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 varicose veins are not treated, they continuously progress and can lead to complications over time.The main complications - trophic ulcers, thrombophlebitis, changes in skin color without treatment develop in 70% of patients with varicose veins.
Symptoms of varicose veins
- Swollen varicose veins on the legs
- Heaviness in the legs, tiredness in the evening
- Swelling of the feet in the evening after physical activity
- Discoloration of the skin on the lower leg
- Inflammation of the saphenous veins - thrombophlebitis
- Trophic ulcers of the skin
Varicose veins causes and risk factors
- Complex heredity - congenital insufficiency of the valvular apparatus
- Heavy physical work in a standing position
- Frequent pregnancies and deliveries
- Walking in high heels
Modern methods of treating varicose veins of the lower extremities in our clinics allow solving this problem without resorting to serious surgical interventions, without pain, incisions and hospitalization.
The modern level of phlebology allows varicose veins to be treated painlessly for the patient, very aesthetically and reliably.The first signs 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 the varicose transformation with pills and leeches as a treatment.
Diagnostics
Complaints and symptoms
Varicose veins begin with the appearance of individual nodules of varicose veins and constantly progress.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 worry patients with varicose veins:
Cosmetic discomfort
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.Cosmetic discomfort is often caused by small varicose veins and spider veins, which do not endanger health, 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
Approximately 30% of patients with varicose veins complain of heaviness in the legs, swelling in the evening and night cramps in the calves.These are signs of chronic venous insufficiency.Gradually, its phenomena worsen, and painful sensations may appear in enlarged nodes.Skin changes and pigmentation develop.In case of severe venous insufficiency, damage to the skin in the lower third of the leg may occur with the formation of a trophic ulcer, which is difficult to treat.Skin inflammation - eczema - often develops in patients with advanced varicose veins.
Examination by a phlebologist
Consultation with a phlebologist is necessary if varicose veins cause you discomfort.The examination is performed lying down and standing up.The patient must fully open his legs.
Varicose veins are diagnosed during a routine examination, which should be done while standing while the veins are full.After the examination, an ultrasound duplex scan is always necessary.As a rule, such a diagnosis will be sufficient.However, if secondary varicose veins are suspected, examination of the deep venous system is necessary.
Ultrasound scanning of veins
In the case of varicose veins, venous ultrasound is tasked with identifying incompetence of venous trunks, identifying dysfunctional venous valves, and identifying blood clots in the superficial and deep venous systems.
The examination begins with an examination of the saphenous veins in a 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 full inhalation, a sign of incapacity is the reverse blood flow).Perforating veins in typical locations and their viability during the Valsalva maneuver are then studied.
After assessing the superficial veins, it is necessary to assess the patency of the deep ones.For this purpose, the popliteal and femoral veins are examined lying down, their patency and valve consistency are assessed.
Contrast venography
Usually, an ultrasound scan 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 systems, especially in the case of relapse 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 the necessary tests and projections are performed.Currently, venography for varicose veins is used very rarely.
Treatment
The "classic" operation of varicose veins under anesthesia with incisions in the groin and along the legs, which was used to remove superficial varicose veins at the beginning of the last century, is an atavism of the past.Patient suffering, long hospitalization 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".Today, the treatment of advanced varicose veins can be carried out without anesthesia and hospitalization.The work of a phlebologist becomes an office, without the attributes of major surgery.
Knowing what causes varicose veins in the legs has allowed us to develop the hemodynamic principles of treatment.Their implementation is possible by removing or disconnecting the vein from the bloodstream.Modern technologies are based on the principle of fusion of the vein walls in the area of insufficient venous valves.The method of influencing the venous circulation can be different, but its goal is the same - to stop the pathological flow of blood through the affected vein (anti-reflux).
How can you cure varicose veins in your legs?
Understanding the cause of varicose veins allows you to choose the right treatment method.The aim of modern treatment of varicose veins is to solve several problems:
- Termination of pathological discharge in the vertical position through the incompetent saphenous veins of the lower extremities.
- Removal of reflux between deep and superficial veins - perforators - the main mechanism for the formation of varicose trophic ulcers.
- Removal of varicose - degenerated surface vessels (varicose veins).
- Compression therapy using special socks and stockings.
Opportunities of the vascular center
Thermal methods for the treatment of varicose veins are endovenous laser coagulation (EVLC) and radiofrequency obliteration (RFO) of the veins of the lower extremities.
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 is still the best method.In laser coagulation, the damaged vein is heated with a laser beam, which has a strong effect of damaging the collagen of the vein wall, causing an inflammatory process in the vein and its overgrowth.Advanced varicose veins on the legs, which are treated with this method, regress completely and without a trace, and the main symptoms disappear: swelling, heaviness in the legs, hyperpigmentation of the skin.
EVLT begins with the insertion of a laser fiber into the lumen of the varicose vein 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 the further development of the disease and its complications.Complete elimination of varicose veins was observed in 98% of patients by proper application of the EVLT method.The possibilities of this method enable the treatment of varicose veins on the legs in women and the correction of venous outflow in trophic ulcers.
Radio Frequency Obliteration (RFO)
The treatment of varicose veins by the method of radiofrequency obliteration (RFO) is a similar thermal method, but the heating of the tissue of the vein wall takes place according to different physical principles due to the energy of radio waves.Radiofrequency obliteration allows you to remove varicose veins and eliminate its symptoms;such treatment does not differ from EVLT in terms of its immediate and long-term results, but it is more laborious for the phlebologist.
