Varicose veins are a vascular pathology when, on the background of weakness of the connective tissue, there is stretching of the venous wall of the vein. 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 calf pain. Considering this, 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 blood vessels allow you to identify varicose veins in the legs. Varicose veins of the lower extremities (ICD code I83) is a very noticeable disease that is easily removed.
Varicose veins in 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 impaired blood flow from the main veins.
Dilated veins of the spermatic cord (varicocele) is manifested by the clinic of secondary pelvic phlebohypertension and can lead to infertility in men. The etiology and pathogenesis of varicose veins is very diverse 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 the patient's health, and sometimes even to his life. The cause of the appearance of varicose veins on the legs can be heavy physical exertion, childbirth, sedentary lifestyle of patients.
To understand what varicose veins look like, just go to a summer beach. Although many people with varicose veins are embarrassed to appear there, you will definitely see how varicose veins manifest in men and women. The disease is so widespread 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 on the legs. Don't be afraid to go to a phlebologist.
Can we reverse 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 on the legs, then phlebologists can unequivocally answer this question - the degenerative destruction of the venous wall cannot disappear without shutting off the affected vein from the blood stream or removing it.
It happens that varicose veins still do not lose their function and increase in volume due to the overflow of blood from the upper parts, and the muscular pump of the lower leg helps the blood to flow into the deep veins.
Depending on the stage of varicose veins, various methods of surgical and conservative treatment can be applied that can stop the progression of varicose veins at different stages. The sequence is as follows: if the vein is irreversibly affected, then it must be removed or coagulated, or glued.
Why are initial varicose veins irreversible without surgical intervention? For the effective treatment of varicose veins on the legs, it is necessary to recognize where the pathological venous blood discharge comes from and remove it with minimal trauma. However, dilated varicose tributaries can restore their function on their own and without surgical intervention if the phlebologist eliminates the pathological discharges, which cause varicose veins and irreversibly changed veins.
Modern treatment of varicose veins has advanced significantly since the first varicose vein surgeries for men and women in the 19th century. Depending on the degree of varicose veins, a classification of the disease and appropriate treatment methods are drawn up.
Clinics of the Innovative Vascular Center know how to treat varicose veins with minimal medical, psychological and cosmetic discomfort. We do not have to remove varicose veins according to the classic scheme. In the arsenal of phlebologists, the hemodynamic concept of treatment of the main causes of varicose veins, a technique that includes the correction of only the pathologically altered venous outflow and the removal of only the affected veins.
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 balls of varicose veins on the legs can be an unpleasant symptom due to aesthetic problems, but the fairer sex is not ready to change the ugly appearance of neglected subcutaneous varicose veins for large scars. Therefore, clinics offer both cosmetic and radical treatments that have the best ratings of patients.
A bit of anatomy and physiology
Varicose veins are defined as primary dilatation of the subcutaneous venous trunks of the lower extremities, due to congenital, contributing, and manufacturing factors. The chance of getting varicose veins exists in 40% of adults on the planet. In developed countries, signs of varicose veins are detected in half of the population.
The saphenous veins on the legs represent two large venous systems - the system of large and small 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 flows into the deep vein on the thigh, from the inner side of the common femoral artery.
On the way from the trunk and tributaries of the large vein, short venous trunks can be recognized - perforators that connect it to the deep veins of the lower leg and thigh, which causes varicose veins 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 bends along the posterior surface of the lower leg and enters the popliteal vein. Between themselves, the large and small veins are connected by separate dressings. In the subcutaneous trunks there are numerous venous valves that ensure the movement of blood to the heart and prevent reverse blood flow.
Due to the innate weakness of the venous wall and the load on it, the failure of the internal valve apparatus of the veins develops, the blood begins to move in the opposite direction, which causes the overflow of the saphenous vein, its further stretching and the development of severe varicose veins. Therefore, without eliminating the pathological blood discharge, it is impossible to achieve a cure for chronic varicose veins.
The classification of subcutaneous varicose veins on the legs is formed by the name and 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 extensibility and weakness of the venous wall and increased intravenous pressure.
- Increased pressure on the veins due to a long-term lifestyle, heavy physical exertion, pregnancy and childbirth.
