Varicose veins are a vascular pathology when, against the background of weak connective tissue, 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 leads to a decrease in the speed of blood flow, venous congestion and contributes to pain in the calves. Against this background, 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 vessels allow you to recognize varicose veins in the legs. Varicose disease of the lower limbs (ICD code I83) is a highly visible disease that is easy to eliminate.
Varicose veins in the esophagus are included in the symptoms of portal hypertension, and secondary varicose nodes in the female perineum indicate varicose veins of the small pelvis and difficulty in the 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 localization of the process. By itself, an increase in the diameter of the veins is not dangerous, but complications from varicose veins carry a great risk to health, and sometimes to the life of the patient. The cause of the appearance of varicose veins in the legs can be heavy physical exertion, childbirth, a 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 embarrassed to appear there, you will certainly see how varicose veins manifest themselves in both 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 varicose veins be reversed?
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 in the legs, phlebologists can unequivocally answer this question - the degenerative destruction of the vein wall cannot go away without turning off the affected vein from blood circulation or removing it.
It happens that the dilated veins do not lose their function and increase in volume due to the overflow of blood from the overlying sections, and the muscle pump of the lower leg helps the outflow of blood into the deep veins.
Depending on the stage of the varicose veins, various surgical and conservative treatment methods can be applied to stop the progression of the varicose veins at different stages. The order here is: if the vein is irreversibly affected, it must be removed or coagulated or glued.
Why are even the initial varicose veins irreversible without surgery? For effective treatment of varicose veins in the legs, it is necessary to recognize where the pathological outflow of venous blood comes from and remove it with minimal trauma. However, enlarged varicose tributaries can restore their function on their own and without surgical intervention if the phlebologist eliminates pathological discharges, which cause irreversibly changed varicose veins and veins.
Modern treatment of varicose veins has come a long way since the first varicose vein operations 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 established.
The clinics of the Innovative Vascular Center know how to treat varicose veins with a minimum of medical, psychological and aesthetic inconvenience. We do not need to remove varicose veins according to the classical scheme. In the arsenal of phlebologists is the hemodynamic concept of treating the main causes of varicose veins, a technique that involves the correction of only pathologically impaired venous outflow and the elimination of only 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. In women, the presence of balls 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 for large scars. Therefore, clinics offer cosmetic and radical treatments that have the best patient reviews.
A bit of anatomy and physiology
The definition of varicose veins is the primary expansion of the subcutaneous venous trunks of the lower limbs, due to congenital, contributing and producing factors. The risk of having 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 of the legs are represented by two large venous systems - the system of large 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 to the trunk and tributaries of the great saphenous vein, one can identify short venous trunks - perforators that connect it with the deep veins of the lower leg and thigh, which cause varicose veins away from the main trunks. These perforators are designed to facilitate the flow of blood through the deep venous system.
The small saphenous vein forms at the level of the external malleolus, it is characterized by several bends along the posterior aspect of the lower leg and merges with the popliteal vein. Between themselves, the large and small saphenous veins are connected by separate overflows. In the subcutaneous trunks, numerous venous valves provide blood movement to the heart and prevent reverse blood flow.
Due to the congenital weakness of the venous wall and its load, the failure of the internal valve apparatus of the veins develops, the blood begins to move in the opposite direction, causing the saphenous vein to overflow, its further stretchingand the development of severe varicose veins. Therefore, without eliminating the pathological outflow of blood, it is impossible to cure chronic varicose veins.
The classification of subcutaneous varicose veins on the legs is formed from the name and cause of the development of the disease, 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 distensibility and weakness of the vein wall and increased intravenous pressure.
- Increased pressure on the veins due to a long lifestyle, heavy physical exertion, pregnancy and childbirth.
- Congenital and acquired obstructions to venous outflow (compression syndromes, tumors and bone formations pressing on the veins.
- Sequelae of history of 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 its first signs appear. Varicose veins on the legs is a disease that is continuously progressing and prone to complications, therefore, without medical intervention, one cannot count on a cure. Consider the main indications for the treatment of varicose veins in the legs.
