Varicose veins of the legs are a disease of the saphenous veins, in which their pathological expansion develops.Varicose veins are swollen varicose veins that usually develop on the legs.Varicose veins develop more often in women than in men.For a long time, varicose veins have only been a cosmetic problem (varicose veins), but if left untreated, they continually progress and can lead to complications over time.The main complications - trophic ulcers, thrombophlebitis, changes in skin color without treatment develop in 70% of patients with varicose veins.
Symptoms of varicose veins
- Swollen and dilated veins in the legs
- Heaviness in the legs, tiredness in the evening
- Swelling of the feet in the evening after physical activity
- Change in skin color on the lower leg
- Inflammation of the saphenous veins - thrombophlebitis
- Trophic skin ulcers
Causes of varicose veins and risk factors
- Compound inheritance: congenital insufficiency of the valve system
- Heavy physical work while standing
- Frequent pregnancies and births
- Walking in high heels
Modern methods of treatment of varicose veins of the lower extremities in our clinics allow you to solve this problem without resorting to serious surgical interventions, without pain, incisions and hospitalization.
The modern level of phlebology allows you to treat varicose veins painlessly for the patient, very aesthetically and reliably.The first signs of varicose veins should be a reason to contact a phlebologist.Varicose veins of the lower extremities imply the complete disappearance of the tone of the venous wall, so it is useless to influence varicose transformation with tablets and leeches as treatment.
Diagnostics
Complaints and symptoms
Varicose veins begin with the appearance of single nodules of dilated veins and steadily progress.Varicose veins do not cause any problems initially, but over time they become a risk factor for serious health risks.So, let's look at the main problems that worry patients with varicose veins:
Cosmetic discomfort
Most patients with varicose veins only complain of unsightly varicose knots that ruin the appearance of their legs.Such disorders are often caused by varicose veins in women.Most often, cosmetic discomfort is caused by small varicose veins and varicose veins, which do not threaten health, but force you to close your legs.Such patients require treatment for cosmetic reasons, so only minimally invasive methods (without incisions) are recommended for them.
Chronic venous insufficiency
About 30% of patients suffering from varicose veins complain of heaviness in the legs, swelling in the evening and night-time cramps in the calves.These are signs of chronic venous insufficiency.Gradually, its phenomena worsen and painful sensations may appear in the varicose nodes.Skin changes and pigmentation develop.With severe venous insufficiency, the skin of the lower third of the leg can be damaged with the formation of a trophic ulcer, which is difficult to treat.Often patients with advanced varicose veins develop skin inflammation - eczema.
Examination by a phlebologist
Consultation with a phlebologist is necessary if varicose veins cause discomfort.The examination is carried out lying and standing.The patient must open his legs completely.
Varicose veins are diagnosed during a routine examination, which should be performed standing while the veins are full.After the examination, a duplex ultrasound is always necessary.As a rule, such a diagnosis will be sufficient.However, if secondary varicose veins are suspected, examination of the deep venous system is necessary.
Ultrasound scan of the veins
In the case of varicose veins, ultrasound of the veins has the task of identifying the incompetence of the venous trunks, identifying non-functioning venous valves and identifying blood clots in the superficial and deep venous systems.
The exam begins with examining the saphenous veins in a standing position.The diameter and patency of the large and small saphenous vein are studied, the consistency of the valves is determined (Valsalva maneuver - tension of the abdominal muscles with a full inhalation, a sign of incompetence is the reverse flow of blood).Subsequently, the perforating veins in typical locations and their vitality during the Valsalva maneuver are studied.
After evaluating the superficial veins, it is necessary to evaluate the patency of the deep ones.For this purpose, in a lying position, the popliteal and femoral veins are examined, their patency and the consistency of the valves are also assessed.
Contrast venography
Usually, ultrasound is sufficient for a complete diagnosis of venous pathology, but in some cases it is necessary to study the relationship between the state of the deep and superficial venous system, especially in case of relapses of varicose veins and secondary varicose veins.
To resolve these problems, radiographic examination with contrast is used.The saphenous veins are punctured and contrast is administered.The movement of the contrast is observed on the monitor of the X-ray machine and all necessary tests and projections are performed.Currently, venography for varicose veins is used very rarely.
Treatment
The “classic” varicose vein operation under anesthesia with incisions in the groin area and along the legs, used to remove superficial varicose veins at the beginning of the last century, is an atavism of the past.Patients' suffering, long hospitalization and leg pain after such operations aimed at improving blood flow are completely unjustified.Severe varicose veins can be treated without resorting to “inquisition methods”.Today the treatment of advanced varicose veins can be carried out without anesthesia and hospitalization.The work of a phlebologist becomes outpatient, without the attributes of a major surgical operation.
Knowledge of the causes of varicose veins in the legs has allowed us to develop the hemodynamic principles of treatment.Their implementation is possible by removing or turning off the vein from the blood circulation.Modern technologies are based on the principle of fusion of the venous walls in the area of insufficient venous valves.The method of influencing venous circulation may be different, but its goal is the same: to stop the pathological discharge of blood through the affected vein (antireflux).
