Varicose veins are a vascular pathology when, against the background of connective tissue weakness, 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 decreased blood flow velocity, venous congestion and contributes to calf pain. 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 on the legs. Varicose disease of the lower extremities (ICD code I83) is a very noticeable and easy to remove disease.
Varicose veins in the esophagus are included in the symptoms of portal hypertension, and secondary varicose nodules in the female perineum indicate varices of the small pelvis and difficulty with blood flow 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 location of the process. By itself, an increase in the diameter of the veins is not dangerous, but the complications of varicose veins bring a great risk to the health and sometimes the life of the patient. The cause of the appearance of varicose veins on the legs can be heavy physical exertion, childbirth, sedentary lifestyle of patients.
To understand what varicose veins look like, just go to the summer beach. Although many people with varicose veins are embarrassed to appear there, you will surely see how varicose veins manifest in 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 leg varicose veins are treated with ease. Don't be afraid to go to the phlebologist.
Can we reverse varicose veins?
Many people ask this question, hoping to cure varicose veins at an early stage with the help of medicines or traditional medical methods. If we are talking about varicose veins in the legs, phlebologists can unequivocally answer this question - the degenerative destruction of the venous wall cannot disappear without disconnecting the affected vein from the bloodstream or removing it.
It turns out that the dilated veins may still not lose their function and increase in volume due to the overflow of blood from the overlying sections, and the leg muscle pump helps the outflow of blood to the deep veins.
Depending on the stage of varicose veins, various surgical and conservative treatment methods can be applied that can stop the progression of varicose veins at various stages. The order here is this: if the vein is irreversibly affected, it must be removed or clotted or glued.
Why are even early varicose veins irreversible without surgical intervention? For effective treatment of varicose veins in the legs, it is necessary to recognize where the pathological discharge of venous blood comes from and remove it with minimal trauma. However, expanded varicose tributaries can restore their function on their own and without surgical intervention if the phlebologist eliminates the pathological discharges, which causes irreversibly altered varicose veins and veins.
Modern treatment of varicose veins has advanced significantly since the first operations on varicose veins in men and women in the 19th century. Depending on the degree of varicose veins, a classification of the disease and suitable methods of treatment are compiled.
Clinics at Centro Vascular Inovador know how to treat varicose veins with minimal medical, psychological and aesthetic disorders. We do not need to remove varicose veins according to the classical scheme. In the arsenal of phlebologists, the hemodynamic concept of treatment of the main causes of varicose veins, a technique that involves the correction only of the pathologically altered venous flow and the removal of only the affected veins.
Treatment cannot be directed 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 a bothersome symptom due to cosmetic problems, but the fair sex is not ready to change the ugly appearance of subcutaneous varicose veins neglected by large scars. Therefore, the clinics offer cosmetic and radical treatments that have the best patient ratings.
A little anatomy and physiology
The definition of varicose veins is the primary expansion of the subcutaneous venous trunks of the lower extremities, due to congenital, contributing and producing factors. The chance of getting 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 in the legs are represented by two major venous systems - the large and small saphenous vein system. The great saphenous vein originates in the foot, from where it travels along the inner side of the leg to the inguinal region, where it flows into the deep vein of the thigh, starting from the interior of the common femoral artery.
In the course of the trunk and tributaries of the great saphenous vein, short venous trunks can be identified - perforators that connect it with the deep veins of the lower leg and thigh, which causes varicose veins away from the main trunks. These perforators are designed to facilitate the path of blood to the deep venous system.
The small saphenous vein is formed on the external malleolus and is characterized by several curves along the posterior aspect of the leg and confluence with the popliteal vein. To each other, the large and small saphenous veins are connected by separate overflows. In the subcutaneous trunks there are numerous venous valves that ensure the movement of blood to the heart and prevent the reverse flow of blood.
Due to congenital weakness of the venous wall and the load on it, failure of the internal valve apparatus of the veins develops, blood begins to move in the opposite direction, causing overflow of the saphenous vein, its further stretching and the development of severe varicose veins. . Therefore, without eliminating the pathological discharge of blood, it is impossible to achieve a cure for chronic varicose veins.
The classification of subcutaneous varicose veins in 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. Lower extremity varicose veins are formed by a combination of several factors:
- Congenital distensibility and weakness of the venous wall and increased intravenous pressure.
- Increased pressure in the veins due to a long-term lifestyle, heavy physical exertion, pregnancy and childbirth.
- Congenital and acquired obstructions to venous flow (compression syndromes, tumors, and bone formations pressing on the veins.
- Sequelae of past deep vein thrombosis
Modern principles of varicose vein treatment
Many patients often ask the question - what treatment is needed for varicose veins, if only the first signs appear. Leg varicose veins are a disease that is continually progressing and prone to complications, so without medical intervention, recovery cannot be counted on. Consider the main indications for the treatment of varicose veins on the legs.
