Varicose veins are a vascular pathology when, against the background of weakness of the connective tissue, 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 a decrease in blood flow velocity, venous congestion, and contributes to pain in the calves. 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 in the legs. Varicose disease of the lower extremities (ICD code I83) is a very noticeable disease that is easy to remove.
Varicose veins in the esophagus are included in the symptoms of portal hypertension, and secondary varicose nodes in the female perineum indicate varicose veins of the small pelvis and difficulty in outflow of blood from the main veins.
Varicose veins of the spermatic cord (varicocele) is 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 localization of the process. In itself, an increase in the diameter of the veins is not dangerous, but the complications of varicose veins carry a great risk to health, and sometimes to the life of the patient. The cause of the onset of varicose veins in the legs can be heavy physical exertion, childbirth, a sedentary lifestyle of patients.
To understand what varicose veins look like, just go to the 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. The disease is so widespread that you will definitely see it. After reading this article to the end, you will understand how easily varicose veins of the legs are treated. Do not be afraid of going to the phlebologist.
Can we reverse varicose veins?
Many people ask this question, hoping to cure varicose veins at the initial stage with the help of medicines or traditional medical methods. If we are talking about varicose veins in the legs, then phlebologists can unequivocally answer this question - the degenerative destruction of the venous wall cannot disappear without turning off the affected vein from the bloodstream or removing it.
It happens that the dilated veins may still not lose their function and increase in volume due to overflow of blood from the overlying sections, and the muscle pump of the lower leg helps the outflow of blood into the deep veins.
Depending on the stage of varicose veins, various methods of surgical and conservative treatment 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, then it must be removed or coagulated, or glued.
Why is even the initial 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 pathological discharges, which causes varicose veins and irreversibly changed veins.
The modern treatment of varicose veins has advanced significantly since the first operations for 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 is compiled.
The clinics of the Innovative Vascular Center know how to treat varicose veins with minimal medical, psychological and cosmetic inconvenience. We do not need to remove varicose veins according to the classical scheme. In the arsenal of phlebologists, the hemodynamic concept of treating the main causes of varicose veins, a technique that involves the correction of only pathologically altered venous outflow and the removal of only 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 balls 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 neglected subcutaneous varicose veins for large scars. Therefore, the clinics offer both cosmetic and radical treatments that have the best patient reviews.
Some 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 large venous systems - the system of large and small saphenous veins. The great saphenous vein originates in the foot, from where it runs along the inner surface of the leg to the inguinal region, where it flows into the deep vein on the thigh, from the inside of the common femoral artery.
On the way from 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 leg and thigh, which causes varicose veins away from the main trunks. These perforators are designed to facilitate the path of blood into the deep venous system.
The small saphenous vein is formed at the external malleolus, it is characterized by several bends along the posterior surface of the lower leg and confluence with the popliteal vein. Between themselves, 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 the congenital weakness of the venous wall and the load on it, the failure of the internal valve apparatus of the veins develops, the 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 on 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. Varicose veins of the lower extremities 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 standing lifestyle, heavy physical exertion, pregnancy and childbirth.
- Congenital and acquired obstructions to venous outflow (compression syndromes, tumors and bone formations pressing on the veins.
- Sequelae of past deep vein thrombosis
Modern principles of treatment of varicose veins
Many patients often ask the question - what treatment is needed for varicose veins, if only its first signs appear. Varicose veins on the legs are a disease that is continuously progressing and 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.
Relief of symptoms of chronic venous insufficiency
Venous hypertension is a subjectively unpleasant consequence of impaired venous outflow, but varicose veins themselves do not hurt. Symptoms of varicose veins that require prevention and treatment include feelings of heaviness in the legs, swelling in the evenings, increased leg fatigue, and even pain in the calf muscles. With the progression of the disease, stagnation develops in venous perforators and deep veins, which can lead to skin hyperpigmentation, cause eczema in varicose veins, and heaviness in the calves is noted.
