Varicose veins are a vascular pathology when, against the background of connective tissue weakness, a 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 causes decreased blood flow velocity, venous congestion, and contributes to calf pain. Against this background, varicose veins can lead to thrombophlebitis - an inflammation of the affected veins, which is terrible for the development of thromboembolic complications. Visible external cones along the vessels allow you to recognize varicose veins on the legs. Varicose disease of the lower extremities (ICD code I83) is a very noticeable disease that is easy to remove.
Varicose veins in the esophagus are included in the symptoms of portal hypertension, and secondary varicose nodes in the female perineum indicate small pelvic varicose veins and difficulty in outflow of blood from the main veins.
Varicose veins of the spermatic cord (varicocele) are manifested by 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 location of the process. In itself, an increase in the diameter of the veins is not dangerous, but the complications of varicose veins carry a great risk to health, and sometimes to the life of the patient. The cause of the appearance of varicose veins on 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 appear there, you will surely see how varicose veins manifest themselves in 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 easily varicose veins on the legs are treated. Do not be afraid to go to the phlebologist.
Can we reverse varicose veins?
Many people ask this question in the hope of curing varicose veins at the initial stage with the help of drugs or traditional medical methods. If we are talking about varicose veins on the legs, then phlebologists can unequivocally answer this question: the degenerative destruction of the vein wall cannot go away without disconnecting the affected vein from the bloodstream or removing it.
It happens that the dilated veins may not yet lose their function and increase in volume due to the overflow of blood from the overlying sections, and the muscular pump of the lower leg helps blood flow into the deep veins.
Depending on the stage of varicose veins, various surgical and conservative treatment methods can be applied that can stop the progression of varicose veins in various 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 surgical intervention? For effective treatment of varicose veins in the legs, it is necessary to recognize where the pathological discharge of venous blood comes from and eliminate it with minimal trauma. However, expanded varicose tributaries can restore their function on their own and without surgical intervention if the pathological secretions are removed by the phlebologist, which causes varicose veins and irreversibly changed veins.
Modern varicose vein treatment has come a long way since the first varicose vein operations on men and women in the 19th century. Depending on the degree of varicose veins, a classification of the disease and suitable treatment methods are compiled.
The Innovative Vascular Center clinics know how to treat varicose veins with minimal medical, psychological, and cosmetic inconvenience. We do not need to remove varicose veins according to the classical scheme. In the arsenal of phlebologists, the hemodynamic concept of treatment of the main causes of varicose veins - a technique that involves the correction of pathologically disturbed venous outflow and the removal of 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 varicose veins on the legs can be an annoying symptom for aesthetic problems, but the fair sex is not willing to change the ugly appearance of neglected subcutaneous varicose veins for large scars. For this reason, the clinics offer both aesthetic and radical treatments that have the best patient evaluations.
Some anatomy and physiology.
The definition of varicose veins is the primary expansion of the subcutaneous venous trunks of the lower extremities, due to congenital, contributing and producing factors. The possibility of contracting varicose veins exists in 40% of adults on the planet. In developed countries, signs of varicose veins are detected in half the population.
The saphenous veins in the legs are represented by two large venous systems: the system of great and small saphenous veins. The great saphenous vein originates in the foot, from where it runs along the inner surface of the leg to the inguinal region, where it empties into the deep vein of the thigh, from inside the common femoral artery.
On the way from the trunk and tributaries of the great saphenous vein, short, perforating venous trunks can be identified, connecting it with the deep veins of the lower leg and thigh, causing varicose veins to recede of the main trunks. These perforators are designed to facilitate the passage of blood into the deep venous system.
The small saphenous vein forms at the lateral malleolus, is characterized by several curves along the posterior surface of the lower leg, and confluence with the popliteal vein. Between them, the large and small saphenous veins are connected by separate outflows. In the subcutaneous trunks there are numerous venous valves that ensure the movement of blood towards the heart and prevent the reverse flow of blood.
Due to the congenital weakness of the venous wall and the load on it, the failure of the internal valvular apparatus of the veins develops, the blood begins to move in the opposite direction, which causes the saphenous vein to overflow, its further stretching. and development. of severe varicose veins. Therefore, without eliminating the pathological discharge of blood, it is impossible to achieve a cure for chronic varicose veins.
The classification of subcutaneous varicose veins in the legs is formed from the name and cause of the development of the disease, the affected venous group and the stage of chronic venous insufficiency. Varicose veins of the lower extremities are formed by a combination of several factors:
- Congenital distensibility and weakness of the venous wall and increased intravenous pressure.
- Increased pressure in the veins due to a long lifestyle, intense physical exertion, pregnancy and childbirth.
- Congenital and acquired obstructions to venous flow (compression syndromes, tumors and bone formations that press on the veins).
