Varicose veins are vascular pathologies when, against the background of connective tissue weakness, stretching of the venous wall occurs. The diameter of the vein increases, and the wall becomes thinner.
Large diameter veins lead to a decrease in blood flow velocity, venous congestion, and contribute to calf pain. Against this background, varicose veins can cause thrombophlebitis - inflammation of the affected vein, which is terrible for the development of thromboembolic complications. External cones visible along the vessels allow you to recognize varicose veins in the legs. Varicose veins of the lower leg (ICD code I83) is a very noticeable disease that is easy to dismiss.
Varicose veins in the esophagus are included in the symptoms of portal hypertension, and secondary varicose nodes in the female perineum indicate small pelvic varicose veins and difficulty in the outflow of blood from the main vein.
Varicose veins of the spermatic cord (varicocele) are indicated by the clinic of secondary pelvic phlebohypertension and can cause infertility in men. The etiology and pathogenesis of varicose veins are very diverse depending on the localization of the process. By itself, the 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 to the life of the patient. The cause of varicose veins in the legs can be heavy physical exercise, childbirth, inactive lifestyle of the patient.
To understand what varicose veins look like, just go to a summer beach. Although many carriers of varicose veins are embarrassed to appear there, you will definitely see how varicose veins manifest themselves in men and women. This disease is so prevalent that you will definitely see it. After reading this article to the end, you will understand how easy it is to treat varicose veins. Do not be afraid to go to a 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 talk about varicose veins in the legs, then the phlebologist can answer this question clearly - the degenerative destruction of the vein walls cannot disappear without turning off the affected veins from the blood flow or removing them.
It happens that the dilated vein may still not lose its function and increase in volume due to the overflow of blood from its upper part, and the muscle pump of the lower leg helps the outflow of blood into the deep vein.
Depending on the stage of varicose veins, various surgical and conservative treatment methods can be used that can stop the development of varicose veins at various stages. The order here is this: if the affected vein cannot be restored, then it must be removed or coagulated, or glued.
Why early varicose veins can not be restored without surgical intervention? For the 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, enlarged varicose tributaries can restore their function on their own and without surgical intervention if the phlebologist eliminates the pathological discharge, which causes varicose veins and veins to change irreversibly.
Modern treatment of varicose veins has advanced significantly since the first surgeries for varicose veins in 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 arranged.
Innovative Vascular Center clinics know how to treat varicose veins with minimal medical, psychological and cosmetic discomfort. We do not need to remove varicose veins according to the classic scheme. In the phlebologist's arsenal, the hemodynamic concept to treat the main cause of varicose veins, a technique that involves the correction of only the pathologically altered venous outflow 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 an annoying symptom due to aesthetic problems, but the fair sex is not ready to change the ugly appearance of subcutaneous varicose veins that are neglected for large scars. Therefore, the clinic offers cosmetic and radical treatments that have the best patient reviews.
Some anatomy and physiology
The definition of varicose veins is the main expansion of the trunk of the subcutaneous veins in the lower part of the leg, due to congenital, contributory and productive factors. Chances of getting varicose veins exist 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 large venous systems - the great and small saphenous vein systems. The great saphenous vein originates in the leg, from where it runs along the inner surface of the leg to the inguinal region, where it flows into the deep vein in the thigh, from the inside of the common femoral artery.
On the way from the trunk and tributaries of the great saphenous vein, a short venous trunk can be identified - a perforator that connects it to the deep veins of the leg and lower thigh, which causes varicose veins away from the main trunk. These perforators are designed to facilitate the passage of blood into the deep venous system.
The small saphenous vein is formed in the external malleolus, it is characterized by several bends along the posterior surface of the lower leg and the meeting with the popliteal vein. Between themselves, the great and small saphenous veins are connected by separate overflows. In the subcutaneous trunk there are many venous valves that ensure the movement of blood to the heart and prevent the backflow of blood.
Due to the congenital weakness of the vein wall and the load on it, the failure of the internal valve device of the vein develops, the blood begins to move in the opposite direction, causing the overflow of the saphenous vein, further stretching and development. severe varicose veins. Therefore, without eliminating the pathological discharge of the blood, it is impossible to achieve a cure for 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 degree of chronic venous insufficiency. Varicose veins on the lower leg are formed by a combination of several factors:
- Congenital distensibility and weakness of the venous wall and increased intravenous pressure.
- Increased pressure on the veins due to a long lifestyle, heavy physical exercise, pregnancy and childbirth.
- Congenital and acquired obstruction to venous outflow (compression syndrome, tumors and bone formations that press on veins.
- Effects 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. Varicose veins on the legs is a disease that continues to develop and is prone to complications, therefore, without medical intervention, one cannot count on recovery. Consider the main indications for the treatment of varicose veins in the legs.
