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 on 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 of the legs
- Heaviness in the legs, fatigue in the evening
- Swelling of the legs in the evening after physical activity
- Change in the color 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 births
- 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 makes it possible to treat varicose veins painlessly for the patient, very aesthetic and reliable.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 tablets and leeches as a treatment.
Diagnosis
Complaints and symptoms
Varicose veins begin with the appearance of single nodules of varicose veins and progress steadily.At first, varicose veins do not cause any problems, 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.Quite often, cosmetic discomfort is caused by small varicose veins and spider veins, which do not threaten health, but force you to close your legs.Such patients need treatment for cosmetic reasons, so only minimally invasive (no incisions) 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 nocturnal 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.With severe venous insufficiency, the skin in the lower third of the leg can be damaged with the formation of a trophic ulcer, which is difficult to treat.Often, patients with advanced varicose veins develop skin inflammation - eczema.
Review by a phlebologist
Consultation with a phlebologist is necessary if varicose veins cause you discomfort.The examination is performed in a lying and standing position.The patient should open his legs completely.
Varicose veins are diagnosed during a routine examination, which should be done standing up 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, an examination of the deep venous system is necessary.
Ultrasound scan of veins
In varicose veins, venous ultrasound is tasked with detecting incompetence of venous trunks, detecting non-functioning venous valves, and detecting blood clots in the superficial and deep venous system.
The examination begins with examination of the saphenous veins in a standing position.The diameter and patency of the great and small saphenous veins are examined, 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).Perforating veins in typical locations and their viability during the Valsalva maneuver are then examined.
After evaluating the superficial veins, it is necessary to evaluate the patency of the deep ones.For this purpose, in the supine position, the popliteal and femoral veins are examined, their patency and the consistency of the valves 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 examine the relationship between the state of the deep and superficial venous systems, especially in the case of recurrent varicose veins and secondary varicose veins.
Contrast X-ray examination is used to solve these problems.The saphenous veins are punctured and contrast is administered.The movement of the contrast is observed on the monitor of the X-ray machine and all necessary examinations 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 area and along the legs, used to remove superficial varicose veins at the beginning of the last century, is an atavism of the past.The suffering of patients, long hospitalization and pain in the legs 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 done without anesthesia and hospitalization.The phlebologist's work becomes office-based, without the trappings of major surgery.
Knowing the causes of varicose veins in the legs allowed us to develop hemodynamic principles of treatment.Their implementation is possible by removing or excluding the vein from the circulation.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 may be different, but its purpose is the same - to stop the pathological flow of blood through the affected vein (anti-reflux).
How can you cure 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 a vertical position through the incompetent saphenous veins of the lower extremities.
- Elimination of reflux between deep and superficial veins - perforators - the main mechanism for the development of varicose trophic ulcers.
- Removal of dilated - degenerated surface vessels (varices).
- Compression therapy using special socks and stockings.
Capabilities of the judicial 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 of 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 by a laser beam, which provides a strong effect of damaging the collagen of the venous wall, causing an inflammatory process in the vein and its overgrowth.The enlarged varicose veins of the legs, which are treated with this method, regress completely and without a trace, and its main symptoms disappear: swelling, heaviness in the legs, hyperpigmentation of the skin.
EVLT begins by installing 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 the further development of the disease and its complications.Complete removal of varicose veins is observed in 98% of patients with proper use of the EVLT method.The possibilities of this method allow both the treatment of varicose veins of 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 radio frequency obliteration (RFO) is a similar thermal method, but the heating of the tissue of the venous wall is carried out according to different physical principles due to radio wave energy.Radiofrequency obliteration allows you to remove varicose veins and eliminate their symptoms;such treatment in its immediate and long-term results does not differ from EVLT, but is more difficult 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 the further development of varicose veins, and the patient to be treated on an outpatient basis without disrupting his lifestyle.In the hands of a novice phlebologist, thermal ablation methods can cause unpleasant complications: reduced 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 original form, but also the highly pronounced varicose veins of 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 of the hands after frequent injections gave rise to the idea that some substances can cause inflammation of the walls of the veins - thrombophlebitis and their subsequent sticking with the disappearance of the lumen of the vein.After the appearance of the Fegan method, when treatment began to be performed 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 with 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 to rely on a long-term effect of sclerotherapy, since 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 sclerosing treatment, 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 low cost of treatment.Injections of sclerosant lead to sticking of the veins and stopping the pathological process - reflux of blood through the saphenous veins.The drug is usually injected as a foam into varicose veins.A spasm of dilated subcutaneous vessels is formed, prolonged contact of the foamy form of the sclerosant with the vein wall and their subsequent inflammation and adhesion.This process proceeds unevenly and the degree of obliteration of the vein is not the same, so 40% of patients after sclerotherapy have recurrences of varicose veins.After sclerotherapy, the affected area of the veins of the lower limbs closes and over time completely heals, and the blood flow in the opposite direction stops.In order to prevent the occurrence of skin necrosis due to the penetration of the foamy form of the sclerosant into the subcutaneous tissue, the application is carried out strictly under ultrasound control.
