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 frequently in women than in men.For a long time, varicose veins were just a cosmetic problem (spider veins), but if left untreated, they continually progress and can cause complications over time.The main complications (trophic ulcers, thrombophlebitis and changes in skin color without treatment) develop in 70% of patients with varicose veins.
Symptoms of varicose veins
- Swollen and dilated veins in the legs.
- Heaviness in the legs, fatigue at night.
- Swelling of the feet at night after physical activity.
- Change in skin color on the lower leg.
- Inflammation of the saphenous veins - thrombophlebitis
- Trophic skin ulcers.
Causes of varicose veins and risk factors.
- Compound inheritance: congenital insufficiency of the valvular apparatus.
- Heavy physical work while standing
- Frequent pregnancies and births.
- Walking 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 allows varicose veins to be treated without pain for the patient, in a very aesthetic and reliable way.The first signs of varicose veins should be a reason to consult a phlebologist.Varicose veins of the lower extremities imply 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 treatment.
Diagnosis
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 nodules that spoil the appearance of their legs.These discomforts are especially 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.These patients require treatment for aesthetic reasons, so only minimally invasive methods (without incisions) are recommended.
Chronic venous insufficiency
Approximately 30% of patients with varicose veins complain of heaviness in the legs, swelling at night and night cramps in the calves.These are signs of chronic venous insufficiency.Gradually, its phenomena worsen and painful sensations may appear in the varicose nodes.Skin changes and pigmentation develop.In case of severe venous insufficiency, the skin of the lower third of the leg can be damaged and form 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 exam is performed lying down and standing.The patient must open his legs completely.
Varicose veins are diagnosed during a routine examination, which must be performed standing while the veins are full.After the examination, a duplex ultrasound is always necessary.As a rule, such a diagnosis will be sufficient.However, if secondary varicose veins are suspected, an examination of the deep venous system is necessary.
Ultrasound examination of veins.
In the case of varicose veins, ultrasound of the veins has the task of identifying insufficiency of the venous trunks, identifying non-functioning venous valves and detecting blood clots in the superficial and deep venous systems.
The examination begins with examination of the saphenous veins in the standing position.The diameter and patency of the great and small saphenous veins are studied, the consistency of the valves is determined (Valsalva maneuver: tension of the abdominal muscles with a full inhalation, a sign of incompetence is the reverse flow of blood).The perforating veins are then studied in typical locations and their viability during the Valsalva maneuver.
After evaluating the superficial veins, it is necessary to evaluate the patency of the deep ones.To do this, lying down, the popliteal and femoral veins are examined, their patency and the consistency of the valves are also evaluated.
Contrast venography
Usually, ultrasound 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 case of relapses of varicose veins and secondary varicose veins.
To resolve these problems, a contrast-enhanced X-ray examination is used.The saphenous veins are punctured and contrast is administered.The contrast movement 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” varicose vein operation under anesthesia with incisions in the groin area and along the legs, which was used to eliminate superficial varicose veins at the beginning of the last century, is an atavism of the past.The suffering of patients, long hospital stays and leg pain after such operations aimed at improving blood flow are completely unjustified.Severe varicose veins can be treated without resorting to “inquisition methods.”Nowadays, the treatment of advanced varicose veins can be performed without anesthesia or hospitalization.The work of a phlebologist becomes office-based, without the attributes of major surgery.
Knowledge of the causes of varicose veins in the legs allowed us to develop hemodynamic principles of treatment.Its implementation is possible by removing or disconnecting the vein from blood circulation.Modern technologies are based on the principle of fusion of vein walls in the zone of insufficient venous valves.The method of influencing venous circulation may be different, but its goal is the same: stopping the pathological discharge of blood through the affected vein (antireflux).
How can varicose veins in the legs be cured?
Understanding the cause of varicose veins allows you to choose the right treatment method.The goal of modern varicose vein treatment is to solve several problems:
- Termination of pathological discharge in an upright position through the incompetent saphenous veins of the lower extremities.
- Elimination of reflux between deep and superficial (perforating) veins, the main mechanism for the development of varicose trophic ulcers.
- Removal of varicose veins - degenerated superficial vessels (varicose veins).
- Compression therapy using special stockings and socks.
Capacities of the vascular center.
Thermal methods to treat varicose veins are endovenous laser coagulation (EVLC) and radiofrequency obliteration (RFO) of the lower extremity veins.
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 remains the best method.With laser coagulation, the damaged vein is heated with a laser beam, which produces a strong effect of damaging the collagen of the vein wall, causing an inflammatory process in the vein and its excessive growth.Advanced varicose veins of the legs, which are treated with this method, recede completely and without a trace, and their 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 puncture, which is guided 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 further development of the disease and its complications.Complete elimination of varicose veins is observed in 98% of patients with proper use of the EVLT method.The capabilities of this method make it possible to treat varicose veins of the legs in women and correct venous flow in trophic ulcers.
Radio Frequency Obliteration (RFO)
Treatment of varicose veins using the radiofrequency obliteration (RFO) method is a similar thermal method, but the heating of the vein wall tissue occurs according to different physical principles due to the energy of radio waves.Radiofrequency obliteration allows varicose veins to be eliminated and their symptoms eliminated;Such treatment in its immediate and long-term results does not differ from EVLT, but is more thorough for a phlebologist.
Other thermal methods
When deciding how to treat varicose veins, phlebologists often use exotic methods.Varicose veins were treated with thermal effects using superheated steam and bipolar electrocoagulation.However, modern thermal methods are more effective and allow the doctor to prevent further development of varicose veins and treat the patient on an outpatient basis without altering his 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 make it possible to get rid of not only the initial form but also very pronounced varicose veins on the legs without incisions.In the photographs in the “Treatment Results” section you can see the view before and after the minimally invasive treatment.