The most popular and publicly 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 specialists belated. It is important to understand that such remedies do not affect the course of varicose veins, which is why they can only slightly alleviate 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 (trophic ulcers, thrombophlebitis, venous bleeding)
In about 50% of cases, varicose disease is complicated by local inflammatory processes, which expands the indications for active surgical tactics. Most often, the patient comes to treat varicose veins when its complications develop - thrombophlebitis (ICD code I80), which hurts a lot or a trophic ulcer appears. 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, its cause is also removed, and this is varicose veins.
A 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 granulations and is accompanied by constant damage to the subcutaneous tissue around.
Beginning varicose ulcers are prone to progression and respond very poorly to conservative treatment. The optimal method of treatment today is laser correction of the venous outflow (EVLK) for varicose veins of the great or small saphenous veins and the correct local treatment (special dressings, washing the ulcer). One does not work without the other, so it is not necessary to count on the healing of a trophic ulcer only from ointments. An obligatory component of the treatment is compression therapy with the help of special compression stockings. They greatly alleviate the complaints of patients.
Cosmetic indications for varicose veins
Varicose veins are a disease that rarely leads to dangerous complications, but often makes you turn to specialists. Bulging varicose veins bring a lot of aesthetic problems to their owners. Usually young patients are embarrassed by these knots and hide their legs. If men are not so afraid of varicose veins and they can constantly walk in trousers, then women constantly want to walk with their legs open.
The good news is that advanced varicose veins in the legs of women or men can now be eliminated in a single procedure of laser photocoagulation of varicose veins without any traces. 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 lasts 40-50 minutes. The laser gives an amazing cosmetic result and a stable recovery from the manifestations of varicose veins, which is why EVLT is popular with doctors and young patients with varicose veins of the legs at any stage.
Prevention of the development of complications of varicose veins
The solution of these problems is possible by conservative and operational 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 vessels that work in the opposite direction, through which a pronounced discharge occurs, to solve the second problem, it is necessary to remove or turn off dilated veins from the blood circulation.
Diagnosis of varicose veins
To make a correct diagnosis of superficial vein disease, an examination by an experienced specialist and ultrasound scanning of the saphenous and deep veins from the abdomen to the feet is necessary. 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 in the amount of phlebography on an angiographic unit. After treatment, patients need periodic monitoring of the condition of the operated veins, which doctors carry out using ultrasound diagnostics. If at the diagnostic stage the doctor has questions about the state of deep veins, then MRI diagnostics or CT with contrast accurately determine their patency.
Methods of treatment of varicose veins in the vascular center
A vascular surgeon can cure varicose veins of the lower extremities only by eliminating the causes of its appearance. It is necessary to fight the cause of the development of varicose veins and the progression of the disease. Consider the main technologies with proven effectiveness.
Laser treatment of varicose veins (EVLT)
Endovenous laser coagulation is based on heating the venous wall with a coherent light beam. Varicose veins can be effectively treated without incisions and general anesthesia. A light-conducting fiber is inserted into a vein through a puncture under ultrasound guidance. Laser energy of a certain wavelength at the moment of its occurrence is absorbed by the venous wall, which leads to its heating and destruction of the connective tissue. As a result, the wall of the vein turns into scar tissue and the blood flow through the affected vein stops completely. The same effect is achieved as with the surgical removal of a vein, 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 development of the nodes. Rare side effects include numbness of the skin in the area of the coagulated vein, inflammation and blood clots in the coagulated veins. The overall incidence of such complications does not exceed 1%. In the Innovative Vascular Center, EVLK is the "gold standard", it can cure any varicose veins, both in the initial and advanced stages. Patients leave the best reviews just after laser treatment.
Radiofrequency obliteration of varicose veins (RFO)
In terms of its impact and effect, RFO, like the laser, is referred to as thermal methods for the treatment of 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 in the probe head, which is then transferred to the vessel walls. Heating the wall leads to thermal destruction of its structural elements, followed by scarring of the vein.