Relief of symptoms of chronic venous insufficiency
Venous hypertension is a subjectively unpleasant consequence of impaired venous flow, but varicose veins themselves do not hurt. Symptoms of varicose veins that require prevention and treatment include a feeling of heaviness in the legs, swelling at night, increased fatigue in the legs, and even pain in the calf muscles. As the disease progresses, stagnation in venous perforators and deep veins develops, which can lead to hyperpigmentation of the skin, cause eczema in varicose veins and heaviness in the calves.
The most popular and publicly advertised method to treat the symptoms of varicose veins in the legs is to take several pills for varicose veins, using ointments and creams, which makes contacting specialists late. It is important to understand that these remedies do not affect the course of varicose veins, which is why they may only slightly alleviate the complaints and symptoms in the early stages. It is not worth counting on the fact that varicose veins will disappear after treatment with these drugs.
Treatment of varicose vein complications (trophic ulcers, thrombophlebitis, venous bleeding)
In about 50% of cases, varicose disease is complicated by local inflammatory processes, which broadens the indications for active surgical tactics. Most often, the patient treats varicose veins when their complications develop - thrombophlebitis (ICD code I80), which hurts a lot or a trophic ulcer appears. Sometimes disturbed by nocturnal 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 laser coagulation. Clinical recommendations do not give an unambiguous answer to this question, but with an active approach, along with thrombophlebitis, its cause is also removed, and that is varicose veins.
Trophic ulcer is an extreme manifestation of chronic venous insufficiency and is a great danger. It looks like a skin defect in the medial malleolus area with active purulent secretion, 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 ideal method of treatment today is venous flow laser correction (EVLK) for varicose veins of the large or small saphenous veins and correct local treatment (special dressings, ulcer washing). One doesn't work without the other, so it's not necessary to rely on healing a trophic ulcer with ointments alone. A mandatory component of treatment is compression therapy with the help of 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 it often makes you turn to specialists. Protruding varicose veins bring many aesthetic problems to their owners. Young patients are usually embarrassed by these knots and hide their legs. If men are not so afraid of varicose veins and can constantly walk around in pants, women constantly want to walk with their legs spread.
The good news is that advanced varicose veins in the legs of women or men can now be eliminated in a single 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 taken to the operating table under local anesthesia and the operation takes 40 to 50 minutes. The laser offers an amazing cosmetic result and a stable recovery from varicose veins manifestations, which is why EVLT is popular among doctors and young patients with varicose veins in the legs at any stage.
Prevention of the development of varicose vein complications
The solution of these problems is possible by conservative and operational methods. The main objective of modern phlebology is to minimize surgical trauma in the treatment of varicose veins with the greatest 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 disconnect the dilated veins from the blood circulation.
varicose vein diagnosis
To make a correct diagnosis of superficial venous disease, an examination by an experienced specialist and an ultrasound of the saphenous and deep veins from the abdomen to the feet are necessary. The 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 on the amount of phlebography in an angiographic unit. After treatment, patients need periodic monitoring of the condition of the operated veins, which doctors perform using ultrasound diagnostics. If at the diagnostic stage the doctor has doubts about the state of the deep veins, the diagnosis of magnetic resonance imaging or computed tomography with contrast will accurately determine their permeability.
Methods of treatment of varicose veins in the vascular center
A vascular surgeon can cure varicose veins of the lower extremities just by eliminating the causes of their appearance. It is necessary to fight the cause of the development of varicose veins and the progression of the disease. Consider leading technologies with proven effectiveness.
Varicose Vein Laser Treatment (EVLT)
Endovenous laser coagulation is based on heating the venous wall with a coherent beam of light. Varicose veins can be treated effectively without incisions and general anesthesia. A light-conducting fiber is inserted into a vein through a puncture under ultrasound guidance. The laser energy of a certain wavelength at the time of its occurrence is absorbed by the venous wall, which leads to its heating and destruction of the connective tissue. As a result, the vein wall turns into scar tissue and blood flow through the affected vein stops completely. The same effect is obtained with the surgical removal of a vein, but only without incisions, general anesthesia and pain.
In terms of effectiveness, EVLK exceeds the open operation of phlebectomy. 98% of all operated patients recover from varicose veins, regardless of the degree of development of the nodules. 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 such complications does not exceed 1%. At the Innovative Vascular Center, EVLK is the "gold standard", it can cure any varicose veins, both early and advanced. Patients leave the best ratings right after laser treatment.
Radiofrequency obliteration of varicose veins (RFO)
In terms of impact and effect, RFO, like laser, is referred to as thermal methods for treating varicose veins, but a different physical principle is used there. The radiosonde is also inserted into the vein through a puncture. The intervention is performed under local anesthesia. The RFO principle is based on the generation of thermal energy at the probe head, which is then transferred to the vessel walls. The heating of the wall leads to the thermal destruction of its structural elements, followed by healing of the vein.
