialists. Prominent varicose veins bring many aesthetic problems to their owners. Usually, young patients are ashamed of these nodules and hide their legs. If men are not so afraid of varicose veins and can constantly walk in pants, then women constantly want to walk with open legs.
The good news is that advanced varicose veins on the legs of women and men can now be eliminated with a single procedure of laser photocoagulation of varicose veins without any trace. Modern interventions are performed without incisions, through minimal punctures, which are absolutely invisible 3-4 weeks after the intervention. The patient is taken to the operating table under local anesthesia, and the operation lasts 40-50 minutes. The laser gives 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.
Preventing the development of complications from varicose veins
Solving these problems is possible through conservative and operative methods. The main 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 that work in the opposite direction, through which a pronounced discharge is obtained, to solve the second problem, it is necessary to remove or exclude varicose veins from the circulation.
Diagnosis of varicose veins
For the correct diagnosis of superficial vein disease, an examination by an experienced specialist and an ultrasound scan of subcutaneous and deep veins from the abdomen to the legs are required. The information from these research methods is sufficient for the correct recognition of this diagnosis in the majority of patients. The main signs of varicose veins of the legs can be determined with the naked eye, and the causes can be established with ultrasound.
In some cases, doctors perform invasive studies in the amount of phlebography per angiographic unit. After the treatment, patients need periodic monitoring of the condition of the operated veins, which doctors perform with the help of ultrasound diagnostics. If at the diagnostic stage the doctor has questions about the condition of the deep veins, then MRI diagnostics or CT with contrast accurately determine their patency.
Methods of treatment of varicose veins in the vascular center
A vascular surgeon can cure varicose veins of the lower extremities only by eliminating the causes of their appearance. It is necessary to fight the cause of the development of varicose veins and the progression of the disease. Consider core technologies with proven effectiveness.
Laser Varicose Vein Treatment (EVLT)
Endovenous laser coagulation is based on heating the venous wall with a coherent light beam. Varicose veins can be effectively treated without incisions and general anesthesia. A light-conducting fiber is inserted into a vein through a puncture under ultrasound guidance. Laser energy with a certain wavelength at the moment of occurrence is absorbed by the venous wall, which leads to its heating and destruction of the connective tissue. As a result, the vein wall becomes scarred and the blood flow through the affected vein stops completely. The same effect is achieved as with surgical removal of a vein, but only without incisions, general anesthesia and pain.
In terms of effectiveness, EVLK surpasses open phlebectomy surgery. 98% of all operated patients recover from varicose veins, regardless of the degree of development of the nodes. Rare side effects include tingling of the skin in the area of the coagulated vein, inflammation and blood clots in the coagulated vein. The overall incidence of such complications does not exceed 1%. At the Innovative Vascular Center, EVLK is the "gold standard", treating all types of varicose veins, both in the initial and advanced stages. Patients leave the best reviews right after laser treatment.
Radiofrequency Varicose Vein Obliteration (RFO)
In its impact and effect, RFO, like the laser, is related to the thermal methods of treating varicose veins, but a different physical principle is used there. The radioprobe is also inserted into the vein through a puncture. The intervention is performed under local anesthesia. The principle of RFO is based on the generation of thermal energy in the head of the probe, which is then transferred to the walls of the vessel. Heating of the wall leads to thermal destruction of its structural elements, followed by scarring of the vein.
Both methods (EVLK and RFA) refer to thermoablative (thermal) technologies. In terms of their effectiveness, they are similar, but the laser heats the vein wall itself, while the 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, after the laser, the recurrence rate is less than with radiofrequency obliteration. Doctors note the absence of recurrence of varicose veins in 98% after EVLK and 86% after RFO. Based on the experience of 20 years of work, phlebologists have come to the conclusion that thermal methods of varicose veins are treated more effectively than conventional surgery to remove veins.
Non-thermal methods for removing varicose veins
In the 1970s, surgeons began to show increased interest in minimally invasive types of surgical treatment of varicose veins and began to use electrocoagulators. A good idea, but poorly implemented in practice. Patients had skin burns, which is perhaps the reason why doctors are afraid to use thermal methods for a long time with varicose veins. Chemical methods used to remove veins have been proven to be safe and quite effective. These include sclerotherapy in various variants and adhesive obliteration.
Sclerotherapy
Sclerotherapy is the intravenous administration of special drugs that cause damage to the venous wall, followed by obliteration (overgrowth) of the lumen of the varicose vein. The history of this method begins in the 19th century and has an interesting path of development. In the vascular center, specialists use the most modern technology - a foam form of sclerotherapy. Constant treatment for six months allows you to get rid of varicose veins of the lower extremities for a long time. Although the recurrence rate is about 50% in 5 years. In sclerotherapy, the treatment is not aimed precisely at the causes of varicose veins, but eliminates the venous nodes themselves, which is why it can be used in combination with other minimally invasive methods (EVLK, RFO). A feature of sclerotherapy is the appearance of dense cones - coagulum at the site of sclerotic veins, which pass up to six months.