Relieves the symptoms of chronic venous insufficiency
Venous hypertension is a subjectively unpleasant consequence of impaired venous outflow, but varicose veins themselves are painless. Symptoms of varicose veins that require prevention and treatment include 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 perforator veins and deep veins, which can cause hyperpigmentation of the skin, cause eczema in varicose veins, and heaviness in the calves is noted.
The most popular and openly advertised method of treating the symptoms of varicose veins in the legs is taking various pills for varicose veins, using ointments and creams, which makes contacting a specialist late. It is important to understand that the drugs do not affect the course of varicose veins, which is why they can only slightly reduce complaints and symptoms in the early stages. It is not worth counting on the fact that varicose veins will disappear after treatment with such drugs.
Treatment of complications of varicose veins (tropical ulcers, thrombophlebitis, venous bleeding)
In about 50% of cases, varicose veins are complicated by a local inflammatory process, which expands the indications for active surgical tactics. Often, patients come to treat varicose veins when complications develop - thrombophlebitis (ICD code I80), which is very painful or trophic ulcers appear. Sometimes disturbed 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 laser coagulation. Clinical recommendations do not give an unambiguous answer to this question, but with an active approach, along with thrombophlebitis, the cause is also removed, and this 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 area of the medial malleolus with active purulent discharge, flaccid granulation and is accompanied by continuous damage to the surrounding subcutaneous tissue.
Early varicose ulcers are prone to development and respond very poorly to conservative treatment. The optimal treatment method today is venous outflow laser correction (EVLK) for varicose veins of the large or small saphenous vein and proper local treatment (special dressings, ulcer washing). One does not work without the other, so there is no need to rely on healing trophic ulcers only from ointments. A mandatory component of treatment is compression therapy with the help of special compression stockings. They greatly reduce patient complaints.
Cosmetic indications for varicose veins
Varicose veins are diseases that rarely lead to dangerous complications, but often make you turn to a specialist. Bulging varicose veins bring many aesthetic problems to their owners. Usually young patients are embarrassed by this knot and hide their legs. If men are not so afraid of varicose veins and they can always walk in pants, then women always want to walk with open legs.
The good news is that advanced varicose veins in women's or men's legs can now be eliminated in a single varicose vein laser photocoagulation procedure without any side effects. Modern interventions are performed without incisions, through minimal punctures, which are completely invisible already 3-4 weeks after the intervention. The patient is brought to the operating table under local anesthesia, and the operation lasts 40-50 minutes. The laser provides amazing cosmetic results and a stable recovery from the manifestations of varicose veins, which is why EVLT is popular among doctors and young patients with varicose veins of the legs at any stage.
Prevention of the development of complications of varicose veins
The solution to this problem 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 channel that works in the opposite direction, where a clear discharge occurs, to solve the second problem, it is necessary to remove or turn off the dilated vein from the blood circulation.
Diagnosis of varicose veins
To make a correct diagnosis of superficial vein disease, an examination by an experienced specialist and an ultrasound scan of the saphenous and deep veins from the abdomen to the legs are necessary. Information from this research method is sufficient for the correct recognition of this diagnosis in most patients. The main signs of varicose veins in the legs can be determined with the naked eye, and the cause can be established using ultrasound.
In some cases, doctors perform invasive tests in total phlebography at the angiography unit. After treatment, the patient needs regular monitoring of the condition of the treated vein, which is done by the doctor using ultrasound diagnostics. If at the diagnostic stage the doctor has questions about the state of the deep veins, then MRI or CT diagnostics with contrast accurately determine their patency.
Methods of treatment of varicose veins in the vascular center
Vascular surgeons can cure varicose veins on the lower leg simply by eliminating the cause of their appearance. It is necessary to fight the cause of the development of varicose veins and the development of the disease. Consider key technologies with proven effectiveness.
Varicose vein laser treatment (EVLT)
Endovenous laser coagulation is based on heating the vein 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. Laser energy with a certain wavelength at the moment of its occurrence is absorbed by the vein wall, which leads to heating and destruction of 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 achieved as with vein removal surgery, but only without incisions, general anesthesia and pain.
In terms of its effectiveness, EVLK exceeds the open operation of phlebectomy. 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 frozen vein, inflammation and blood clots in the pooled 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 vein, both in the early and advanced stages. Patients leave the best reviews after laser treatment.
Radiofrequency ablation of varicose veins (RFO)
In terms of its effects and effects, RFO, like laser, is referred to as a thermal method for the treatment of varicose veins, but different physical principles are used there. A radiosonde is also inserted into a vein through a puncture. The intervention is performed under local anesthesia. The principle of RFO is based on the generation of thermal energy in the probe head, which is then transferred to the vessel wall. Heating the wall leads to thermal destruction of its structural elements, followed by scarring of the veins.
Both of these methods (EVLK and RFA) refer to thermoablative (thermal) technology. 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 the heat is transferred to the wall through the liquid part of the blood.
According to experts, EVLT more radically destroys the affected vein structure, therefore, after the laser, the frequency of relapse is less than with radiofrequency destruction. Doctors stated 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 concluded that the thermal method of varicose veins is treated more effectively than conventional vein removal surgery.