How to cure varicose veins on the legs?
Understanding the cause of varicose veins allows you to choose the right treatment method.The goal of modern treatment of varicose veins is to solve several problems:
- Cessation of pathological discharge in a vertical position through the incompetent saphenous veins of the lower extremities.
- Elimination of reflux between the deep and superficial veins - perforators - the main mechanism for the development of varicose trophic ulcers.
- Removal of varicose-degenerated superficial vessels (varices).
- Compression therapy with special stockings and socks.
Capacity of the vascular center
Thermal methods for the treatment of varicose veins are endovenous laser coagulation (EVLC) and radiofrequency obliteration (RFO) of the veins of the lower extremities.
Endovenous laser coagulation is an effective treatment for varicose veins, the principle of which is based on the thermal effect of laser energy.This treatment was introduced in 2001 and is still the best method.With laser coagulation, the damaged vein is heated by a laser beam, which provides a strong damaging effect on the collagen of the venous wall, causing an inflammatory process in the vein and its overgrowth.Advanced varicose veins on the legs, treated with this method, regress completely and without a trace, and its main symptoms disappear: swelling, heaviness in the legs, hyperpigmentation of the skin.
EVLT begins with the installation of a laser fiber into the lumen of a varicose vessel through a skin puncture, which is guided along the affected vein to the site of the incompetent valve.For the patient, this method is a safe, painless and reliable way to prevent further development of the disease and its complications.Complete elimination of varicose veins is observed in 98% of patients with the correct use of the EVLT method.The capabilities of this method allow both to treat varicose veins on the legs in women and to correct venous outflow in trophic ulcers.
Radio Frequency Cancellation (RFO)
Treatment of varicose veins with the radiofrequency obliteration (RFO) method is a similar thermal method, but heating of the tissue of the venous wall occurs according to different physical principles due to the energy of radio waves.Radiofrequency obliteration allows you to remove varicose veins and eliminate their symptoms;such treatment in its immediate and long-term results does not differ from EVLT, but is more scrupulous for a phlebologist.
Other thermal 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 allow the doctor to prevent the further development of varicose veins and treat the patient on an outpatient basis without disturbing his lifestyle.In the hands of a novice phlebologist, thermal ablation methods can cause unpleasant complications: decreased sensitivity, burns, seals.The effectiveness of this method in the hands of an experienced phlebologist is more than 98%, and the laser and RFO method allow you to eliminate not only the initial form but also severely pronounced varicose veins on the legs without incisions.In the photographs in the “Treatment Results” section you can see the view before and after the minimally invasive treatment.
Non-thermal methods to eliminate stem reflux
For many years, phlebologists have been thinking about how to treat varicose veins of the lower extremities without incisions and pain.The disappearance of the saphenous veins in the arms after frequent injections gave rise to the idea that some substances can cause inflammation of the venous walls: thrombophlebitis and their subsequent sticking with the disappearance of the vein lumen.After the advent of the Fegan method, when treatment began to be carried out based on the cause of varicose veins, the development of non-thermal sclerobliteration methods began.Since then, varicose veins on the legs, especially in women, are treated not only with a scalpel, but also with a syringe.
Sclerotherapy
Sclerotherapy appeared in the practice of doctors at the end of the 19th century.In recent years, the method of treating varicose veins by injections of a special substance (sclerosant) has reached perfection.The main purpose of sclerotherapy is to inject a drug into a varicose vein, which causes inflammation and subsequent sticking of the varicose vein.Sclerotherapy does not involve eliminating the cause of venous insufficiency and is more suitable for some forms of varicose veins or in the initial stages of the disease.Advanced varicose veins of the lower extremities are treated with more complex methods;damage to the trunk of the large or small saphenous vein does not allow you to count on the long-term effect of sclerotherapy, since a recurrence is sure to occur due to reflux.
Sclerotherapy can be performed in the absence of allergy to tetradecyl sulfate or polidocanol.These substances are the main sclerosing substances.During sclerosing treatment, manifestations of thrombophlebitis may occur, especially if liquid forms of the drug are used.Perforating vein sclerotherapy is highly effective in the treatment of venous trophic ulcers.It is possible to eliminate the manifestations of varicose veins of the lower extremities at any stage with the help of sclerotherapy, but the recurrence rate is about 40% in the next 5 years.
The advantage of sclerotherapy is a good immediate effect and low cost of treatment.Sclerosant injections lead to gluing of the veins and cessation of the pathological process - reflux of blood through the saphenous veins.The drug is usually injected in the form of foam into varicose veins.A spasm of the dilated subcutaneous vessels is formed, a prolonged contact of the foamy form of the sclerosant with the wall of the vein and their subsequent inflammation and sticking.This process occurs unevenly and the degree of obliteration of the vein is not the same, so 40% of patients after sclerotherapy have relapses of varicose veins.After sclerotherapy, the affected area of \u200b\u200bthe veins of the lower extremities closes and over time heals completely, and blood flow in the opposite direction stops.To prevent the onset of skin necrosis due to the penetration of the foamy form of sclerosant into the subcutaneous tissue, administration is carried out strictly under ultrasound control.