Relief of symptoms of chronic venous insufficiency
Venous hypertension is a subjectively unpleasant consequence of impaired venous outflow, but the varicose veins themselves do not hurt. Symptoms of varicose veins that require prevention and treatment include feelings of heaviness in the legs, swelling in the evening, increased leg fatigue, and even pain in the calf muscles. With the progression of the disease, stagnation develops in the venous perforators and deep veins, which can lead to hyperpigmentation of the skin, cause eczema in the 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 pills for varicose veins, using ointments and creams, which delay contact with specialists. It is important to understand that such remedies do not affect the course of varicose veins, therefore they can only slightly alleviate complaints and symptoms in the early stages. It should not be counted 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 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 its complications develop - thrombophlebitis (ICD code I80), which hurts very badly or a trophic ulcer appears. Sometimes bothered 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 coagulation with laser. Clinical recommendations do not give an unambiguous answer to this question, but with an active approach, associated with thrombophlebitis, its cause is also eliminated, and it is varicose veins.
A trophic ulcer is an extreme manifestation of chronic venous insufficiency and represents a great danger. It looks like a skin defect in the region 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 very poorly to conservative treatment. The optimal treatment method today is laser venous outflow correction (EVLK) for varicose veins of the large or small saphenous veins and the correct local treatment (special dressings, ulcer washing). One does not work without the other, so it is not necessary to rely on healing a trophic ulcer only from ointments. A mandatory component of treatment is compression therapy using 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 turn to specialists. Bulging varicose veins cause a lot of aesthetic problems for their owners. Usually, young patients are embarrassed by these knots and hide their legs. If men are not so afraid of varicose veins and they can constantly walk in trousers, then women constantly want to walk with their legs open.
The good news is that advanced varicose veins in women's or men's legs can now be removed in just one varicose vein laser photocoagulation procedure without a trace. Modern interventions are performed without incisions, through minimal punctures, which are absolutely invisible already 3-4 weeks after the intervention. The patient is brought to the operating table under local anesthesia and the operation lasts 40 to 50 minutes. The laser gives an amazing aesthetic result and stable recovery from 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 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 run in the opposite direction, through which a pronounced discharge occurs, to solve the second problem, it is necessary to remove or extinguish the dilated veins of theblood circulation.
Diagnosis of varicose veins
To make a correct diagnosis of superficial venous disease, an examination by an experienced specialist and an ultrasound examination of the saphenous and deep veins from the abdomen to the feet are necessary. 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 by mounting the venogram on an angiography machine. After treatment, patients need periodic monitoring of the condition of the operated veins, which doctors carry out using ultrasound diagnostics. If at the diagnostic stage the doctor has questions about the condition of the deep veins, the MRI diagnostics or computed tomography with contrast accurately determine their patency.
Methods of treating varicose veins in the vascular center
A vascular surgeon can cure varicose veins of the lower extremities only by eliminating the causes of its appearance. It is necessary to fight against the cause 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 treated effectively without incisions or general anesthesia. A light-conducting fiber is inserted into a vein through an ultrasound-guided puncture. Laser energy of a certain wavelength at the time of its appearance is absorbed by the vein wall, which leads to its heating and the destruction of connective tissue. As a result, the wall of the vein turns into scar tissue and the blood flow through the affected vein stops completely. The same effect is achieved as with the surgical removal of a vein, but only without incisions, general anesthesia and pain.
In terms of effectiveness, EVLK surpasses the open phlebectomy operation. 98% of all operated patients recover from varicose veins, regardless of the degree of node development. Rare side effects include numbness of the skin in the area of the clotted vein, inflammation and blood clots in the clotted veins. The overall incidence of these complications does not exceed 1%. In the innovative vascular center, EVLK is the "gold standard", it can cure all varicose veins, both in the initial and advanced stages. Patients leave the best reviews right after laser treatment.
Radiofrequency obliteration of varicose veins (RFO)
In terms of impact and effect, RFO, like laser, is called thermal method for the treatment of varicose veins, but a different physical principle is used in it. The radiosonde is also inserted into the vein through a puncture. The operation 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, followed by scarring of the vein.