Non-thermal method to get rid of varicose veins
In the 70s of the XX century, surgeons began to show an increased interest in the type of minimally invasive surgical treatment for varicose veins and began to use electrocoagulators. Good idea, but poorly implemented in practice. Patients experience skin burns, which is why doctors are afraid to use thermal methods for a long time with varicose veins. Chemical methods used to remove veins have been proven to be safe and quite effective. This includes sclerotherapy in various variants and adhesive removal.
Sclerotherapy
Sclerotherapy is the intravenous administration of special drugs that cause damage to the vein wall, followed by the destruction (over-enhancement) of the lumen of the varicose veins. The history of this method begins in the 19th century and has an interesting development path. In the vascular center, specialists use the most advanced technology - a foam form of sclerotherapy. Continuous treatment for six months allows you to get rid of varicose veins on the lower legs for a long time. Although the recurrence rate is about 50% in 5 years. With sclerotherapy, the treatment does not have a precise focus on the causes of varicose veins, but eliminates the venous node itself, therefore it can be used in combination with other minimally invasive methods (EVLK, RFO). A feature of sclerotherapy is the appearance of dense cones - coagulum at the site of sclerotic veins, which resolves up to six months.
Attaching veins to varicose veins with special glue
Venaseal technology is the name of a non-thermal method to eliminate the varicose veins of the saphenous vein, which involves the introduction of a special glue into the vein lumen, which polymerizes in the vein lumen, causing its blockage. This idea seems interesting and has grown in the last decade, but there are some problems. First, the glue remains in the affected vein as a foreign body, it does not dissolve. Second, there is a risk of periphlebitis around the closed vein, as the body's response to a foreign body. Third, it is an expensive method of treatment.
The cost of varicose vein treatment 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 yet to be identified, but research is underway and it is possible that varicose veins will become a disease where the entire treatment regimen will turn into one "magical" injection. It is characteristic that this method has not yet been considered in the latest clinical guidelines, but has been actively offered by several phlebological centers.
Surgical method of treating varicose veins on the lower leg
Doctors have been dealing with the question of how to remove large varicose veins from superficial veins on the legs and the prevention of complications since the middle of the 19th century. The history of the struggle with enlarged veins explains how from the initial large incisions that disfigure the legs, surgery has gone to micropunctures, which allow you to deal with varicose veins without cosmetic defects.
Advanced phlebologists use elements of classical surgery in the form of microphlebectomy using punctures to remove varicose veins and individual tributaries. This is probably the most cosmetic method to get rid of varicose veins on thin skin. A month after such an operation, there is no redness on the skin.
Other thermal methods
When deciding how to treat varicose veins, phlebologists often use exotic methods. Varicose veins are treated with heat exposure using superheated steam and bipolar electrocoagulation. However, modern thermal methods are more effective and they allow doctors to prevent the further development of varicose veins, and patients are treated on an outpatient basis without interfering with their lifestyle. In the hands of a novice phlebologist, the thermal ablation method 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 allow you to get rid of not only the initial form, but also severely 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 dilated vessel lumen. As the developers envisioned, 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 technology for the treatment of varicose veins that does not require the use 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 glue in the phlebological market should begin in the near future. However, there are certain disadvantages: The presence of foreign bodies in the human body. Rolled 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 from occluded vessels may appear.
The use of glue in the trunk of the great saphenous vein does not eliminate the need to deal with the elimination of varicose tributaries, which is why doctors need to remove signs of subcutaneous varicose veins with sclerotherapy or miniphlebectomy. The visible effect of the use of glue is shown only in the case of combination with other methods to eliminate varicose veins. Patients have to pay more. The unreasonable cost of adhesive kits makes this procedure more expensive than modern laser or radio frequency methods.
In the clinic, preference is given to thermal methods. Phlebologists believe that it is better to perform good local anesthesia than to treat varicose veins in the legs with expensive and untested methods. Moreover, the results are the same. If a relapse occurs, the patient will have to perform a complex operation to remove the closed vessels, because other methods will no longer be used.
The modern method of combined treatment of reflux along the trunk of the subcutaneous vein adds additional weight to conventional sclerotherapy. The mechano-chemical procedure is 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 great saphenous vein through a puncture under ultrasound guidance. After installing the catheter in the right place, the device is connected. The sharp rotating head of the catheter makes up to 3. 5 thousand rotations per minute, causing significant damage to the inner layer of the vein wall. In parallel, 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 inflammation and adhesion.
This is a modern microsurgical aesthetic method to remove varicose veins. It implies a delicate technique of piercing and pulling varicose tributaries with the help of special tools. This operation is not for novice phlebologists, you need to master fine operation skills. Miniphlebectomy is surgery without the use of a scalpel and is performed under local anesthesia. The puncture is done towards the skin line, so after 2 months it is almost invisible.