Non-thermal methods to eliminate stem reflux.
For many years, phlebologists have been thinking 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 walls of the veins - thrombophlebitis and their subsequent gluing with the disappearance of the lumen of the veins.After the appearance of the Fegan method, when treatment began to be carried out depending on the cause of varicose veins, the development of non-thermal scleroobliteration methods began.Since then, varicose veins of 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 goal of sclerotherapy is to inject a drug into a varicose vein, which causes inflammation and subsequent sticking of the varicose vein.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 us to count on a long-term effect of sclerotherapy, since a relapse due to reflux will surely occur.
Sclerotherapy can be performed in the absence of allergy to tetradecyl sulfate or polidocanol.These substances are the main sclerosants.During sclerosing treatment, manifestations of thrombophlebitis may appear, especially if liquid forms of the drug are used.Sclerotherapy of perforator 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 relapse rate is about 40% in the next 5 years.
The advantage of sclerotherapy is a good immediate effect and low treatment cost.Sclerosant injections cause gluing of the veins and the cessation of the pathological process - the reflux of blood through the saphenous veins.The medication is usually injected in foam form into varicose veins.A spasm of the dilated subcutaneous vessels is formed, prolonged contact of the foamy form of the sclerosant with the wall of the veins and their subsequent inflammation and sticking.This process occurs unevenly and the degree of obliteration of the vein is not the same, which is why 40% of patients after sclerotherapy have relapses of varicose veins.After sclerotherapy, the affected area of the lower extremity veins is closed and over time it heals completely and blood flow in the opposite direction stops.To prevent the appearance of skin necrosis due to the penetration of the foamy form of the sclerosant into the subcutaneous tissue, the 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 to eliminate varicose veins through sclerotherapy depends on the stage of the varicose veins and the condition of the veins.The course of treatment usually consists of 2-3 procedures.The area of skin over the sclerotic vessel may acquire a dark tone for 2-3 months (hyperpigmentation appears).It can ruin a woman's legs for several months, so it is best to perform this treatment in the winter months.Drug treatment and ultrasound-guided vascular punctures can accelerate the process of resorption of intravascular fluid accumulations (clots), the risk of which is approximately 10%.Clots form when there is insufficient compression, but they will certainly disappear over time.Many patients know that one month after sclerotherapy, the signs of varicose veins of the lower extremities disappear for many years, so sclerotherapy remains one of the most popular treatment methods.
Using special glue
Since its inception, this method has aroused great interest among phlebologists.It consists of 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.According to the developers, this method does not require anesthesia and a "plug" appears in the vessel that reliably blocks 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 use of compression stockings.
Most women can return to normal activities immediately.Symptoms of chronic venous insufficiency are relieved shortly after the procedure.The process of active promotion of this glue on the phlebological market should begin in the near future.However, there are certain disadvantages: The presence of a foreign body in the human body.Curdled cola 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 stuck vessel may occur.
Using glue on the trunk of the great saphenous vein does not eliminate the need to remove varicose tributaries, so doctors will need to eliminate signs of subcutaneous varicose vein using sclerotherapy or miniphlebectomy.The visible effect of using glue appears only when combined with other methods of removing varicose veins.The patient has to pay more.The excessively high cost of the gluing kit makes this procedure much 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 administer a good local anesthesia than to treat varicose veins of the saphenous veins of the legs with an expensive and unproven method.Furthermore, the result is, at best, the same.If a relapse occurs, the patient will have to undergo a complex operation to remove the sealed vessel, since other methods will no longer be applicable.
Mechanochemical destruction technology.
The modern method of combined treatment of reflux along the subcutaneous venous trunks adds extra weight to conventional sclerotherapy.Mechanochemical procedures involve 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 location, the device is connected.The sharp head of the catheter rotates at 3.5 thousand revolutions per minute, causing serious damage to the inner layer of the venous wall.At the same time, a sclerosing drug is injected through the catheter, which “mixes” in the lumen of the vessel and, using the rotating part of the catheter, acts on the vascular wall, causing its inflammation and sticking.
To date, the only advantage of this technology is the absence of the need for tumescent anesthesia.According to its inventors, mechanochemical obliteration should cause a stronger obliteration effect than foam sclerotherapy, although for some reason convincing data have not yet been presented.It is clear that this type of varicose veins can be treated with other minimally invasive methods, so its advantages are not obvious.We will have to wait for more studies to be carried out in Europe or the US to determine precisely the place this technology occupies.
Miniphlebectomy
This is a modern microsurgical aesthetic method of removing varicose veins.This is a delicate technique of puncture and extraction of varicose veins using special tools.This operation is not for a novice phlebologist;it is necessary to have the skills of delicate surgery.Miniphlebectomy is a no-scalpel operation and is performed under local anesthesia.The 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 involved the use of 1 to 3 cm incisions, since it is aesthetically impeccable, painless and very effective.By assuming how varicose veins manifest, the doctor can clearly plan micropunctures and get by with minimal intervention.The patient can return home on his own feet immediately after the operation.Miniphlebectomy can be a stand-alone effective method of treating varicose veins or used in combination after laser coagulation of varicose veins.Removal of varicose veins is carried out using a special technique developed by Professor Varadi.This technique has been perfectly mastered by our phlebologists and allows you to eliminate varicose veins in the legs, an effective treatment regardless of their cause.
Treatment results
Results of varicose vein treatment.
The results of modern therapy for varicose veins can be considered very good.Any technology, if done 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 flow.The innovative vascular center is ready to help you tackle any venous disease without incisions or pain.We know how to cure varicose veins and we have extensive experience.Treatment of varicose veins should not be a problem in the modern high-tech world.