Varicose veins are a vascular pathology when, against the background of connective tissue weakness, the venous wall of the vein becomes elongated. 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. In light of this, varicose veins can lead to thrombophlebitis - inflammation of the affected veins, which is terrible for the development of thromboembolic complications. The external cones visible along the veins allow the identification of varicose veins in the legs. Varicose veins of the lower limbs (ICD code I83) is a very noticeable disease that can be easily removed.
Varicose veins of the esophagus are among the symptoms of portal hypertension, and secondary varicose nodes of the female perineum indicate pelvic varicose veins and difficulty in the outflow of blood from the main veins.
Varicose veins of the spermatic cord (varicocele) are manifested in 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. The increase in the diameter of the veins is not dangerous in itself, but the complications of varicose veins pose a great risk to health, and sometimes even to the patient's life. Varicose veins of the legs can be caused by heavy physical exertion, childbirth, and the sedentary lifestyle of patients.
To understand what varicose veins look like, go to the summer beach. Although many people with varicose veins are ashamed to show themselves there, you will definitely see how varicose veins manifest themselves in men and women. The disease is so common that you will definitely see it. After reading this article to the end, you will understand how easy it is to treat varicose veins of the legs. Do not be afraid to consult a phlebologist.
Can we reverse varicose veins?
Many people ask this question, hoping to cure varicose veins at the initial stage with the help of drugs or traditional medical methods. If we talk about varicose veins of the legs, phlebologists can clearly answer this question - the degenerative destruction of the venous wall cannot disappear without disconnecting the affected vein from the blood stream or removing it.
It happens that the dilated veins do not lose their function and their volume due to the overflowing blood of the covering sections, and the muscle pump of the leg helps the blood to flow out into the deep veins.
Depending on the stage of varicose veins, different surgical and conservative treatment methods can be used to stop the progression of varicose veins at different stages. The order here is as follows: if the vein is irreversibly affected, it must be removed, or coagulated, or glued.
Why is the initial varicose vein irreversible without surgery? To effectively treat varicose veins in the legs, the source of the abnormal venous blood must be recognized and removed with minimal trauma. However, dilated varicose tributaries can restore their function on their own and without surgical intervention, if the phlebologist eliminates the pathological discharge that causes varicose veins and irreversibly changed veins.
Modern treatment of varicose veins has advanced significantly since the first varicose vein surgeries performed on men and women in the 19th century. Depending on the degree of varicose veins, the classification of the disease and the appropriate treatment methods are compiled.
The clinics of the Innovative Vascular Center know how to treat varicose veins with minimal medical, psychological and cosmetic discomfort. Varicose veins do not need to be removed according to the classic scheme. In the arsenal of phlebologists is the hemodynamic concept of treating the main causes of varicose veins, a technique that includes only the correction of pathologically altered venous outflow and the removal of only the affected veins.
The 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 varicose veins on the legs can be an annoying symptom due to aesthetic problems, but the fair sex is not ready to change the ugly appearance of neglected subcutaneous varicose veins due to large scars. Therefore, the clinics offer both cosmetic and radical treatments, which have the best patient reviews.
Some anatomy and physiology
Varicose veins are defined as the primary dilation of the subcutaneous venous trunk of the lower extremities, which is congenital, contributing and under the influence of productive factors. 40% of adults on the planet have a chance of developing varicose veins. In developed countries, signs of varicose veins are detected in half of the population.
The saphenous veins in the legs are represented by two large venous systems - the system of the great and small saphenous veins. The great saphenous vein originates from the foot, from where it runs on the inner surface of the leg to the inguinal region, where it flows into the deep vein in the thigh, from inside the common femoral artery.
From the trunk of the great saphenous vein and its tributaries, short venous trunks can be identified along the way - perforators that connect it with the deep veins of the lower leg and thigh, which causes the formation of varicose veins far 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 at the external malleolus, it is characterized by several bends on the posterior surface of the lower leg and its confluence with the popliteal vein. The great and small saphenous veins are connected to each other by separate overflows. In the subcutaneous trunks, there are many venous valves that ensure that blood enters the heart and prevent blood from flowing back.