These two methods (EVLK and RFA) refer to thermoablative (thermal) technologies. In terms of efficiency, they are similar, 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 destroys the structure of the affected vein more radically. Therefore, after laser, the frequency of relapses is lower than that of 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 more effectively treated than conventional vein removal surgery.
Non-thermal methods of obliterating varicose veins
In the 70s of the 20th century, surgeons began to show increased interest in minimally invasive types of surgical treatment of varicose veins and began to use electrocoagulators. Good idea, but poorly implemented. Patients had skin burns, which is perhaps why doctors were afraid to use thermal methods for a long time with varicose veins. Chemical methods used for vein obliteration have proven to be safe and quite effective. These include sclerotherapy in various variations and adhesive obliteration.
Sclerotherapy
Sclerotherapy is the intravenous administration of special drugs that damage the vein wall, followed by obliteration (overgrowth) of the lumen of the varicose vein. The history of this method began in the 19th century and has an interesting development path. At the vascular center, specialists use the most advanced technology - a form of sclerotherapy foam. 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 focus exactly 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 feature of sclerotherapy is the appearance of dense cones - coagulus at the site of sclerotic veins, which resolve for up to six months.
Glue veins with varicose veins with special glue
Venaseal technology is the name of a non-thermal method of obliterating the varicose trunks of the saphenous veins, which involves the introduction of a special glue into the lumen of the vein, which polymerizes inside the lumen of the vein. vein, causing it to become blocked. The idea seems interesting and developed over the last decade, but there are several pitfalls. First, the glue remains inside the affected veins like a foreign body, it does not dissolve. Secondly, there are risks of periphlebitis around a blocked vein, by reaction of the organism to a foreign body. 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 regarding the long-term results of such treatment. The advantages of this technology have not yet been identified, but research is being actively carried out and it is possible that varicose veins will become a disease in which the entire treatment regimen will turn into a "magic" injection. It is characteristic that this method has not yet been considered in the latest clinical recommendations, but is already actively offered by some phlebology centers.
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 the superficial veins of the legs and the prevention of complications since the middle of the 19th century. The history of the fight against enlarged veins clearly shows how, from the first large incisions that disfigured the legs, surgery progressed to micro-perforations, which allow varicose veins to be treated without aesthetic defects.
Advanced phlebologists use elements of conventional 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
To decide how to treat varicose veins, phlebologists often used exotic methods. Varicose veins were treated by thermal exposure to 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 his lifestyle. In the hands of a novice phlebologist, thermal ablation methods can lead to 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 allows you to get rid of not only the initial shape, but also pronounced severe varicose veins on the legs without incisions.
Use 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 lumen of the vessel, this glue polymerizes and fills the lumen of the dilated vessel. As conceived by the developers, this method does not require any 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 in the legs. Venasil is the only varicose vein treatment technology that does not require the wearing of compression stockings.
Most women can resume normal activities immediately. Symptoms of chronic venous insufficiency are relieved soon after the procedure. The process of actively promoting this glue in the phlebological market should begin in the near future. However, there are some 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 appear.
The use of glue in the trunk of the great saphenous vein does not eliminate the need to deal with the removal of tributary varices, so doctors will need to eliminate signs of subcutaneous varices by 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 cost of the bonding 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 anesthetic than to treat varicose veins of the legs with an expensive and untested method. Moreover, the result is at best the same. 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. 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. A catheter is inserted into the main saphenous vein by a puncture under ultrasound guidance. After installing the catheter in the right place, the device is connected. The rotating pointed head of the catheter makes up to 3. 5 thousand revolutions per minute, causing pronounced damage to the inner layer of the vein wall. In parallel, a sclerosing agent is injected through the catheter, which "mixes" into 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 for removing varicose tributaries. It involves a delicate technique of puncturing and pulling varicose tributaries using special tools. This operation is not for a novice phlebologist, you need to master delicate operation techniques. Miniphlebectomy is a no-scalpel operation performed under local anesthesia. The punctures are performed in the direction of the skin lines, so after 2 months they are almost invisible.