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 in the legs.Varicose veins develop more often in women than in men.For a long time, varicose veins were only a cosmetic problem (spider veins), but if varicose veins are not treated, they constantly 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
- Varicose veins in the legs
- Heaviness in the legs, fatigue in the evening
- Swelling of legs in the evening after physical activity
- Discoloration of the skin on the bottom of the leg
- Inflammation of the saphenous veins - thrombophlebitis
- Trophic ulcers of the skin
Varicose veins causes and risk factors
- Complicated inheritance - congenital failure of the valve apparatus
- Heavy physical work while standing
- Frequent pregnancies and births
- I walked in high heels
Modern methods of treating varicose veins of the lower extremities in our clinics make it possible to solve this problem without resorting to serious surgical interventions, without pain, incisions and hospitalization.
The modern level of phlebology makes it possible to treat varicose veins painlessly for the patient, in a very aesthetic and reliable way.The first signs of varicose veins should be a reason to contact a phlebologist.Varicose veins of the lower extremities mean a complete disappearance of the tone of the venous wall, therefore it is useless to influence the transformation of varicose veins with tablets and leeches as a treatment.
Diagnosing
Complaints and symptoms
Varicose veins begin with the appearance of single nodules of dilated veins and progress steadily.Varicose veins do not cause any problems at first, but over time they become a risk factor for serious health risks.So, let's look at the main problems that concern patients with varicose veins:
Cosmetic discomfort
Most patients with varicose veins only complain of unsightly varicose veins that spoil the appearance of their legs.Such complaints are especially often caused by varicose veins in women.Very often, cosmetic discomfort is caused by small varicose veins and spider 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 (no incisions) are recommended.
Chronic venous insufficiency
Approximately 30% of patients with varicose veins complain of heaviness in the legs, swelling in the evening and nighttime cramps in the calves.These are signs of chronic venous insufficiency.Gradually, its symptoms worsen and painful sensations may appear in the varicose veins.Skin changes and pigmentation develop.With severe venous insufficiency, the skin on 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 you any discomfort.The examination is performed lying down and standing.The patient should fully open the legs.
Varicose veins are diagnosed during a routine examination, which should be done standing up while the veins are full.After the examination, a duplex ultrasound scan 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 scanning of veins
In the case of varicose veins, venous ultrasound is tasked with identifying incompetence of the venous trunks, identifying malfunctioning venous valves, and identifying blood clots in the superficial and deep venous systems.
The examination begins with the examination of the saphenous veins in the legs.The diameter and patency of the great and small saphenous vein is studied, the stability of the valves is determined (Valsalva maneuver - tension of the abdominal muscles with a full suction, a sign of disability is the reverse blood flow).Perforator veins in typical locations and their stability during the Valsalva maneuver are then studied.
After evaluating the superficial veins, it is necessary to evaluate the patency of the deep veins.For this purpose, in stretching, the popliteal and femoral veins are examined, their patency and valve consistency are also evaluated.
Contrast venography
Usually, ultrasound scanning 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 cases of relapses of varicose veins and secondary varicose veins.
To solve these problems, X-ray examination with contrast is used.The saphenous veins are punctured and contrast is given.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" operation of varicose veins under anesthesia with incisions in the groin area and along the legs, which was used to remove superficial varicose veins at the beginning of the last century, is an atavism of the past.Patient suffering, long hospitalization and leg pain after such operations aimed at improving blood circulation are completely unjustified.Severe varicose veins can be treated without resorting to "inquisition methods".Today, the treatment of advanced varicose veins can be performed without anesthesia and hospitalization.The work of a phlebologist becomes office-based, without the attributes of major surgery.
Knowing what causes varicose veins in the legs 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 melting the vein walls in the area of insufficient venous valves.The method of influencing the venous circulation may be different, but its purpose is the same - to stop the pathological discharge of blood through the affected vein (anti-reflux).
How can you cure varicose veins in the legs?
Understanding the cause of varicose veins allows you to choose the right treatment method.The purpose of modern treatment of varicose veins is to solve several problems:
- Interruption of pathological discharge in the vertical position through incompetent saphenous veins of the lower extremities.
- Elimination of reflux between deep and superficial veins - perforators - the main mechanism for the development of varicose trophic ulcers.
- Removal of superficial varicose vessels - degenerated (varicose).
- Compression therapy using special socks and stockings.
Capabilities of the vascular center
Thermal methods for the treatment of varicose veins are endovenous laser coagulation (EVLC) and radiofrequency ablation (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 effect of damaging the collagen of the venous wall, causing an inflammatory process in the vein and its excessive growth.Advanced varicose veins in the legs, which are treated with this method, regress completely and without leaving 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 graft, which is directed 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 the further development of the disease and its complications.Complete elimination of varicose veins is observed in 98% of patients with the proper use of the EVLT method.The capabilities of this method make it possible to treat varicose veins in women's legs and correct venous outflow in trophic ulcers.
Radio Frequency Fading (RFO)
The treatment of varicose veins using the radiofrequency ablation method (RFO) is a similar thermal method, but the heating of the venous wall tissue occurs according to different physical principles due to the energy of radio waves.Radiofrequency ablation allows you to remove varicose veins and eliminate its symptoms;Such treatment in its immediate and long-term results does not differ from EVLT, but it is more laborious 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 they 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 removal 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 methods make it possible to remove not only the initial form, but also veins with pronounced varicose veins on the legs without incisions.In the pictures from the "Treatment results" section you can see the appearance before and after the minimally invasive treatment.