As a result of the congenital weakness of the vein wall and the load on it, the internal valvular apparatus of the veins develops, the blood moves in the opposite direction, which causes the saphenous vein to overflow, further stretch and develop. in case of severe varicose veins. Therefore, it is impossible to cure chronic varicose veins without stopping the abnormal blood flow.
The classification of subcutaneous varicose veins on the legs is based on the name of the disease and the cause of its development, the affected venous pool and the stage of chronic venous insufficiency. Varicose veins of the lower limbs are formed by a combination of several factors:
- Congenital expansion and weakness of the venous wall and increased intravenous pressure.
- Increased pressure on the veins due to long-term lifestyle, heavy physical exertion, pregnancy and childbirth.
- Congenital and acquired obstructions to venous outflow (compression syndromes, tumors and bone formations pressing on 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 when only the first signs appear. Varicose veins on the legs are a constantly developing disease prone to complications, so we cannot expect to be cured without medical intervention. Consider the main indications for the treatment of varicose veins of the legs.
Alleviation of symptoms of chronic venous insufficiency
Venous hypertension is a subjectively unpleasant consequence of a violation of venous outflow, but varicose veins themselves do not hurt. 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, congestion develops in the venous perforators and deep veins, which can lead to hyperpigmentation of the skin, 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 to take various anti-varicose pills, ointments and creams, which delays contacting a specialist. It is important to understand that such drugs do not affect the course of varicose veins, so they can only alleviate complaints and symptoms in the early stages to a small extent. It is not worth counting on the fact that varicose veins disappear after treatment with such drugs.
Treatment of complications of varicose veins (trophic ulcers, thrombophlebitis, venous bleeding).
In about 50% of cases, varicose disease is complicated by local inflammatory processes, which expands the indications for active surgical tactics. Most often, the patient comes to treat varicose veins when complications develop - thrombophlebitis (ICD code I80), which is very painful, or a trophic ulcer appears. Sometimes it is disturbed by night cramps in the calf muscles, redness, pain.
Thrombophlebitis can be treated conservatively (heparin ointment, lyoton, compresses) or more actively - removal of the affected varicose veins or laser coagulation. The clinical recommendations do not give a clear answer to this question, but with an active approach, the cause of thrombophlebitis is eliminated, which is varicose veins.
Trophic ulcer is an extreme manifestation of chronic venous insufficiency and poses a great danger. It appears as a skin defect in the area of the medial malleolus, with active purulent discharge, flaccid granulations, and permanent damage to the surrounding subcutaneous tissue.
Incipient varicose ulcers tend to progress and respond very poorly to conservative treatment. Nowadays, the optimal treatment method is laser correction of venous outflow (EVLK) in the case of large or small varicose veins and appropriate local treatment (special bandages, washing the ulcer). One does not work without the other, so you don't have to count on ointments alone to heal a trophic ulcer. A mandatory part of the treatment is compression therapy using special compression stockings. They alleviate patients' complaints to a great extent.
Cosmetic indications for varicose veins
Varicose veins is a disease that rarely leads to dangerous complications, but often requires a specialist. Bulging varicose veins bring many aesthetic problems to their owners. Usually, young patients are embarrassed by these lumps and hide their legs. If men are not so afraid of varicose veins and can walk in pants all the time, then women want to walk with open legs all the time.
The good news is that advanced varicose veins on the legs of women or men can now be eliminated without leaving a trace with a single laser photocoagulation procedure for varicose veins. Modern interventions are performed without incisions, with minimal punctures, which are completely invisible 3-4 weeks after the intervention. The patient is placed on the operating table under local anesthesia, the operation lasts 40-50 minutes. The laser gives an amazing cosmetic result and stable healing of the manifestations of varicose veins, which is why EVLT is popular among doctors and young patients who have varicose veins in any part of the legs.