Foam sclerotherapy can be used as a stand-alone method or in combination with laser treatment to remove varicose veins.The number of sessions to remove varicose veins by 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 acquire a dark shade in 2-3 months (hyperpigmentation appears).It can ruin a woman's feet for several months, so this treatment is best done during the winter months.Drug treatment and vascular punctures under ultrasound control can accelerate the resorption process of intravascular fluid accumulations (coagules), the risk of which is about 10%.Clots form when there is not enough compression, but they will certainly 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.
With the help of special glue
Since its inception, this method has caused great interest among phlebologists.It represents gluing the trunk of the great saphenous vein with a special cyanoacrylate glue.In the lumen of the vessel, this adhesive 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 vessel, which reliably blocks blood flow.Considering this, half an hour is enough for the procedure to remove varicose veins on the legs.Venasil is the only varicose vein treatment technology that does not require wearing compression stockings.
Most women can immediately return to normal activities.Symptoms of chronic venous insufficiency are relieved soon after the procedure.The process of active promotion of this adhesive in the phlebological market should begin in the near future.However, there are some disadvantages: The presence of a foreign body in the human body.Cured glue remains forever in the vessel 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.
The use of glue in the trunk of the great saphenous vein does not eliminate the need to eliminate the enlarged tributaries, so doctors will have to eliminate the signs of subcutaneous varicose veins with sclerotherapy or miniphlebectomy.The visible effect of using glue appears only when it is combined with other methods of removing 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 radio frequency method.
Thermal methods are preferred in our clinic.We believe that it is better to give good local anesthesia than to treat varicose veins of the saphenous veins of the legs with an expensive and unproven method.Other than that, the result is the same at best.If a relapse occurs, the patient will have to undergo a complex operation to remove the sealed vessel, as other methods will no longer be applicable.
Mechanochemical erasure technology
The modern method of combined treatment of reflux along the subcutaneous venous trunks adds an additional burden to conventional sclerotherapy.Mechano-chemical procedures mean a combination of mechanical damage to the inner surface of the venous wall and introduction of a sclerosing drug.The catheter is inserted into the main saphenous vein through a puncture under ultrasound control.After installing the catheter in the desired place, the device is connected.The rotating sharp head of the catheter makes up to 3.5 thousand revolutions per minute, causing severe damage to the inner layer of the venous wall.At the same time, a sclerosing drug is injected through the catheter, which "mixes" into the lumen of the vessel and, with the help of the rotating part of the catheter, acts on the vessel wall, 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 should, according to its inventors, 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 studies 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 a delicate technique of drilling and pulling varicose veins using special instruments.This operation is not for the novice phlebologist;you must have delicate surgery skills.Miniphlebectomy is an operation without the use of a scalpel and is performed under local anesthesia.Punctures are performed in the direction of the skin lines, so after 2 months they are practically invisible.
Miniphlebectomy replaces the classic operation of varicose veins, in which incisions of 1-3 cm are made, because it is aesthetically flawless, painless and very effective.By understanding how varicose veins manifest, the doctor can clearly plan micropunctures and manage with minimal intervention.Immediately after the operation, the patient can go home alone.Miniphlebectomy can be an independent effective method of treating varicose veins or 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 mastered perfectly by our phlebologists and allows the removal of varicose veins on the legs - an effective treatment, regardless of the cause.
Treatment results
Results of the 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 have never had serious problems with venous outflow.The innovative vascular center is ready to help you deal with any venous disease without incisions and pain.We know how to treat varicose veins and have extensive experience.Varicose vein treatment should not be a problem in today's high-tech world.