Both of these methods (EVLK and RFA) refer to thermoablative (thermal) technologies. In terms of their effectiveness, they are similar, however, the laser heats the vein wall itself, while RFO heats up 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 the laser, the frequency of relapses is less than with radiofrequency obliteration. Doctors noted 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 thermal methods of varicose veins are treated more effectively than conventional vein removal surgery.
Non-thermal methods of obliteration of varicose veins
In the 70s of the XX century, surgeons began to show an increased interest in minimally invasive types of surgical treatment for varicose veins and began to use electrocoagulators. Good idea, but poorly implemented in practice. Patients had skin burns, which may be why doctors were afraid to use thermal methods for a long time with varicose veins. Chemical methods used for vein obliteration 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. In 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 about 50% in 5 years. With sclerotherapy, the treatment does not have an exact focus on the causes of varicose veins, but eliminates the venous nodes themselves, therefore it can be used in combination with other minimally invasive methods (EVLK, RFO). A feature of sclerotherapy is the appearance of dense cones - coagulus at the site of sclerotic veins, which resolve up to six months.
Gluing veins with varicose veins with special glue
Venaseal technology is the name of a non-thermal method of obliteration of varicose trunks of saphenous veins, which involves the introduction of a special glue into the lumen of the vein, which polymerizes inside the lumen of the vein, causing its blockage. The idea looks interesting and developed in the last decade, but there are several pitfalls. Firstly, the glue remains inside the affected veins as a foreign body, it does not dissolve. Secondly, there are risks of periphlebitis around a sealed vein, as a reaction of the body to a foreign body. Thirdly, 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 regarding the long-term results of such treatment. The advantages of this technology have not yet been identified, but research is being actively conducted and it is possible that varicose veins will become a disease in which the entire treatment regimen will turn into one "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 treatment of varicose veins of the lower extremities
Doctors have been dealing with the question of how to get rid of large varicose veins of the 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 makes it clear how from early large incisions that disfigure the legs, surgery has gone to micro-punctures, 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 individual varicose veins and tributaries. This may be the most cosmetic method for removing varicose veins in thin skin. A month after such an 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 they allow the doctor to prevent the further development of varicose veins, and the patient to be treated on an outpatient basis without disturbing 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 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 lumen of the vessel, this glue polymerizes and fills the lumen of the dilated vessel. As conceived by the developers, this method does not require any anesthesia, and a "plug" appears in the vessel, which reliably blocks the 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 wearing of compression stockings.
Most women can return to normal activities immediately. Symptoms of chronic venous insufficiency are relieved soon 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. Curled 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 of the glued vessel 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 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 unreasonably high cost of the gluing kit makes this procedure much more expensive than the modern laser or radio frequency method.
In the clinic, preference is given to thermal methods. Phlebologists believe that it is better to do good local anesthesia than to treat varicose veins in the legs with an expensive and untested method. Moreover, the result is the same at best. In the event that a relapse occurs, the patient will have to perform a complex operation to remove the sealed vessel, since other methods will no longer be applicable.
The modern method of combined treatment of reflux along the subcutaneous venous trunks adds extra weight to conventional sclerotherapy. Mechano-chemical 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 through a puncture under ultrasound guidance. After installing the catheter in the right place, the device is connected. The rotating sharp head of the catheter makes up to 3. 5 thousand revolutions per minute, causing pronounced damage to the inner layer of the venous wall. In parallel, a sclerosing agent is injected through the catheter, which "mixes" in the lumen of the vessel and, with the help of the rotating part of the catheter, acts on the vascular wall, causing its inflammation and gluing.
This is a modern microsurgical aesthetic method for removing varicose tributaries. It implies a delicate technique of puncturing and pulling 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. The punctures are carried out in the direction of the skin lines, so after 2 months they are almost invisible.