- Congenital and acquired venous outflow obstructions (compression syndromes, tumors and bone formations that press 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, if only the first signs appear. Varicose veins on the legs are a disease that progresses continuously and is prone to complications, so recovery cannot be counted on without medical intervention. Consider the main indications for the treatment of varicose veins on the legs.
Alleviation of symptoms of chronic venous insufficiency
Venous hypertension is a subjectively unpleasant consequence of disturbed 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, there is stagnation in venous perforators and deep veins, which can lead to hyperpigmentation of the skin, cause eczema in varicose veins, and heaviness in the calves is noted.
The most popular and publicly advertised method of treating the symptoms of varicose veins on the legs is taking various pills for varicose veins, using ointments and creams, which is why contacting a specialist is delayed. It is important to understand that such drugs do not affect the flow of varicose veins, which is why they can only slightly alleviate the 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 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 to the treatment of varicose veins when complications develop - thrombophlebitis (ICD code I80) which hurts a lot or a trophic ulcer appears. Night cramps in the lower leg muscles, skin redness, pain are sometimes disturbing.
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 removed, namely 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, flaccid granulations, and is accompanied by continuous damage to the surrounding subcutaneous tissue.
Initial 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 proper local treatment (special dressings, washing of ulcers). One does not work without the other, so you should not count on healing a trophic ulcer from fat alone. A mandatory component of the treatment is compression therapy with the help of special compression stockings. They greatly alleviate patients' complaints.
Cosmetic indications for varicose veins
Varicose veins are a disease that rarely leads to dangerous complications, but often forces you to consult a specialist. Protruding 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 afraid of varicose veins and can constantly walk in pants, then women constantly 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 eliminated with just one procedure of laser photocoagulation of varicose veins without leaving any traces. Modern interventions are performed without incisions, through minimal punctures, which are absolutely invisible already 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 incredible cosmetic result and a stable recovery from the manifestations of varicose veins, which is why EVLT is popular with doctors and young patients with varicose veins of the legs at any stage.
Prevention of the development of complications of varicose veins
The solution of these problems is possible with 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 there is pronounced discharge, to solve the second problem, it is necessary to remove or exclude dilated veins from the bloodstream.
Diagnosis of varicose veins
For the correct diagnosis of superficial vein disease, an examination by an experienced specialist and an ultrasound scan of the saphenous and deep veins from the abdomen to the feet are necessary. Data from these research methods are sufficient for correct recognition of this diagnosis in the vast majority of patients. The main signs of varicose veins on the legs can be determined with the naked eye, and the causes can be determined by ultrasound.
In some cases, doctors perform invasive tests in the amount of phlebography on the angiography unit. After the treatment, patients need periodic monitoring of the condition of the operated veins, which doctors perform with ultrasound diagnostics. If during the diagnostic phase the doctor has questions about the state 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 removing the cause of its occurrence. It is necessary to fight against the causes of the development of varicose veins and the progression of the disease. Consider the main technologies with proven effectiveness.
Laser treatment of varicose veins (EVLT)
Endovenous laser coagulation is based on heating the vein wall with a coherent light beam. Varicose veins can be effectively treated without incisions and general anesthesia. A light-conducting fiber is inserted into the vein through a puncture under ultrasound guidance. Laser energy of a certain wavelength at the moment of its occurrence is absorbed by the vein wall, which leads to its heating and destruction of the 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 the vein, but only without incisions, general anesthesia and pain.
In terms of its 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 numbness of the skin in the area of the coagulated vein, inflammation and blood clots in the coagulated vein. The total incidence of such complications does not exceed 1%. In the Innovative Vascular Center, EVLK is the "gold standard", it can cure any varicose veins, both in the initial and advanced stages. Patients leave the best reviews immediately after the laser treatment.
Radiofrequency obliteration of varicose veins (RFO)
Due to its influence and effect, RFO, like the laser, is called thermal methods for the treatment of varicose veins, but a different physical principle is used here. The radioprobe is also inserted into the vein through the 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 the wall leads to thermal destruction of its structural elements, after which vein scars occur.
