In varicose veins, the veins stretch and dilate, and nodular deformities appear on them.At the same time, the functioning of the valve apparatus is disrupted, which leads to disruption of blood flow in the affected vein.
Varicose veins not only lead to a pronounced cosmetic defect, but can also be accompanied by disorders in the flow of blood to the heart, its stagnation in the organs, dermatitis, eczema, cellulite and trophic ulcers.Furthermore, inflammation and venous thrombosis may develop.
Symptoms include dilation, tortuosity of the veins with the formation of knots, varicose veins or varicose veins, intermittent and then permanent swelling, bronze color of the legs, inflammation of the skin and subcutaneous fat, and the development of trophic ulcers.
Fortunately, today there are ways to treat varicose veins that do not require surgery.
Modern treatment without surgery
The essence of all procedures is to remove varicose veins.In recent years, phlebology (the science of treating veins) has changed a lot and today it is possible to get rid of varicose veins quite quickly and easily.There are several methods to eliminate venous pathologies:
- Sclerotherapy.
- Application of biological glue.
- Laser coagulation.
- Radiofrequency ablation.
- Traditional operations.
- Miniphlebectomy.
Sclerotherapy
The essence of the technology is that a special liquid preparation, a sclerosant, is injected into the diseased vein through a small puncture with a syringe.
A tightly held thrombotic “seal” forms in the vein, stopping blood flow in the vessel.As a result, the vein gradually dissolves.
The drug is administered both under visual control and under ultrasound control.This allows you to eliminate invisible blood vessels on the surface and control the diffusion of the drug through the vessels.
To consolidate the effect after administration of the sclerosant, the patient is advised to wear compression stockings for several weeks or even months.Repeated administration of sclerosant is often necessary;in this case we are talking about conducting a sclerotherapy cycle consisting of several sessions.
Today sclerotherapy is used only to remove intradermal spider veins.In the removal of the saphenous veins, the technique is used in addition to other methods (EVLT, RFA, traditional interventions) for the removal of small diameter venous ducts.
Closure of the veins with biological glue
A special drug successfully closes the veins in different stages of varicose veins.The procedure is similar to the previous one, but in this case an adhesive substance is introduced into the lumen which, upon contact with the blood, polymerizes, squeezes the blood and forms a polymeric “seal”.After the cessation of blood flow through the vein, as in sclerotherapy, fibrous tissue forms and the vessel is partially reabsorbed.The materials for this procedure are quite expensive.
Laser coagulation (EVLC)
The laser is used in two ways:
Endovenous laser coagulation/ablation/obliteration or endovenous laser therapy (EVLK, EVLA, EVLO, EVLT) is used both for the removal of large main veins and for the removal of smaller but deeply located veins, such as perforators.
The procedure is performed under local anesthesia and lasts 20 minutes to an hour.A laser light guide is inserted into the vein through a small puncture, and with the help of light energy, coagulation ("bending") of blood proteins is caused, forming a protein-erythrocyte clot ("seal") in the lumen, which blocks the lumen of the vessel.
After the cessation of blood flow, the lumen of the vein fills with fibrous tissue, then gradually resolves.
The effect of the laser can be compared to the removal of a vein.The patient can go home immediately after surgery and wear compression stockings for several weeks or months.
Percutaneous laser coagulation (PLC).In this case, the vein is shot directly through the skin with a focused laser beam.This method removes only very thin intradermal vessels, less than 0.1 mm, located superficially (usually capillaries, venules or arterioles).The disadvantages of the method are frequent relapses and burns.
By the way, the cost of laser treatment for varicose veins is usually lower than the price of previous methods.
Radiofrequency ablation/obliteration (RFA, RFO)
Only large veins are removed by radiofrequency ablation.The method is basically similar to laser removal, however, with RFA, the effect on the veins is not a laser, but a very high frequency current (radio waves).
The RFA technique is effective, but has one big drawback - a considerable price (due to the high cost of equipment and consumables).
Surgical treatment - phlebectomy
The operation is shown:
- if desired by the patient;
- in the presence of some anatomical characteristics of the structure of the large veins that prevent minimally invasive interventions (EVLT, RFA);
- with estial thrombosis of the large venous trunks.
Fortunately, today the way we perform surgeries to treat varicose veins (phlebectomy) has also changed.
If previously, to remove a diseased vein, it was necessary to make incisions along the entire length of the leg, today it is sufficient to make two small incisions (sometimes one is enough) and remove a large vein using a special probe.
This not only preserves the beauty of the legs (does not leave very noticeable scars), but also makes the operation itself less traumatic and the recovery period faster.
If the case is not very advanced, it is not even necessary to go to hospital for surgery, but to return home after the anesthesia has worn off.
Miniphlebectomy
It consists in the fact that through small punctures of the skin (up to 1-2, less often 3 mm), the veins are grabbed with special “hooks” that look like crochets and pulled out, where they are crossed and removed in fragments.
This procedure is performed under local anesthesia or general anesthesia.The disadvantages of the procedure are labor intensity, the inability to remove deep and large trunks and a high percentage of residual veins and their fragments.Today this technique is used as an adjunct to EVLT, RFA or traditional surgery.
Both minimally invasive and traditional surgical methods give approximately the same results, which mainly depend on the degree of advanced stage of the disease.To achieve better results from treatment, combinations of different methods are used, for example, EVLT and sclerotherapy or miniphlebectomy, RFA and sclerotherapy, surgery and miniphlebectomy, etc.
Only an experienced doctor can select a treatment package based on the anatomical characteristics of varicose veins, the degree and severity of the disease, the presence of complications, the general state of health, taking into account the patient's personal needs and wishes.