Varicose veins is a vascular pathology when the venous wall of the vessel is stretched against the background of connective tissue weakness. The diameter of the vein increases, its wall becomes thinner.
The large diameter of the vein causes a decrease in the speed of blood flow, venous congestion and contributes to pain in the calves. Against this background, varicose veins can cause thrombophlebitis - inflammation of the affected vessels, which is terrible for the development of thromboembolic complications. External cones visible along the vessels allow to recognize varicose veins in the legs. Varicose veins of the lower extremities (ICD code I83) is a very noticeable disease that is easy to eliminate.
Esophageal varicose veins are among the symptoms of portal hypertension, and secondary varicose nodes in the female perineum indicate varicose dilatation of the small pelvic vessels and difficulty in the outflow of blood from the main vessels.
Varicose veins of the spermatic cord (varicocele) are manifested by the clinic of secondary pelvic phlebohypertension and can cause infertility in men. The etiology and pathogenesis of varicose veins are very different depending on the localization of the process. In itself, the increase in the diameter of the veins is not dangerous, but the complications of varicose veins pose a great risk to health, and sometimes to the patient's life. The reason for the onset of varicose veins in the legs can be heavy physical exertion, childbirth, and the sedentary lifestyle of patients.
To understand what varicose veins look like, it is enough to go to the summer beach. Although many carriers of varicose veins are ashamed to be seen there, you will definitely 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 till the end, you will understand how to treat varicose veins of the legs easily. Do not be afraid to go to a phlebologist.
Can we reverse varicose veins?
Many people ask this question, hoping to treat varicose veins in the early stages with the help of drugs or traditional medical methods. If we are talking about varicose veins in the legs, phlebologists can unequivocally answer this question - the degenerative destruction of the venous wall cannot disappear without shutting off the affected vein from the blood flow or removing it.
It happens that dilated veins may still not lose their function and may increase in volume due to blood flow from the upper parts, and the muscle pump of the lower leg helps blood to 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 development of varicose veins at different stages. Here is the rule: if the vein is irreversibly affected, then it needs to be removed or coagulated or glued.
Why are even primary varicose veins irreversible without surgery? For the 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, dilated varicose veins can recover their functions independently and without surgical intervention if the phlebologist removes pathological discharges that cause varicose veins and irreversibly changed veins.
Modern treatment of varicose veins has evolved significantly since the first operations for varicose veins in men and women in the 19th century. Depending on the degree of varicose veins, the classification of the disease and appropriate treatment methods are drawn up.
Innovative Vascular Center clinics know how to treat varicose veins with minimal medical, psychological and cosmetic concerns. According to the classic scheme, we do not need to remove varicose veins. In the arsenal of phlebologists, the hemodynamic concept, which treats the underlying causes of varicose veins, is a technique that involves the correction of pathologically altered venous flow and the removal of only the affected veins.
Treatment cannot be directed to the etiology of the disease, but the pathogenesis of the problem is known, so it can be stopped. The presence of balls of varicose veins on the legs in women can be an annoying symptom due to aesthetic problems, but the fair sex is not ready to exchange the ugly appearance of neglected subcutaneous varicose veins for large scars. Therefore, clinics offer both cosmetic and radical treatment with the best patient reviews.
Some anatomy and physiology
The definition of varicose veins is the main dilation of the subcutaneous venous trunks of the lower extremities due to congenital, contributing and producing factors. 40% of adults on the planet have a chance of getting varicose veins. In developed countries, signs of varicose veins are found in half of the population.
The saphenous veins in the legs are represented by two large venous systems - the large and small saphenous vein system. The great saphenous vein starts from the place where it passes through the inner surface of the leg to the groin, from there to the deep vein of the thigh, inside the common femoral artery.
Going from the trunk and branches of the great saphenous vein, short venous trunks can be identified - perforators that connect it with the deep veins of the lower leg and thigh, causing varicose veins to move away from the main trunks. These perforators are designed to facilitate the passage of blood into the deep venous system.