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 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 working in the opposite direction, through which pronounced secretion occurs, to solve the second problem, to remove or turn off the dilated veins from the blood circulation.
Diagnosis of varicose veins
The correct diagnosis of superficial vein disease requires an examination by an experienced specialist, as well as an ultrasound examination of the abdominal veins and deep veins from the abdomen to the legs. The information obtained from these research methods is sufficient to correctly recognize the 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 with the help of ultrasound.
In some cases, doctors perform invasive tests in the amount of phlebography on an angiography unit. After the treatment, patients must regularly check the condition of the operated veins, which is performed by doctors using ultrasound diagnostics. If at the diagnostic stage the doctor has questions about the condition of the deep veins, then MRI diagnostics or contrast CT will accurately determine their patency.
Varicose veins treatment methods in the vascular center
A vascular surgeon can cure varicose veins of the lower limbs only by eliminating the causes of their appearance. The cause of the development of varicose veins and the progression of the disease must be dealt with. Consider the main technologies that have been proven to be effective.
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 incision or general anesthesia. The light-conducting fiber is injected into the vein under ultrasound guidance. Laser energy of a certain wavelength is absorbed by the vein wall at the moment of occurrence, which leads to its heating and the destruction of the connective tissue. As a result, the wall of the vein turns into scar tissue and blood flow through the affected vein stops completely. The same effect as surgical removal of the vein can be achieved, but only without an incision, general anesthesia and pain.
In terms of its effectiveness, EVLK exceeds the open surgery 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 coagulated veins, inflammation and blood clots in the coagulated veins. The general incidence of such complications does not exceed 1%. In the Innovative Vascular Center, EVLK is the "gold standard", it can cure any type of varicose veins, both in the initial and advanced stages. Patients describe the best evaluations immediately after the laser treatment.
Radiofrequency obliteration (RFO) of varicose veins
In terms of its effect and effect, RFO is referred to as a thermal method for the treatment of varicose veins, similar to the laser, but there a different physical principle is used. The radio probe is also inserted into the vein by puncture. The intervention is performed under local anesthesia. The RFO principle is based on the production of thermal energy in the probe head, which is then transferred to the vessel walls. Heating the wall leads to thermal failure of the structural elements, which then leads to scarring of the vein.
Both methods (EVLK and RFA) apply to thermoablative (thermal) technologies. They are similar in terms of effectiveness, however, the laser heats the vein wall itself, while the RFO heats the working surface of the probe, and heat is applied to the wall through the liquid part of the blood.
According to experts, EVLT radically destroys the structure of the affected vein, which is why the frequency of relapses after the laser is lower than in the case of radiofrequency obliteration. Doctors noticed the absence of recurrence of varicose veins in 98% after EVLK and in 86% after RFO. Based on the experience of 20 years of work, phlebologists have come to the conclusion that thermal methods of varicose veins can be treated more effectively than traditional vein removal surgery.
Non-thermal methods of removing varicose veins
The XX. In the 1970s, surgeons showed increased interest in minimally invasive types of surgical treatment of varicose veins and began to use electrocoagulators. Good idea, but poorly executed. Patients suffered skin burns, which is why doctors were afraid of using thermal methods for varicose veins for a long time. Chemical methods used to eliminate veins have been shown to be safe and quite effective. These include various forms of sclerotherapy and adhesive removal.
Sclerotherapy
Sclerotherapy is the intravenous administration of special drugs that cause damage to the vein wall, followed by the disappearance (overgrowth) of the vein lumen. The history of this method began in the 19th century and shows an interesting development path. In the vascular center, specialists use the most advanced technology - the foam form of sclerotherapy. Long-term treatment for six months allows you to get rid of varicose veins of the lower limbs for a long time. Although the recurrence rate in 5 years is about 50%. With sclerotherapy, the treatment does not exactly focus on the causes of varicose veins, but eliminates the venous knots themselves, which is why it can also be used in combination with other minimally invasive methods (EVLK, RFO). One of the features of sclerotherapy is the appearance of dense cones - coagules at the site of sclerotic veins, which resolve within six months.