- Sequelae 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 their first signs appear. Varicose veins on the legs is a continuously progressing disease and is prone to complications, therefore, without medical intervention, recovery cannot be counted on. Consider the main indications for the treatment of varicose veins on 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 heavy legs, swelling at night, increased leg fatigue, and even calf muscle pain. With the progression of the disease, stagnation develops in the perforating veins 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 contacting specialists late. It is important to understand that such remedies do not affect the course of varicose veins, so they can only slightly relieve discomfort and symptoms in the early 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 hemorrhage)
In about 50% of cases, varicose disease is complicated by local inflammatory processes, which expands the indications for active surgical tactics. In most cases, the patient comes to treat varicose veins when their complications develop - thrombophlebitis (ICD code I80), which is very painful or a trophic ulcer appears. Sometimes 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, along with thrombophlebitis, its cause is also eliminated, and it is varicose veins.
A trophic ulcer is an extreme manifestation of chronic venous insufficiency and is a great danger. It looks like a skin defect in the area of the medial malleolus with active purulent discharge, flaccid granulations, and is accompanied by constant damage to the surrounding subcutaneous tissue.
Early varicose ulcers are prone to progression and respond poorly to conservative treatment. The optimal method of treatment today is laser correction of venous outflow (EVLK) for varicose veins of the large or small saphenous veins and the correct local treatment (special dressings, washing of the ulcer). One does not work without the other, so it is not necessary to count on the healing of a trophic ulcer only with ointments. An obligatory component of treatment is compression therapy with the help of special compression stockings. They greatly alleviate patient complaints.
Cosmetic indications for varicose veins.
Varicose veins are a disease that rarely leads to dangerous complications, but often makes it necessary to go to specialists. Bulging varicose veins bring a lot of aesthetic problems to their owners. Usually young patients are embarrassed by these knots and hide their legs. If men are not so afraid of varicose veins and can constantly walk in pants, then women always want to walk with their legs spread.
The good news is that advanced varicose veins in the legs of women or men can now be removed in a single varicose vein laser photocoagulation procedure without a trace. Modern interventions are performed without incisions, through minimal punctures, which are absolutely invisible 3-4 weeks after the intervention. The patient is brought to the operating table under local anesthesia and the operation lasts 40-50 minutes. The laser provides an amazing cosmetic result and stable recovery from varicose vein manifestations, which is why EVLT is popular with doctors and young patients with varicose veins in the legs at any stage.
Prevention of the development of complications of varicose veins.
The solution of these problems is possible by conservative and operational 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 occurs, to solve the second problem, it is necessary to remove or turn off the dilated veins from the blood circulation.
Diagnosis of varicose veins
To make a correct diagnosis of superficial vein disease, an examination by an experienced specialist and ultrasound of the deep and saphenous veins from the abdomen to the feet is necessary. The information from these research methods is sufficient for the correct recognition of this diagnosis in the vast majority of patients. The main signs of varicose veins in the legs can be determined with the naked eye, and the causes can be established using ultrasound.
In some cases, doctors perform invasive tests in the amount of phlebography in an angiographic unit. After treatment, patients need regular monitoring of the condition of the operated veins, which is carried out by doctors using ultrasound diagnostics. If at the diagnostic stage the doctor has questions about the state of the deep veins, then diagnostic MRI or contrast-enhanced computed tomography 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 the main technologies with proven effectiveness.
Varicose Vein Laser Treatment (EVLT)
Endovenous laser coagulation is based on heating the vein wall with a coherent beam of light. Varicose veins can be treated effectively without incisions or general anesthesia. A light-conducting fiber is inserted into a vein through a puncture under ultrasound guidance. Laser energy of a certain wavelength at the time of its appearance is absorbed by the venous wall, 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. The same effect is achieved as with surgical removal of a vein, but only without incisions, general anesthesia and pain.
In terms of its efficacy, EVLK outperforms the open phlebectomy operation. 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 in the area of the coagulated vein, swelling, and blood clots in the coagulated veins. The overall incidence of such complications does not exceed 1%. At the Innovative Vascular Center, EVLK is the "gold standard", it can cure any varicose vein, both in the early and advanced stages. Patients leave the best reviews right after laser treatment.
Radio Frequency Obliteration of Varicose Veins (RFO)
In terms of its impact and effect, RFO, like laser, are called thermal methods for the treatment of varicose veins, but a different physical principle is used there. The radiotracer is also inserted into the vein through a puncture. The intervention 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 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, however, the laser heats the vein wall, 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, after laser, the frequency of relapses is lower than with radiofrequency obliteration. Physicians noted freedom from varicose vein recurrence in 98% after EVLK and 86% after RFO. Based on the experience of 20 years of work, phlebologists concluded that thermal methods for varicose veins are treated more effectively than conventional vein stripping surgery.