The small saphenous vein originates at the external malleolus, is characterized by several bends along the posterior surface of the lower leg and merges with the popliteal vein. The large and small saphenous veins are connected by separate floodgates. 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, the malfunction of the internal valve apparatus of the vessels develops, the blood begins to move in the opposite direction, causing the saphenous vein to overflow, its further extension and development. severe varicose veins. Therefore, it is impossible to achieve the treatment of chronic varicose veins without eliminating the pathological discharge of blood.
The classification of subcutaneous varicose veins in the legs is formed by the 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 caused by a combination of several factors:
- Congenital stretching and weakness of the venous wall and increased intra-venous pressure.
- Increased pressure on blood vessels due to long-term lifestyle, heavy physical exertion, pregnancy and childbirth.
- Congenital and acquired obstructions of the venous exit (compression syndromes, tumors and bony joints pressing on the veins).
- Consequences of previous deep vein thrombosis
Modern principles of treatment of varicose veins
Many patients often ask the question - what treatment is needed for varicose veins, only if its first signs appear. Varicose veins in the legs are a disease that develops continuously and is prone to complications, so you cannot hope to recover without medical intervention. Consider the main indications for the treatment of varicose veins in the legs.
Elimination of symptoms of chronic venous insufficiency
Venous hypertension is a subjectively unpleasant consequence of a violation of venous flow, but varicose veins themselves are not harmful. Symptoms of varicose veins that require prevention and treatment include heaviness in the legs, evening swelling, increased leg fatigue, and even pain in the calf muscles. As the disease progresses, stagnation develops in venous perforators and deep veins, which can cause hyperpigmentation of the skin, eczema in varicose veins, heaviness in the calves.
The most popular and publicly advertised method of treating the symptoms of varicose veins in the legs is delaying contact with specialists by taking various pills, ointments and creams for varicose veins. It is important to understand that such tools do not affect the course of varicose veins, so they can only slightly alleviate complaints and symptoms in the early stages. It is not worth believing 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 veins are complicated by local inflammatory processes, which expands the indications for active surgical tactics. Often, the patient comes to treat varicose veins, his complications develop - thrombophlebitis (ICD code I80), it causes a lot of pain, or a trophic ulcer appears. Sometimes he is disturbed by night cramps in the calf muscles, redness of the skin, pain.
Thrombophlebitis can be treated 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, its cause is also eliminated, which is varicose veins.
Trophic ulcer is an extreme manifestation of chronic venous insufficiency and is a great danger. Active purulent discharge resembles a skin defect in the region of the medial malleolus with loose granulations and is accompanied by permanent damage to the surrounding subcutaneous tissue.
Initial varicose ulcers tend to progress and respond very poorly to conservative treatment. Today, the optimal treatment method for varicose veins of the great or small saphenous veins is laser correction of venous flow (EVLK) and proper local treatment (special dressings, washing of the ulcer). One does not work without the other, so it is not necessary to rely on the healing of trophic ulcers from ointments alone. A mandatory component of treatment is compression therapy with the help of special compression stockings. They greatly alleviate the complaints of patients.
Cosmetic instructions for varicose veins
Varicose veins are a disease that rarely causes dangerous complications, but often calls for specialists. Bulging varicose veins bring many aesthetic problems to their owners. Usually, young patients are embarrassed by these nodules and hide their legs. If men are not so afraid of varicose veins and can always walk in pants, women always want to walk with their legs open.
The good news is that advanced varicose veins on the legs of women or men can now be removed without any scars with a single procedure of laser photocoagulation of varicose veins. Modern interventions are performed without incisions, through minimal punctures that are completely 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 provides an amazing cosmetic result and a stable recovery from the manifestations of varicose veins, so EVLT is popular among doctors and young patients with varicose veins of the legs at any stage.
Prevention of complications of varicose veins
Solving these problems is possible with conservative and operative methods. The main goal of modern phlebology is to minimize surgical trauma with the longest possible therapeutic and cosmetic effect in the treatment of varicose veins. To solve the first problem, it is necessary to close the venous vessels running in the opposite direction, through which an open flow occurs, to solve the second problem, it is necessary to remove or turn off the enlarged vessels from the bloodstream.