Both of these methods (EVLK and RFA) refer to thermoablative (thermal) technologies. They are similar in their effectiveness, however, 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 the frequency of recurrence 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 the experience of 20 years of work, phlebologists have concluded that thermal methods of varicose veins are treated more effectively than conventional vein removal operations.
Non-thermal methods of obliteration of 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 why doctors may have been afraid to use thermal methods for varicose veins for a long time. Chemical methods used to obliterate veins have proven to be safe and quite effective. This includes sclerotherapy in various variants and adhesive obliteration.
Sclerotherapy
Sclerotherapy is the intravenous administration of special drugs that cause damage to the vein wall, followed by obliteration (excessive growth) of the lumen of varicose veins. The history of this method begins in the 19th century and has an interesting development path. In the vascular center, experts use the most advanced technology - a foam form of 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 about 50% in 5 years. With sclerotherapy, the treatment does not exactly focus on the causes of varicose veins, but eliminates the venous nodes themselves, so it can be used in combination with other minimally invasive methods (EVLK, RFO). A characteristic of sclerotherapy is the appearance of dense cones - coagulum at the site of sclerotic veins, which disappear up to six months.
Vein gluing in varicose veins with a special glue
Venaseal technology is the name of a non-thermal method of obliteration of dilated vein trunks, which involves introducing a special glue into the vein lumen, which polymerizes inside the vein lumen, causing its blockage. The idea seems interesting and developed in the last decade, but there are several 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 the 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 being actively conducted, 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 has not yet been considered in the latest clinical guidelines, butis already actively offered by some phlebological centers.
Surgical methods of treating 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 on the legs and the prevention of complications since the middle of the 19th century. The history of the struggle with varicose veins clearly shows how from the early large incisions that disfigure the legs, surgery has gone to micro-punctures, which allow you to deal with varicose veins without cosmetic defects.
Advanced phlebologists use elements of classic 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 on thin skin. A month after such an operation, there is not even any 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 the further development of varicose veins, and the patient to be treated on an outpatient basis without disrupting their 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 very pronounced varicose veins on the legs without incisions.
Use of special glue
Since its inception, this method has aroused great interest among phlebologists. It involves gluing the trunk of the great saphenous vein with a special cyanoacrylate glue. In the lumen of the blood vessel, this glue polymerizes and fills the lumen of the dilated vessel. As envisioned by the developers, this method does not require any anesthesia, and a "plug" appears in the container that reliably blocks blood flow. Considering that, half an hour is enough for the procedure of removing varicose veins on the legs. Venasil is the only technology for the treatment of varicose veins that does not require wearing compression stockings.
Most women can return to normal activities immediately. Symptoms of chronic venous insufficiency disappear shortly after the procedure. The process of active promotion of this glue on the phlebology market should begin in the near future. However, there are certain disadvantages: The presence of a foreign body in the human body. Twisted glue remains in the vessel forever and can cause chronic allergies, sometimes inflammation of the vessel wall or rejection of the polymer with suppuration. Acute thrombophlebitis of a stuck vessel may occur.
The use of glue in the trunk of the great saphenous vein does not eliminate the need to eliminate dilated tributaries, which is why doctors will have to remove signs of subcutaneous varicose veins with sclerotherapy or miniphlebectomy. The visible effect of the use of glue is manifested only in the case of combination with other methods of eliminating varicose veins. The patient has to pay more. The unreasonably high price of the gluing kit makes this procedure much more expensive than modern laser or radiofrequency methods.
In the clinic, preference is given to thermal methods. Phlebologists believe that it is better to make a good local anesthesia than to treat varicose veins on the legs with an expensive and unproven method. Moreover, the result is the same at best. In case of recurrence, the patient will have to perform 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 additional weight to conventional sclerotherapy. Mechano-chemical procedures are understood as a combination of mechanical damage to the inner surface of the vein wall and the introduction of a sclerosing agent. The catheter is introduced into the main saphenous vein through a puncture under ultrasound control. After placing 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 vascular wall, causing its inflammation and adhesion.
This is a modern microsurgical aesthetic method for removing varicose veins. It involves the delicate technique of puncturing and withdrawing varicose tributaries with the help of special tools. This operation is not for the novice phlebologist, you must master the skills of delicate operation. Miniphlebectomy is an operation without the use of 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.