Non-thermal methods of obliteration of varicose veins.
In the 70s of the 20th century, surgeons began to show increased interest in minimally invasive types of surgical treatment for varicose veins and began to use electrocoagulators. Good idea, but poorly implemented in practice. Patients had skin burns, which may be why doctors were afraid to use thermal methods for a long time with varicose veins. Chemical methods used for vein obliteration have been shown 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 damage the vein wall, followed by obliteration (overgrowth) of the varicose vein lumen. The history of this method began in the XIX century and has an interesting development path. In the vascular center, specialists use the most advanced technology - a form of foam sclerotherapy. Persistent 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 around 50% in 5 years. With sclerotherapy, the treatment does not have an exact focus on the causes of varicose veins, but rather eliminates the venous nodules themselves, so it can be used in combination with other minimally invasive methods (EVLK, RFO). A feature of sclerotherapy is the appearance of dense cones - clots at the site of the sclerotic veins, which resolve up to six months.
Gluing veins with varicose veins with special glue.
Venaseal technology is the name of a non-thermal method of obliteration of the varicose trunks of the saphenous veins, which consists in 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 has been developed in the last decade, but there are several pitfalls. First of all, the glue remains inside the affected veins as a foreign body, it does not dissolve. Second, there are risks of periphlebitis around a sealed vein, as the body reacts to a foreign body. Third, it is an expensive method of treatment.
The cost of treating varicose veins with this method is approximately 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 research is being actively conducted and it is possible that varicose veins will become a disease in which the entire treatment regimen becomes a "magic" injection. It is characteristic that this method has not yet been considered in the latest clinical guidelines, but some phlebology centers already actively offer it.
Surgical methods of 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 superficial veins on the legs and the prevention of complications since the middle of the XIX century. The history of the fight against dilated veins makes it clear how from the first large incisions that disfigured the legs, surgery has gone on to micro-punctures, which allow varicose veins to be treated without aesthetic defects.
Advanced phlebologists use elements of classical surgery in the form of puncture microphlebectomy to remove varicose veins and individual tributaries. This may be the most cosmetic method of removing varicose veins in fine skin. A month after such an operation, there is not even redness on the skin.
Other thermal methods
When deciding how to treat varicose veins, phlebologists often used 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 further development of varicose veins and the patient to be treated on an outpatient basis without disturbing her 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 the laser method and RFO allow you to get rid of not only the initial form, but also pronounced severe varicose veins on the legs without incisions.
Using special glue
Since its inception, this method has aroused great interest among phlebologists. It consists of gluing the trunk of the great saphenous vein with a special cyanoacrylate glue. In the vessel lumen, this glue polymerizes and fills the dilated vessel lumen. As conceived by the developers, this method does not require anesthesia, and a "plug" appears in the vessel, which reliably blocks the flow of blood. Given this, half an hour is enough for the procedure to remove varicose veins on the legs. Venasil is the only varicose vein treatment technology that does not require the use of 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. Curly 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 on the trunk of the great saphenous vein does not eliminate the need to address the removal of varicose tributaries, so clinicians should eliminate signs of subcutaneous varices with sclerotherapy or miniphlebectomy. The visible effect of the use of glue is manifested only in the case of combination with other methods of removing varicose veins. The patient has to pay more. The excessively high cost of the gluing kit makes this procedure much more expensive than the modern laser or radio frequency method.
In the clinic, preference is given to thermal methods. Phlebologists believe that it is better to do a good local anesthesia than to treat varicose veins on the legs with an expensive and unproven method. Also, the result is the same at best. In the event of a relapse, the patient will have to perform a complex operation to remove the sealed vessel, since other methods will no longer be applicable.
The modern method of combined treatment of reflux along the subcutaneous venous trunks adds additional weight to conventional sclerotherapy. Mechanochemical procedures are understood as a combination of mechanical damage to the inner surface of the venous wall and the introduction of a sclerosing agent. A catheter is inserted into the main saphenous vein through a puncture under ultrasound guidance. After installing the catheter in the correct place, the device is connected. The rotating sharp head of the catheter reaches up to 3. 5 thousand revolutions per minute, which causes pronounced damage to the inner layer of the venous 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 vascular wall, causing its inflammation and sticking.
This is a modern microsurgical aesthetic method to remove varicose tributaries. It involves a delicate technique of puncture and extraction of varicose tributaries with the help of special tools. This operation is not for a novice phlebologist, you need to master the skills of delicate operation. Miniphlebectomy is a no-scalpel operation and is performed under local anesthesia. Punctures are made in the direction of the skin lines, so at 2 months they are almost invisible.