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 often in women than in men.For a long time, varicose veins were only a cosmetic problem (spider veins), but if left untreated, varicose veins continue to progress and can cause complications over time.The main complications - trophic ulcers, thrombophlebitis, skin discoloration without treatment develop in 70% of patients with varicose veins.
Symptoms of varicose veins
- Swollen dilated veins in the legs
- Heaviness in the legs, fatigue in the evening
- Swelling of legs in the evening after physical activity
- Discoloration of the skin of the lower leg
- Inflammation of the saphenous veins - thrombophlebitis
- Trophic ulcers of the skin
Varicose veins causes and risk factors
- Complex heredity - congenital deficiency of the valve apparatus
- Heavy physical labor while standing
- Frequent pregnancies and births
- Walking in high heels
In our clinics, modern methods of treating varicose veins of the lower limbs allow us to solve this problem without resorting to serious surgical interventions, without pain, cuts and hospitalization.
The modern level of phlebology allows the patient to treat varicose veins painlessly, very aesthetically and reliably.The first symptoms of varicose veins should be a reason to contact 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 varicose transformation with tablets and leeches as a treatment.
Diagnostics
Complaints and symptoms
Varicose veins begin with the appearance of single nodules of dilated veins and continue to progress.Varicose veins may 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 concern
Most patients with varicose veins only complain of unsightly varicose veins that spoil the appearance of their legs.Such complaints are especially often caused by varicose veins in women.Often cosmetic discomfort is caused by small varicose veins and spider veins, which do not pose a health threat, but force you to close your legs.Such patients require treatment for cosmetic reasons, so only minimally invasive (no incision) methods are recommended for them.
Chronic venous insufficiency
About 30% of patients with varicose veins complain of heaviness in the legs, swelling in the evening, and night cramps in the calves.These are symptoms of chronic venous insufficiency.Gradually, his symptoms worsen, and painful sensations may appear in the varicose veins.Skin changes and pigmentation develop.With severe venous insufficiency, the skin in the lower third of the leg can be damaged by the formation of trophic ulcers, which are difficult to treat.Often, patients with developed varicose veins develop skin inflammation - eczema.
Examination by a phlebologist
If varicose veins cause any discomfort, a consultation with a phlebologist is necessary.The examination is performed lying and standing.The patient should open his legs completely.
Varicose veins are diagnosed during a routine examination, which should be done while standing while the veins are full.After the examination, a duplex ultrasound scan is always necessary.As a rule, such a diagnosis will be enough.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 is responsible for determining the incompetence of the venous bodies, identifying non-functioning venous valves, and identifying blood clots in the superficial and deep venous systems.
The examination begins with examination of the saphenous veins while standing.The diameter and patency of the great and small saphenous vein are studied, the consistency of the valves is determined (Valsalva maneuver - tension of the abdominal muscles with full inhalation, a sign of incompetence is the reverse flow of blood).Then the perforating vessels in typical places and their viability during the Valsalva maneuver are studied.
After evaluating the superficial veins, it is necessary to evaluate the patency of the deep ones.For this purpose, lying down, the popliteal and femoral veins are examined, their patency and the consistency of the valves are also evaluated.
Contrast venography
Usually, ultrasound examination is sufficient for the 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 the case of relapses of varicose veins and secondary varicose veins.
Contrast X-ray examination is used to solve these problems.The saphenous veins are punctured and contrast is given.The movement of the contrast is observed on the monitor of the X-ray machine, and all necessary tests and predictions are made.Currently, venography is used very rarely for varicose veins.
Treatment
The "classic" operation of varicose veins under anesthesia with incisions in the groin area and along the legs, which was used at the beginning of the last century to eliminate superficial varicose veins, is an atavism of the past.After such operations aimed at improving blood flow, patients suffer, stay in the hospital for a long time, and have pain in the legs, which is completely unreasonable.Severe varicose veins can be treated without resorting to "inquisition methods".Today, the treatment of advanced varicose veins can be performed without anesthesia and hospitalization.A phlebologist's work is office-based without the attributes of major surgery.
Knowing what causes varicose veins in the legs allowed us to develop the hemodynamic principles of treatment.Their implementation is possible by removing or shutting off the blood vessel.Modern technologies are based on the principle of joining the vessel walls in the area of venous valve insufficiency.The method of influencing the venous circulation may be different, but its purpose is the same - to stop the pathological flow of blood through the affected vein (anti-reflux).