Non-thermal methods for eliminating flow reflux
For many years, phlebologists have thought about how to cure 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 vein walls - thrombophlebitis and their subsequent adhesion with the disappearance of the lumen of the veins.After the advent of the Fegan method, when the treatment began to be carried out based on the cause of varicose veins, the development of non-thermal scleroblading methods began.Since then, varicose veins in 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 using injections of a special substance (sclerosant) has reached perfection.The main point of sclerotherapy is the injection of a drug into a varicose vein, which causes inflammation and subsequent adhesion of varicose veins.Sclerotherapy does not involve eliminating the cause of venous insufficiency and is more suitable for certain 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 great or small saphenous vein does not allow one to rely on a long-term effect of sclerotherapy, since a relapse is sure to occur due to reflux.
Sclerotherapy can be done in the absence of an allergy to tetradecyl sulfate or polidocanol.These substances are the main sclerosants.During sclerotherapy, manifestations of thrombophlebitis may occur, especially if liquid forms of the drug are used.Sclerotherapy of perforating veins is very 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% during the next 5 years.
The advantage of sclerotherapy is a good immediate effect and low cost of treatment.Injections of the sclerosant lead to adhesion of the veins and the interruption of the pathological process - the reflux of blood through the saphenous veins.The drug is usually injected in the form of foam into varicose veins.A spasm of the enlarged subcutaneous vessels is formed, the prolonged contact of the foam form of the sclerosant with the wall of the veins and their subsequent inflammation and adhesion.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 the veins of the lower extremities is closed and over time it completely heals, and the flow of blood in the opposite direction stops.To prevent the occurrence of skin necrosis due to the penetration of the foam form of the sclerosant into the subcutaneous tissue, administration is carried out strictly under ultrasound control.
Foam sclerotherapy can be used as a stand-alone method or in combination with laser treatment to eliminate varicose veins.The number of sessions for the elimination of 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 above the sclerotic vessel may take a dark shade for 2-3 months (hyperpigmentation appears).It can ruin a woman's legs for several months, so this treatment is best done in the winter months.Drug treatment and ultrasound-guided vascular punctures can accelerate the resorption process of intravascular fluid accumulations (clots), the risk of which is about 10%.A clot forms when there is insufficient compression, but it will certainly go away with time.Many patients know that within a month after 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 methods of treatment.
Using 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 vessel, this adhesive polymerizes and fills the lumen of the dilated vessel.According to the developers, this method does not require any anesthesia and a "plug" appears in the container, which reliably blocks the blood flow.Taking this into account, half an hour is enough for the procedure to eliminate varicose veins in 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 are relieved immediately after the procedure.The process of active promotion of this adhesive 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.Curd glue remains in the container 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 adjacent vessel may occur.
Using glue on the trunk of the great saphenous vein does not eliminate the need to eliminate the varicose branches, so doctors will have to remove the signs of subcutaneous varicose veins with sclerotherapy or miniphlebectomy.The visible effect of using the adhesive appears only when it is combined with other methods of eliminating varicose veins.The patient has to pay more.The unreasonably high cost of the adhesion kit makes this procedure significantly more expensive than the modern laser or radiofrequency method.
In our clinic, preference is given to thermal methods.We believe that it is better to give good local anesthesia than to treat varicose veins of the saphenous 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 closed vessel, as other methods will no longer be viable.
Mechanical-chemical wiping technology
The modern method of combined treatment of reflux along subcutaneous venous trunks adds weight to conventional sclerotherapy.Mechanical-chemical procedures imply 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 place, the device is connected.The sharp rotating head of the catheter makes up to 3.5 thousand rotations per minute, causing severe damage to the inner layer of the venous wall.At the same time, a sclerosing drug is injected through the catheter, which "mixes" into the lumen of the vessel and, using the rotating part of the catheter, acts on the vascular wall, causing its inflammation and adhesion.
To date, the only advantage of this technology is the absence of the need for tumescent anesthesia.Mechanical-chemical removal, according to its inventors, should cause a stronger erasing effect than foam sclerotherapy, although for some reason convincing data have not 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 have to wait for further studies from Europe or the USA to determine precisely the place of this technology.
Miniphlebectomy
This is a modern aesthetic microsurgical method for removing varicose veins.It involves a delicate technique of drilling and extracting varicose veins using special tools.This operation is not for a novice phlebologist;you must have the skills of delicate surgery.Miniphlebectomy is an operation without the use of a scalpel and is performed under local anesthesia.Punctures are performed 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.Assuming how varicose veins manifest, the doctor can clearly plan the micro-punctures and do it with minimal intervention.The patient can go home on his own feet immediately after the operation.Miniphlebectomy can be an effective independent method for the treatment of varicose veins, or it is used in combination after laser coagulation of varicose veins.Varicose vein removal is performed using a special technique developed by Professor Varadi.This technique is perfectly mastered by our phlebologists and allows the removal of varicose veins in the legs - an effective treatment regardless of its 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 performed well, eliminates the symptoms of varicose veins in the legs.Almost 95% of patients are free of varicose veins for 5 years or more, and 80% of them never have serious problems with venous outflow.The innovative vascular center is ready to help you cope with any venous disease without incisions or pain.We know how to cure varicose veins and have extensive experience.Varicose vein treatment should not be a problem in today's high-tech world.