Diagnosis of varicose veins
To make the correct diagnosis of superficial vascular disease, an examination by an experienced specialist and an ultrasound examination of the saphenous and deep veins from the abdominal cavity to the legs are necessary. The information obtained 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 determined using ultrasound.
In some cases, doctors perform invasive tests in the angiographic department in the amount of phlebography. After treatment, doctors need periodic monitoring of the condition of the operated vessels by doctors using ultrasound diagnostics. If the doctor has questions about the state of the deep veins at the diagnostic stage, MRI diagnostics or contrast-enhanced CT will accurately determine their patency.
Methods of treatment of varicose veins in the vascular center
A vascular surgeon can treat varicose veins of the lower extremities only by eliminating the causes of its appearance. It is necessary to fight the cause of the development of varicose veins and the progression of the disease. Consider key technologies with proven effectiveness.
Laser treatment of varicose veins (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. The light-conducting fiber is inserted into the vein through a puncture under ultrasound guidance. At the moment when laser energy of a certain wavelength is generated, it is absorbed by the venous wall, which causes its heating and the destruction of connective tissue. As a result, the wall of the vessel turns into scar tissue and the blood flow from the affected vessel stops completely. The same effect is achieved by surgical removal of a vein, but only with incisions, general anesthesia and without pain.
Due to its effectiveness, EVLK surpasses the open operation of phlebectomy. 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 clotted vein, inflammation of the clotted veins, and blood clots. The total frequency of such complications does not exceed 1%. In the Innovative Vascular Center, EVLK is the "gold standard", it can heal any varicose veins, both at the initial and advanced stages. Patients leave the best reviews immediately after laser treatment.
Radiofrequency obliteration (RFO) of varicose veins
In terms of its effect and effect, RFO, like a laser, is called thermal methods for the treatment of 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 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 vessel.
Both of these methods (EVLK and RFA) belong to thermoablative (thermal) technologies. They are similar in effectiveness, but the laser heats the vessel 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 destroys the structure of the affected vessel more radically, so the frequency of relapses after the laser is lower than with radiofrequency obliteration. Doctors noted the absence of recurrence of varicose veins in 98% after EVLK and 86% after RFO. Based on 20 years of work experience, phlebologists have come to the conclusion that thermal methods of varicose veins are treated more effectively than conventional vein removal surgery.
Non-thermal methods of obliteration of varicose veins
In the 70s of the 20th century, surgeons began to show increasing interest in minimally invasive types of surgical treatment of varicose veins and began to use electrocoagulators. It's a good idea, but poorly implemented in practice. Patients had skin burns, so doctors were afraid to use thermal methods with varicose veins for a long time. Chemical methods used to obliterate veins have been proven to be safe and quite effective. These include various variants of sclerotherapy and adhesive obliteration.
Sclerotherapy
Sclerotherapy is the intravenous injection 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 began in the 19th century and has undergone an interesting development. At the vascular center, specialists use the most advanced technology - the foam form of sclerotherapy. Continuous 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% within 5 years. Sclerotherapy treatment does not focus precisely on the causes of varicose veins, but removes the venous nodes themselves, so it can be used together with other minimally invasive methods (EVLK, RFO). A feature of sclerotherapy is the appearance of dense cones - clots at the site of sclerotic vessels, which dissolve up to six months.
Bonding of veins with varicose veins with special glue
Venaseal technology is the name of a non-thermal method of obliteration of varicose bodies of saphenous veins, which involves the introduction of a special glue into the lumen of the vein, which polymerizes inside the lumen of the vessel, causing its blockage. The idea seems interesting and advanced over the past decade, but there are a few pitfalls. First, the glue remains inside the affected vessels as a foreign body, it does not dissolve. Second, as the body's reaction to a foreign body, there are risks of periphlebitis around a sealed vein. Third, it is an expensive treatment method.