Bonding of varicose veins with special glue
Venaseal technology is the name of a non-thermal method for obliteration of dilated trunks of saphenous veins, which involves the introduction of a special glue into the lumen of the vein, which polymerizes inside the lumen of the vein, causing its blockage. The idea seems interesting and developed over the last decade, but there are a few pitfalls. First, the glue remains inside the affected veins as a foreign body, it does not dissolve. Second, there is a risk of periphlebitis around a sealed vein, as the body's reaction to a foreign body. Third, it is an expensive method of treatment.
The cost of treating varicose veins with this method is about twice as expensive as 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 research is actively being conducted, and it is possible that varicose veins will become a disease in which the entire treatment regimen will become one "magic" injection. Characteristically, this method is stillnot considered in the latest clinical recommendations, but is already actively offered by some phlebology centers.
Surgical methods for the treatment of varicose veins of the lower extremities
Doctors have been dealing with the question of how to get rid of large varicose veins of the superficial veins of the legs and the prevention of complications since the middle of the 19th century. The history of the fight against varicose veins shows how from the early large incisions that disfigure the legs, surgery has moved to micropunctures that allow you to deal with varicose veins without cosmetic defects.
Advanced phlebologists use elements of classical surgery in the form of microphlebectomy, using punctures to remove individual varicose veins and tributaries. This is perhaps the most cosmetic method for removing varicose veins in thin skin. A month after such an operation, there is not even redness of the skin.
Other thermal methods
When deciding how to treat varicose veins, phlebologists often use exotic methods. Varicose veins were treated with thermal exposure 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 the patient to be treated on an outpatient basis without disrupting his lifestyle. In the hands of a novice phlebologist, thermal ablation methods can cause unpleasant complications: reduced sensitivity, burns, seals. The effectiveness of this method in the hands of an experienced phlebologist is more than 98%, and the laser method and RFO allow you to get rid of not only the initial form, but also severely expressed varicose veins on the legs without incisions.
With the help of special glue
Since its inception, this method has caused great interest among phlebologists. It represents gluing the trunk of the great saphenous vein with a special cyanoacrylate glue. In the lumen of the vessel, this adhesive polymerizes and fills the lumen of the dilated vessel. As conceived by the developers, this method does not require any anesthesia, and a "plug" appears in the vessel, which reliably blocks the blood flow. Given this, half an hour is enough for the procedure to remove varicose veins on the legs. Venasil isthe only varicose vein treatment technology that does not require the wearing of compression stockings.
Most women can immediately return to normal activities. Symptoms of chronic venous insufficiency are relieved soon after the procedure. The process of active promotion of this glue on the phlebological market should begin in the near future. However, there are some disadvantages: The presence of a foreign body in the human body. The rolled glue remains in the vessel forever and can cause chronic allergies, sometimes there is inflammation of the vessel wall or rejection of the polymer with suppuration. Acute thrombophlebitis of the stuck vessel may occur.
The use of glue in the trunk of the great saphenous vein does not eliminate the need to remove the enlarged tributaries, so doctors will have to remove the signs of subcutaneous varicose veins with sclerotherapy or miniphlebectomy. The visible effect of the use of glue is manifested only in the case of a combination with other methods of removing varicose veins. The patient has to pay more. The unreasonably high price 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 make a good local anesthesia than to treat varicose veins of the legs with an expensive and unproven method. Other than that, the result is the same at best. In case of recurrence, the patient will have to undergo a complex operation to remove the sealed vessel, as other methods will no longer be applicable.
The modern method of combined treatment of reflux along the subcutaneous venous trunks adds an additional burden to conventional sclerotherapy. Mechanochemical procedures are understood as a combination of mechanical damage to the inner surface of the venous wall and introduction of a sclerosing agent. The catheter is inserted into the main saphenous vein through a puncture under ultrasound control. After installing the catheter in the correct place, the device is connected. The rotating sharp head of the catheter makes up to 3. 5 thousand revolutions per minute, causing pronounced damage to the inner layer of the venous wall. In parallel, a sclerosing agent is injected through the catheter, which "mixes" into 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 adhesion.
This is a modern microsurgical aesthetic method for removing varicose veins. This involves a delicate technique of drilling and pulling out varicose veins using special instruments. This operation is not for a novice phlebologist, you need to master the skills of delicate operation. Miniphlebectomy is an operation without the use of a scalpel and is performed under local anesthesia. Punctures are performed in the direction of the skin lines, so after 2 months they are almost invisible.