Other thermal 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 allow the doctor to prevent the further development of varicose veins, and the patient to be treated on an outpatient basis without disrupting their lifestyle.In the hands of a novice phlebologist, thermal ablation methods can cause unpleasant complications: reduced sensitivity, burns, seals.The efficiency 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 shape but also very pronounced varicose veins on the legs without incisions.In the photos from 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 on the hands after frequent injections gave rise to the idea that some substances can cause inflammation of the vein walls - thrombophlebitis and their subsequent adhesion with the disappearance 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 methods of scleroobliteration 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 with injections of a special substance (sclerosant) has reached perfection.The main purpose of sclerotherapy is to inject a drug into the varicose vein, which causes inflammation and subsequent adhesion of the varicose vein.Sclerotherapy does not imply removing 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 to count on the long-term effect of sclerotherapy, because a relapse will certainly occur due to reflux.
Sclerotherapy can be performed in the absence of allergy to tetradecyl sulfate or polidocanol.These substances are the main sclerosants.During the treatment of sclerosis, manifestations of thrombophlebitis may occur, especially if liquid forms of the drug are used.Sclerotherapy of perforating 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 recurrence rate is about 40% in the next 5 years.
The advantage of sclerotherapy is a good immediate effect and a low cost of treatment.Injections of sclerosants lead to adhesion of the veins and the cessation of the pathological process - blood reflux through the saphenous veins.The drug is usually injected as a foam into the varicose veins.Spasm of dilated subcutaneous vessels occurs, prolonged contact of the foamy form of sclerosant with the vein wall and their subsequent inflammation and adhesion.This process takes place unevenly and the degree of obliteration of the vein is not the same, so 40% of patients after sclerotherapy have relapses of varicose veins.After sclerotherapy, the affected area of the veins of the lower extremities closes 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 application is carried out under strict ultrasound control.
Foam sclerotherapy can be used as an independent method or in combination with laser treatment to remove varicose veins.The number of sessions for the removal of varicose veins with 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 skin area above the sclerotic vessel may take on a dark shade for 2-3 months (hyperpigmentation appears).It can destroy a woman's legs for several months, so this treatment is best done in the winter months.Drug treatment and ultrasound-guided vascular punctures can accelerate the process of resorption of intravascular fluid accumulations (coagulum), the risk of which is about 10%.Clots form when there is not enough compression, but they will surely disappear with time.Many patients know that within a month after sclerotherapy, the signs of varicose veins of the lower extremities disappear for many years, which is why sclerotherapy is still one of the most popular methods of treatment.
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 blood 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 container, which reliably blocks the flow of blood.Taking this into account, half an hour is enough for the procedure of removing varicose veins on the legs.Venasil is the only technology for the treatment of varicose veins that does not require wearing compression stockings.
Most women can return to normal activities immediately.Symptoms of chronic venous insufficiency disappear shortly after the procedure.The process of active promotion of this glue on the phlebology market should begin in the near future.However, there are certain disadvantages: The presence of a foreign body in the human body.Coagulated glue stays 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 a stuck vessel may occur.
The use of glue in the trunk of the great saphenous vein does not eliminate the need to remove dilated tributaries, which is why doctors will have to remove signs of subcutaneous varicose veins with sclerotherapy or miniphlebectomy.The visible effect of using glue appears only in 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 significantly 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 give a good local anesthesia than to treat varicose veins of the saphenous veins on the legs with an expensive and unproven method.Moreover, the result is the same at best.If a recurrence occurs, the patient will have to undergo a complex operation to remove the sealed vessel, as other methods will no longer be applicable.
Technology of mechano-chemical obliteration
The modern method of combined treatment of reflux along the subcutaneous venous trunks adds additional weight to conventional sclerotherapy.Mechanical-chemical procedures involve a combination of mechanical damage to the inner surface of the vein wall and the introduction of a sclerosing drug.The catheter is introduced into the main saphenous vein through a puncture under ultrasound control.After installing the catheter in the desired location, the device is connected.The rotating sharp head of the catheter makes up to 3.5 thousand revolutions per minute, causing serious damage to the inner layer of the vein wall.At the same time, a sclerosing drug is injected through the catheter, which "mixes" in the lumen of the vessel and acts on the vascular wall using the rotating part of the catheter, causing its inflammation and adhesion.
To date, the only advantage of this technology is the absence of the need for tumescent anesthesia.Mechano-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.It is clear that such varicose veins can be treated with other minimally invasive methods, so its advantages are not obvious.We have to wait for further research from Europe or the US to pinpoint the place of this technology.
Miniphlebectomy
This is a modern microsurgical aesthetic method for removing varicose veins.It involves the delicate technique of puncturing and extracting varicose veins with the help of special tools.This operation is not for the novice phlebologist;you need to have the skills of delicate surgery.Miniphlebectomy is an operation without the use of 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.
Miniphlebectomy has replaced the classic operation of varicose veins, which involves the use of incisions of 1-3 cm, because it is aesthetically flawless, painless and very effective.Assuming how varicose veins manifest, the doctor can clearly plan micropunctures and pass with minimal intervention.The patient can go home independently immediately after the operation.Miniphlebectomy can be an independent effective method of treating varicose veins, or it can be used in combination after laser coagulation of varicose veins.Varicose veins are removed using a special technique developed by Professor Varadi.This technique has been perfectly mastered by our phlebologists and allows the removal of varicose veins on the legs - an effective treatment regardless of the cause.
Treatment results
Results of treatment of varicose veins
The results of modern varicose vein therapy can be considered very good.Any technology, if performed well, removes the symptoms of varicose veins on 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 outflow.The innovative vascular center is ready to help you deal with any vein disease without incisions and pain.We know how to cure varicose veins and have extensive experience.Varicose vein treatment should not be a problem in today's high-tech world.