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 this type of treatment. The advantages of this technology have not yet been determined, but research is actively underway, and it is possible that varicose veins will become a disease in which the entire treatment regimen will turn into one "magic" injection. It is characteristic that this method is not yet considered in the latest clinical guidelines, but it is already actively offered by some phlebological centers.
Surgical treatment of varicose veins of the lower extremities
Doctors have been dealing with the issue of how to get rid of large varicose veins of the superficial veins on the legs and prevent complications since the middle of the 19th century. The history of the fight against varicose veins clarifies how the operation has progressed from the early large incisions that disfigured the legs to micropunctures that allow the fight against varicose veins without cosmetic defects.
Advanced phlebologists use classical surgical elements in the form of microphlebectomy using punctures to eliminate individual varicose veins and branches. This can be the most cosmetic way to remove varicose veins in thin skin. A month after such an operation, there is no redness on the skin.
Other heating methods
When deciding how to treat varicose veins, phlebologists often used exotic methods. Varicose veins were treated with thermal effects using superheated steam and bipolar electrocoagulation. However, modern thermal methods are more effective and they allow the doctor to prevent the further development of varicose veins and receive outpatient treatment without disrupting the patient's lifestyle. In the hands of an inexperienced phlebologist, thermal ablation methods can cause unpleasant complications: decreased sensitivity, burns, seals. In the hands of an experienced phlebologist, the effectiveness of this method is more than 98%, and the laser method and RFO allow you to get rid of not only the initial form, but also severely pronounced varicose veins on the legs without incisions.
Using special glue
Since its inception, this method has attracted great interest among phlebologists. This involves gluing the trunk of the great saphenous vein with a special cyanoacrylate glue. In the lumen of the vessel, this glue polymerizes and fills the lumen of the dilated vessel. As the developers think, this method does not require any anesthesia and a "plug" appears in the vein that reliably blocks the blood flow. Taking this into account, half an hour is enough for the procedure to eliminate varicose veins on the legs. Venasil is the only technology for the treatment of varicose veins that does not require the wearing of compression stockings.
Most women can return to normal activities immediately. Symptoms of chronic venous insufficiency disappear immediately after the procedure. The process of actively promoting this glue in the phlebology market should begin in the near future. However, there are certain disadvantages: The presence of a foreign body in the human body. The curled glue remains forever in the vessel and can cause chronic allergies, sometimes there is inflammation of the vessel wall or rejection of the polymer with pus. Acute thrombophlebitis of the adhesive vessel may appear.
The use of glue in the trunk of the great saphenous vein does not eliminate the need to deal with the elimination of varicose branches, so doctors will have to eliminate the symptoms of subcutaneous varicose veins with sclerotherapy or miniphlebectomy. The visible effect of the use of glue is manifested only in combination with other methods of removing varicose veins. The patient has to pay more. The unreasonably high price of the adhesive kit makes this procedure more expensive than the modern laser or radiofrequency method.
In the clinic, thermal methods are preferred. Phlebologists say that it is better to use good local anesthesia than to treat varicose veins in the legs with an expensive and untested method. Moreover, the result is the same at best. If a relapse occurs, the patient will have to undergo a complex operation to remove the sealed vein, as other methods will no longer be applicable.
The modern method of combined treatment of reflux along subcutaneous venous trunks adds weight to conventional sclerotherapy. Mechanical-chemical procedures are understood as a combination of mechanical damage to the inner surface of the venous wall and the application 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 right place, the device is connected. The rotating sharp head of the catheter makes 3. 5 thousand revolutions per minute and clearly damages the inner layer of the venous wall. In parallel, a sclerosing substance is injected through the catheter, which "mixes" in the lumen of the vessel and affects the vessel wall with the help of the rotating part of the catheter, causing its inflammation and adhesion.
This is a modern microsurgical aesthetic method to eliminate varicose veins. It involves a delicate technique to pierce and pull varicose veins with the help of special tools. This operation is not for an inexperienced phlebologist, it is necessary to master fine operational skills. Miniphlebectomy is an operation that does not use a scalpel and is performed under local anesthesia. Punctures are made in the direction of the skin lines, so after 2 months they are almost invisible.