How to treat varicose veins in the legs?
Understanding the cause of varicose veins allows you to choose the right treatment method.The goal of modern treatment of varicose veins is to solve several problems:
- Termination of pathological discharge in the vertical position through incompetent saphenous vessels of the lower extremities.
- Elimination of reflux between deep and superficial veins - perforators - the main mechanism of the development of varicose trophic ulcers.
- Removal of varicose veins - degenerated superficial veins (varicose veins).
- Compression therapy using special socks and stockings.
Vascular center capabilities
Thermal methods for the treatment of varicose veins are endovenous laser coagulation (EVLC) and radiofrequency obliteration (RFO) of veins of the lower extremities.
Endovenous laser coagulation is an effective treatment of varicose veins, its principle is based on the thermal effect of laser energy.This treatment method was introduced in 2001 and is still the best method.With laser coagulation, the damaged vessel is heated with a laser beam, which ensures a strong effect of collagen damage of the venous wall, causing an inflammatory process in the vessel and its excessive growth.Varicose veins developed in the legs treated with this method are completely and without a trace, and its 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 the varicose vein through a skin puncture directed along the affected vein to the area of the incompetent valve.For the patient, this method is a safe, painless and reliable way to prevent the further development of the disease and its complications.Complete elimination of varicose veins is observed in 98% of patients who use the EVLT method correctly.The possibilities of this method allow both to treat varicose veins on the legs in women and to correct the venous flow in trophic ulcers.
Radiofrequency obliteration (RFO)
Radiofrequency obliteration (RFO) treatment of varicose veins is a similar thermal method, but the heating of the tissue of the venous wall occurs according to different physical principles due to radio wave energy.Radiofrequency obliteration allows to eliminate varicose veins and eliminate its symptoms;in terms of immediate and long-term results, this type of treatment does not differ from EVLT, but it is more troublesome for a phlebologist.
Other heating methods
When deciding how to treat varicose veins, phlebologists often used exotic methods.Varicose veins were treated with thermal effects 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 to treat the patient in an outpatient setting without disrupting the patient's lifestyle.In the hands of an inexperienced phlebologist, thermal ablation methods can cause unpleasant complications: decreased sensitivity, burns, seals.In the hands of an experienced phlebologist, the effectiveness of this method is more than 98%, and the laser method and RFO allow you to get rid of not only the original form, but also acutely expressed varicose veins on the legs without incisions.In the photos in the "Treatment results" section, you can see the scene before and after the minimally invasive treatment.
Non-thermal methods to eliminate root reflux
For many years, phlebologists have been thinking about how to treat varicose veins of the lower extremities without cuts and pain.The disappearance of the saphenous veins in the arms after frequent injections led to the idea that some substances can cause inflammation of the vessel walls - thrombophlebitis and subsequent adhesion with the loss of the vein lumen.After the appearance of the Fegan method, when treatment began to be carried out based on the cause of varicose veins, the development of non-thermal scleroobliteration methods began.Since then, varicose veins on 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 point of sclerotherapy is to inject a drug into the varicose vein, which causes inflammation and subsequent adhesion of the varicose vein.Sclerotherapy does not eliminate the cause of venous insufficiency and is more suitable for certain forms of varicose veins or in the early stages of the disease.Advanced varicose veins of the lower extremities are treated with more complex methods;damage to the body of the great or small saphenous vein does not allow to believe in the long-term effect of sclerotherapy, because relapse due to reflux will definitely occur.
Sclerotherapy can be performed in the absence of allergy to tetradecyl sulfate or polidocanol.These substances are the main sclerosants.Manifestations of thrombophlebitis may occur during sclerosing treatment, especially if liquid forms of the drug are used.Sclerotherapy of perforating veins is highly effective in the treatment of venous trophic ulcers.Manifestations of varicose veins of the lower extremities can be eliminated with the help of sclerotherapy at any stage, but the recurrence rate in the next 5 years is about 40%.
The advantage of sclerotherapy is good immediate effect and low cost of treatment.Injections of sclerosant lead to gluing of vessels and stopping the pathological process - backflow of blood through saphenous vessels.The drug is usually injected into the varicose veins in the form of a foam.Spasm of enlarged subcutaneous vessels occurs, prolonged contact of the foam form of the sclerosant with the vessel wall and their subsequent inflammation and adhesion.This process occurs unevenly and the degree of vein obliteration is not the same, so after sclerotherapy, 40% of patients have relapses of varicose veins.After sclerotherapy, the affected area of the veins of the lower extremities is closed and completely heals over time, and blood flow in the opposite direction stops.In order to prevent the occurrence of skin necrosis due to the penetration of the foam form of the sclerosant into the subcutaneous tissue, the administration is carried out strictly under ultrasound control.