Both methods (EVLK and RFA) refer to thermoablative (thermal) technologies. In terms of effectiveness, they are similar, however, the laser heats the vein wall itself, while the RFO heats the working surface of the probe and heat is transferred to the wall through the liquid part of the blood.
According to experts, EVLT more radically destroys the structure of the affected vein, therefore, after laser, the frequency of relapses is lower than with radiofrequency obliteration. Physicians noted the absence of varicose vein recurrence 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 treated more effectively than conventional vein removal surgery.
Non-thermal methods of varicose vein obliteration
In the 1970s, surgeons began to show a growing interest in minimally invasive types of surgical treatment for varicose veins and switched to electrocoagulators. Good idea, but poorly implemented in practice. Patients had skin burns, which may be why doctors were afraid to use thermal methods for too long with varicose veins. The chemical methods used to obliterate veins have proven to be safe and quite effective. These include sclerotherapy in various variants and adhesive obliteration.
sclerotherapy
Sclerotherapy is the intravenous administration of special drugs that cause damage to the venous 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 foam form of sclerotherapy. 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 have an exact focus on the causes of varicose veins, but eliminates the venous nodules 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 - clots at the site of sclerotic veins, which resolve within six months.
Collage of varicose veins with special glue
Venaseal technology is the name of a non-thermal method of obliterating varicose trunks of saphenous veins, which involves introducing a special glue into the lumen of the vein, which polymerizes within the lumen of the vein, causing its blockage. The idea sounds interesting and developed over the last decade, but there are several pitfalls. Firstly, the glue remains inside the affected veins as a foreign body, it does not dissolve. Second, there are risks of periphlebitis around a sealed vein, 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 being actively carried out and it is possible that varicose veins could become a disease where the entire treatment regimen turns into a "magic" injection. It is characteristic that this method has not yet been considered in the latest clinical guidelines, but is already being actively offered by some phlebological centers.
Surgical methods of treating varicose veins of the lower extremities
Doctors have been dealing with the question of how to get rid of large varicose veins from the superficial veins of the legs and the prevention of complications since the mid-19th century. The history of the fight against dilated veins makes it clear how since the first large incisions that disfigure the legs, surgery has moved to micropunctures, which allow varicose veins to be dealt with without aesthetic defects.
Advanced phlebologists use elements of classical surgery in the form of microphlebectomy using punctures to remove varicose veins and individual tributaries. This may be the most cosmetic method to remove varicose veins on thin skin. One month after this operation, there is not even redness on the skin.
Other thermal methods
When deciding how to treat 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 development of varicose veins and allow the patient to be treated on an outpatient basis without disturbing their 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 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 aroused great interest among phlebologists. It involves gluing the trunk of the great saphenous vein with a special cyanoacrylate glue. In the vessel lumen, this glue polymerizes and fills the lumen of the dilated vessel. As conceived by 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 in 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 right away. Symptoms of chronic venous insufficiency are relieved soon after the procedure. The process of active promotion of 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. Coiled glue stays 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 glued vessel may appear.
The use of glue on the trunk of the great saphenous vein does not eliminate the need to deal with the elimination of varicose tributaries, which is why doctors will have to remove signs of subcutaneous varicose veins with sclerotherapy or miniphlebectomy. The visible effect of the use of glue is manifested only in the case of combination with other methods of eliminating varicose veins. The patient has to pay more. The excessively high cost of the bonding kit makes this procedure much more expensive than the modern laser or radiofrequency method.
In the clinic, preference is given to thermal methods. Phlebologists believe that it is better to have a good local anesthetic than to treat varicose veins in the legs with an expensive and untested method. Also, the result is the same at best. If a relapse occurs, the patient will have to undergo a complex operation to remove the sealed vessel, as other methods are no longer applicable.
The modern method of combined treatment of reflux along the subcutaneous venous trunks adds extra weight to conventional sclerotherapy. Mechanochemical procedures are understood as a combination of mechanical damage to the inner surface of the venous wall and the introduction of a sclerosing agent. A catheter is inserted into the main saphenous vein using an ultrasound-guided puncture. After installing the catheter in the correct location, the device is connected. The sharp rotating head of the catheter makes up to 3. 5 thousand revolutions per minute, causing pronounced 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 vessel lumen 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 the removal of varicose tributaries. It involves a delicate technique of puncturing and pulling out varicose tributaries with the help of special tools. This operation is not for a novice phlebologist, you need to master the skills of delicate operation. Miniphlebectomy is an operation without the use of a scalpel and is performed under local anesthesia. Punctures are carried out in the direction of the skin lines, so after 2 months they are almost invisible.