Varicose vein bonding with special glue
Venaseal technology is the name of the non-thermal method of eliminating varicose veins of the saphenous veins, which involves the introduction of a special glue into the lumen of the vein, which polymerizes in the lumen of the vein and causes blockage. The idea seems interesting and has developed over the past decade, but it has several pitfalls. First of all, the glue stays inside the affected veins as a foreign body and does not dissolve. Second, there is a risk of periphlebitis around the closed veins, 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 underway, and it is possible that varicose veins will become a disease in which the entire treatment regimen becomes a single "magic" injection. It is characteristic that this method has not yet been considered in the latestclinical guidelines, but some phlebology centers are already actively offering it.
Surgical treatment methods for varicose veins of the lower limbs
Since the middle of the 19th century, doctors have been dealing with the question of how to get rid of large superficial varicose veins on the legs and prevent complications. The history of the fight against enlarged veins makes it clear that from the early large incisions that disfigure the legs, surgery has progressed to micropunctures that allow the treatment of varicose veins without cosmetic defects.
Advanced phlebologists use elements of classical surgery in the form of microphlebectomy with punctures to remove individual varicosities and tributaries. This may be the most cosmetic method for removing varicose veins on thin skin. A month after such an operation, the skin is not even red.
Other thermal methods
When deciding on the treatment of 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 to treat the patient on an outpatient basis without disturbing the 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 severe, 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. According to the developers, this method does not require anesthesia, and a "plug" appears in the vessel, which reliably blocks blood flow. Given this, 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, which does not require the wearing of compression stockings.
Most women can return to their normal activities immediately. The symptoms of chronic venous insufficiency subside soon after the procedure. Active promotion of this adhesive in the phlebological market should be started in the near future. However, there are certain disadvantages: The presence of a foreign body in the human body. The curled glue remains in the vessel forever and can cause chronic allergies, sometimes inflammation of the vessel wall occurs, or the rejection of the polymer is accompanied by suppuration. Acute thrombophlebitis of the glued vessel may appear.
The use of glue in the trunk of the great saphenous vein does not eliminate the need to eliminate varicose tributaries, so doctors must remove signs of subcutaneous varicose veins with sclerotherapy or miniphlebectomy. The visible effect of the use of the glue is manifested only in combination with other methods of eliminating varicose veins. The patient has to pay more. The unreasonably high cost of the adhesive kit makes this procedure much more expensive than modern laser or radio frequency methods.
Thermal methods are preferred in the clinic. Phlebologists believe that it is better to use good local anesthesia than to treat varicose veins on the legs with an expensive and untested method. Moreover, the result is the same at best. In the event of a relapse, the patient must undergo a complex operation to remove the blocked vessel, as other methods are no longer applicable.
The modern method of combined treatment of reflux along the subcutaneous venous trunks gives extra weight to traditional sclerotherapy. Mechanical-chemical procedures mean a combination of mechanical damage to the inner surface of the vein wall and the introduction of a sclerosing agent. The catheter is inserted into the main saphenous vein under ultrasound guidance. After the catheter is installed in the correct place, the device is connected. The rotating sharp head of the catheter makes up to 3. 5 thousand revolutions per minute, which causes significant damage to the inner layer of the venous wall. At the same time, a sclerosing agent is injected through the catheter, which "mixes" in the lumen of the vessel and acts on the vessel wall with the help of the rotating part of the catheter, causing inflammation and adhesion.
This is a modern microsurgical aesthetic method for the removal of varicose veins. It is a delicate technique of pricking and pulling the varicose veins using special tools. This operation is not for the novice phlebologist, you need to master the skills of this delicate operation. Miniphlebectomy is a scalpel-free operation performed under local anesthesia. The injections are made in the direction of the skin lines, so they are almost invisible after 2 months.