To eliminate varicose veins, foam sclerotherapy can be used as an independent method or in combination with laser treatment.The number of sessions to eliminate varicose veins using sclerotherapy depends on the stage of varicose veins and the condition of the veins.The course of treatment usually consists of 2-3 procedures.The area of the skin over the sclerotic vein may take a dark shade (hyperpigmentation appears) within 2-3 months.It can destroy a woman's legs within a few months, so this treatment is best done during the winter months.Drug therapy and ultrasound-guided vascular punctures can accelerate the resorption process of intravascular fluid accumulation (clots), which has a risk of approximately 10%.A clot forms when there is enough compression, but it will definitely disappear with time.Many patients know that within a month after sclerotherapy, the symptoms of varicose veins of the lower extremities disappear for many years, so sclerotherapy is still one of the most popular treatment methods.
Using special glue
Since its inception, this method has attracted great interest among phlebologists.This 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.According to the developers, this method does not require any anesthesia, and a "plug" appears in the vein that reliably blocks blood flow.Considering this, half an hour is enough for the procedure to eliminate varicose veins on 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 disappear shortly after the procedure.The process of actively promoting this adhesive to 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 lasts forever on board and can cause chronic allergies;sometimes there is inflammation of the vessel wall or rejection of the polymer with pus.Acute thrombophlebitis of the adhesive vessel may occur.
The use of glue on the trunk of the great saphenous vein does not eliminate the need to remove the varicose veins, so doctors will have to relieve the symptoms of subcutaneous varicose veins with sclerotherapy or miniphlebectomy.The visible effect of using the adhesive appears only when it is combined with other methods of removing varicose veins.The patient has to pay more.The unreasonably high price of the adhesive kit makes this procedure significantly more expensive than the modern laser or radiofrequency method.
Thermal methods are preferred in our clinic.We believe that it is better to give a good local anesthetic than to treat varicose veins of the saphenous veins in the legs with an expensive and unproven method.Moreover, the result is the same at best.If a relapse occurs, the patient will have to undergo a complex operation to remove the sealed vein, as other methods will no longer be applicable.
Mechanical-chemical obliteration technology
The modern method of combined treatment of reflux along subcutaneous venous trunks adds weight to conventional sclerotherapy.Mechanical-chemical procedures mean mechanical damage to the inner surface of the venous wall and application 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 place, the device is connected.The rotating sharp head of the catheter makes 3.5 thousand revolutions per minute and causes 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, affects the vessel wall, causing its inflammation and adhesion.
To date, the only advantage of this technology is the absence of the need for anesthetic anesthesia.Mechanical-chemical obliteration, according to its inventors, should cause a stronger obliteration effect than foam sclerotherapy, although for some reason convincing data have not yet been presented.Obviously, this type of varicose veins can be treated with other minimally invasive methods, so its advantages are not clear.We will have to wait for future research from Europe or the US to pinpoint the location of this technology.
Miniphlebectomy
This is a modern microsurgical aesthetic method to eliminate varicose veins.It involves a delicate technique to puncture and remove varicose veins using special instruments.This operation is not for an inexperienced phlebologist;you must have fine surgical skills.Miniphlebectomy is an operation that does not use a scalpel and is performed under local anesthesia.Punctures are made in the direction of the skin lines, so after 2 months they are practically invisible.
Because miniphlebectomy is aesthetically flawless, painless and very effective, it has replaced the classic operation on varicose veins, which involves the use of 1-3 cm incisions.By assuming how varicose veins manifest, the doctor can clearly plan micropunctures and perform them with minimal intervention.The patient can go home on his own feet immediately after the operation.Miniphlebectomy can be an effective independent method of treating varicose veins or can be used together after laser coagulation of varicose veins.The 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 on the legs - an effective treatment regardless of its cause.
Treatment results
Results of treatment of varicose veins
The results of modern therapy for varicose veins can be considered very good.Any technology, if performed 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 experience serious problems with venous flow.The innovative vascular center is ready to help you cope with any venous disease without cuts and pain.We know how to treat varicose veins and have extensive experience.Treatment of varicose veins should not be a problem in today's high-tech world.