Foam sclerotherapy can be used as a standalone method or in combination with laser treatment to eliminate varicose veins.The number of sessions to eliminate varicose veins using sclerotherapy depends on the stage of varicose veins and the condition of the veins.The course of treatment usually consists of 2-3 procedures.The skin area over the sclerotic vessel may take on a dark shade for 2-3 months (hyperpigmentation appears).It can ruin a woman's legs for several months, so it is best to carry out this treatment in the winter months.Pharmacological treatment and ultrasound-guided vascular punctures can accelerate the process of reabsorption of intravascular fluid accumulations (clots), the risk of which is approximately 10%.Clots form when compression is insufficient, but they will certainly disappear with time.Many patients know that within a month of sclerotherapy the signs of varicose veins of the lower extremities disappear for many years, which is why sclerotherapy is still one of the most popular treatment methods.
Using special glue
Since its inception this method has aroused great interest among phlebologists.This involves 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.According to the developers, this method does not require any anesthesia, and a "plug" appears in the vessel that reliably blocks 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 use of compression stockings.
Most women can return to normal activities immediately.Symptoms of chronic venous insufficiency improve 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 curd glue remains in the container forever and can cause chronic allergies;sometimes inflammation of the vascular wall or rejection of the polymer with suppuration is observed.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 eliminate varicose tributaries, which is why doctors will have to remove signs of subcutaneous varicose veins with sclerotherapy or miniphlebectomy.The visible effect of using glue appears only when combined with other methods of eliminating varicose veins.The patient has to pay more.The unreasonably high cost of the bonding kit makes this procedure significantly more expensive than the modern laser or radio frequency method.
In our clinic, preference is given to thermal methods.We believe that it is better to administer good local anesthesia than to treat varicose veins of the saphenous veins of the legs with an expensive and untested method.Furthermore, the result is at best the same.If a recurrence occurs, the patient will have to undergo a complex operation to remove the sealed vessel, since other methods will no longer be applicable.
Mechano-chemical obliteration technology
The modern method of combined treatment of reflux along the subcutaneous venous trunks adds additional burden to conventional sclerotherapy.Mechano-chemical procedures involve a combination of mechanical damage to the inner surface of the venous wall and the introduction of a sclerosing drug.A catheter is inserted into the main saphenous vein through a puncture under ultrasound guidance.After installing the catheter in the desired location, the device is connected.The sharp, rotating head of the catheter makes up to 3.5 thousand revolutions per minute, causing serious damage to the inner layer of the venous wall.At the same time, a sclerosing drug is injected through the catheter, which "mixes" in the lumen of the vessel and, using the rotating part of the catheter, acts on the vascular wall, causing inflammation and sticking.
To date, the only advantage of this technology is the absence of the need for tumescent anesthesia.Mechano-chemical obliteration should, according to its inventors, trigger a stronger obliteration effect than foam sclerotherapy, although for some reason no convincing data has yet been presented.It is clear that such varicose veins can be treated with other minimally invasive methods, so its advantages are not obvious.We must await further studies from Europe or the United States to accurately determine the place of this technology.
Miniphlebectomy
This is a modern microsurgical aesthetic method of removing varicose veins.This is a delicate technique of puncturing and extracting varicose veins using special instruments.This operation is not for a novice phlebologist;it is necessary to have the skills of delicate surgery.Miniphlebectomy is an operation without the use of a scalpel and is performed under local anesthesia.The punctures are made in the direction of the skin lines, so after 2 months they are practically invisible.
Miniphlebectomy has replaced the classic operation for varicose veins, which involves the use of 1-3 cm incisions, as it is aesthetically flawless, painless and very effective.Starting from the assumption of how varicose veins manifest themselves, the doctor can clearly plan the micropunctures and get by with minimal intervention.The patient can return home on his own feet immediately after the operation.Miniphlebectomy can be an independent effective method for the treatment of varicose veins or used in combination after laser coagulation of varicose veins.Removal of varicose veins is carried out using a special technique developed by Professor Varadi.This technique has been perfectly mastered by our phlebologists and allows the elimination of varicose veins on the legs - an effective treatment regardless of the cause.
Treatment results
Results of treatment of varicose veins
The results of modern therapy for varicose veins can be considered very good.Any technology, if done well, eliminates the symptoms of varicose veins in the legs.Almost 95% of patients have been free of varicose veins for 5 years or more, and 80% of them have never had serious problems with venous outflow.The innovative vascular center is ready to help you deal with any venous disease without incisions or pain.We know how to treat varicose veins and have extensive experience.Treatment of varicose veins should not be a problem in the modern world of high technology.