In varicose veins, the veins elongate and dilate, and nodular deformities appear.At the same time, the functioning of the valve apparatus is disturbed, which leads to interruption of blood flow in the affected vein.
Varicose veins not only lead to a pronounced cosmetic defect, but can also be accompanied by disturbances in the movement of blood to the heart, its stagnation in the organs, dermatitis, eczema, cellulitis and trophic ulcers.In addition, inflammation and venous thrombosis may occur.
Symptoms include dilation, tortuosity of the veins with the formation of nodules, spider veins or spider veins, intermittent and then permanent swelling, tan discoloration of the legs, inflammation of the skin and subcutaneous fat, and the development of trophic ulcers.
Fortunately, today there are ways to treat varicose veins that do not require surgery.
Modern treatment without surgery
The essence of all procedures is the removal of varicose veins.In recent years, phlebology (the science of treating veins) has changed a lot and today you can get rid of varicose veins quite quickly and easily.There are several methods for getting rid of venous pathologies:
- Sclerotherapy.
- Application of biological glue.
- Laser coagulation.
- Radiofrequency ablation.
- Traditional operations.
- Miniphlebectomy.
Sclerotherapy
The essence of the technology is that a special liquid preparation, a sclerosant, is injected into the diseased vein through a small puncture with a syringe.
A tightly fixed thrombotic “seal” is formed in the vein, which stops blood flow in the vessel.As a result, the vein gradually dissolves.
The medicine is administered under visual control and under ultrasound control.This allows sclerosis of vessels to be invisible on the surface and control the spread of the drug through the vessels.
To consolidate the effect after administration of the sclerosant, it is recommended that the patient wear compression stockings for several weeks or even months.Repeated administration of sclerosant is often necessary;In this case, they talk about carrying out a sclerotherapy course consisting of several sessions.
Today, sclerotherapy is only used to remove intradermal spider veins.When removing saphenous veins, the technique is used in addition to other methods (EVLT, RFA, traditional operations) of removing small-diameter venous ducts.
Closing veins with biological glue
A special medicine successfully closes the veins at different stages of varicose veins.The procedure is similar to the previous one, but in this case an adhesive substance is introduced into the lumen which, when it comes into contact with the blood, polymerizes, squeezes the blood and forms a polymeric “seal”.After the cessation of blood flow through the vein, as in sclerotherapy, fibrous tissue forms and the vessel is partially reabsorbed.The materials for this procedure are quite expensive.
Laser coagulation (EVLC)
The laser is used in two ways:
Endovenous laser coagulation/ablation/obliteration or endovenous laser therapy (EVLK, EVLA, EVLO, EVLT) is used both for the removal of large main veins and for the removal of smaller but deeply located veins, e.g. perforators.
The procedure is performed under local anesthesia and takes 20 minutes to an hour.A laser light guide is inserted into the vein through a small puncture and, with the help of light energy, coagulation (“folding”) of blood proteins is caused, forming a protein-erythrocyte clot (“seal”) in the lumen, which blocks the lumen of the vessel.
After the cessation of blood flow, the lumen of the vein overgrows with fibrous tissue and then gradually disappears.
The effect of the laser can be compared to removing a vein.The patient can go home immediately after surgery and wear compression stockings for several weeks or months.
Percutaneous laser coagulation (PLC).In this case, the vein is targeted directly through the skin with a focused laser beam.This method only removes very fine intradermal vessels, less than 0.1 mm, located superficially (usually capillaries, venules or arterioles).The disadvantages of the method are frequent relapses and burns.
In fact, the cost of laser treatment for varicose veins is generally lower than the price of previous methods.
Radiofrequency ablation/obliteration (RFA, RFO)
Only large veins are removed using radiofrequency ablation.The method is fundamentally similar to laser removal, however, with RFA, the effect on the veins is not a laser, but a very high frequency current (radio waves).
The RFA technique is effective, but it has a big disadvantage - a considerable price (due to the high cost of equipment and consumables).
Surgical treatment - phlebectomy
The operation is shown:
- if desired by the patient;
- in the presence of some anatomical features of the structure of large veins that prevent minimally invasive interventions (EVLT, RFA);
- with estial thrombosis of large venous trunks.
Fortunately, the way we perform surgery to treat varicose veins (phlebectomy) has also changed today.
If previously, to remove a diseased vein, it was necessary to make incisions along the entire length of the leg, today it is enough to make two small incisions (sometimes one is enough) and remove a large vein with a special probe.
This not only preserves the beauty of the legs (does not leave very noticeable scars), but also makes the operation itself less traumatic and the recovery period faster.
If the case is not very advanced, you may not even need to go to the hospital for surgery, but return home after the anesthesia wears off.
Miniphlebectomy
It consists in the fact that through small holes in the skin (up to 1-2, less often 3 mm), the veins are grabbed with special “hooks” that look like crochet hooks and pulled out, where they are crossed and removed in fragments.
This procedure is performed under local anesthesia or general anesthesia.The disadvantages of the procedure are the labor intensity, the impossibility of removing deep and large trunks and a high percentage of residual veins and their fragments.Today this technique is used as a complement to EVLT, RFA or traditional surgery.
Minimally invasive and traditional surgical methods provide approximately the same results, which depend mainly on the degree of advanced disease.To obtain better treatment results, combinations of various methods are used, for example, EVLT and sclerotherapy or miniphlebectomy, RFA and sclerotherapy, surgery and miniphlebectomy, etc.
Only an experienced doctor can select a treatment package depending on the anatomical features of varicose veins, the degree and severity of the disease, the presence of complications, the general state of health, taking into account the patient's personal needs and desires.