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 the speed of blood flow, 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. The visible external cones along the vessels allow you to recognize varicose veins in the legs. Varicose disease of the lower limbs (ICD code I83) is a very obvious and easy to remove disease.
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 difficulties in the outflow of blood from the main veins.
Varicose veins of the spermatic cord (varicocele) occur in the clinic of secondary pelvic phlebohypertension and can lead to infertility in men. The etiology and pathogenesis of varicose veins are very different 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 the health and sometimes to the life of the patient. The cause of the onset of varicose veins in the legs can be intense physical exertion, childbirth, a sedentary lifestyle of patients.
To understand what varicose veins look like, just go to the summer beach. Although many varicose vein carriers are embarrassed to appear there, you will surely see how varicose veins manifest 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. Don't be afraid to go to the phlebologist.
Can we reverse varicose veins?
Many people ask this question, hoping to cure varicose veins in the initial stage with the help of traditional medicines or medical methods. If we are talking about varicose veins in the legs, phlebologists can unequivocally answer this question: the degenerative destruction of the venous wall cannot go away 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 the 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 which can stop the progression of varicose veins in various stages. The order here is this: if the vein is irreversibly damaged, it must be removed or coagulated or glued.
Why are even early varicose veins irreversible without surgery? For effective treatment of varicose veins of 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 surgery if the phlebologist eliminates pathological discharges, which cause varicose veins and irreversibly altered veins.
Modern varicose vein treatment has advanced significantly since the first surgeries 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 treatment methods are compiled.
The clinics of the Innovative Vascular Center know how to cure varicose veins with minimal medical, psychological and aesthetic discomfort. It is not necessary to remove varicose veins according to the classic scheme. In the arsenal of phlebologists, the hemodynamic concept of treating the main causes of varicose veins, a technique that involves correcting only the pathologically altered venous outflow and removing only the affected veins.
Treatment cannot be directed to the etiology of the disease, but the pathogenesis of the problem is known, so it can be stopped. In women, the presence of varicose veins balls on the legs can be an annoying symptom for cosmetic 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.
A little bit of anatomy and physiology
The definition of varicose veins is the primary expansion of the subcutaneous venous trunks of the lower limbs, due to congenital, contributing and producing factors. The possibility of contracting varicose veins exists in 40% of adults on the planet. In developed countries, the 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 large and small saphenous vein system. 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 of 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 connecting it with the deep veins of the lower leg and thigh, causing 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, is characterized by numerous loops along the posterior surface of the 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 valvular apparatus of the veins develops, the blood begins to move in the opposite direction, causing the saphenous vein to overflow, its further elongation and development of severe varicose veins. Therefore, without eliminating the pathological discharge of blood, it is impossible to obtain a cure for chronic varicose veins.
The classification of subcutaneous varicose veins on the legs is formed by 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 limbs 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, intense physical exertion, pregnancy and childbirth.
- Congenital and acquired obstructions to venous outflow (compression syndromes, tumors and bone formations pressing on the veins.
- Sequelae of previous 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 the first signs appear. Varicose veins on the legs are an ever-progressing and complicating disease, therefore, without medical intervention, you 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 the varicose veins themselves do not hurt. Symptoms of varicose veins that require prevention and treatment include sensations of heaviness in the legs, swelling in the evening, increased leg fatigue, and even pain in the calf muscles. With the progression of the disease, stagnation develops in the 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 advertised method of treating the symptoms of varicose veins in the legs is the taking of various pills for varicose veins, using ointments and creams, which makes contact with specialists late. It is important to understand that such remedies do not affect the course of varicose veins, which is why they can only slightly relieve ailments 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 broaden 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 very much 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, lioton, compresses) or more actively - removal of the affected varicose vein or its laser coagulation. Clinical recommendations do not give a single answer to this question, but with an active approach, along with thrombophlebitis, its cause is also removed and it comes to 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 surrounding subcutaneous tissue.
Initial varicose ulcers are prone to progression and respond very poorly to conservative treatment. The optimal method of treatment today is laser correction of venous outflow (EVLK) for varicose veins of the large or small saphenous vein and correct local treatment (special dressings, washing the ulcer). One doesn't work without the other, so there's no need to count on healing a trophic ulcer from ointments alone. 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. Protruding varicose veins bring a lot of cosmetic 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 can constantly walk in pants, 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 laser photocoagulation procedure of varicose veins without leaving any traces. Modern interventions are performed without incisions, through minimal punctures, which are absolutely invisible as early as 3-4 weeks after surgery. The patient is brought to the operating table under local anesthesia and the operation takes 40-50 minutes. The laser offers an amazing aesthetic result and 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 with 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 pronounced discharge occurs, to solve the second problem, it is necessary to remove or deactivate the 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 of the saphenous and deep veins from the abdomen to the feet is necessary. The 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 venography on an angiography unit. After treatment, patients need periodic monitoring of the condition of the operated veins, which doctors perform using ultrasound diagnostics. If at the diagnostic stage the doctor has questions about the state of deep veins, 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)
Intravenous laser coagulation is based on heating the venous wall with a coherent beam of light. Varicose veins can be treated effectively without incisions and general anesthesia. A light conducting fiber is inserted into a vein through an ultrasound-guided puncture. Laser energy of a certain wavelength at the time of its occurrence is absorbed by the venous wall, which leads to its heating and the destruction of the connective tissue. As a result, the vein wall turns into scar tissue and the blood flow through the affected vein stops completely. The same effect is achieved with the surgical removal of a vein, but only without incisions, general anesthesia and pain.
In terms of effectiveness, EVLK surpasses the open phlebectomy operation. 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 clotted vein area, inflammation, and blood clots in the clotted veins. The overall incidence of these 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 right after laser treatment.
Radiofrequency (RFO) Obliteration of Varicose Veins
In terms of impact and effect, RFO, like laser, is referred to as thermal methods for treating varicose veins, but a different physical principle is used here. The radiosonde is also inserted into the vein through a puncture. The surgery 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. Warming of 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 effectiveness they are similar, however, the laser heats the venous wall itself, while the RFO heats the working surface of the probe and the 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 lower than with radiofrequency obliteration. Doctors noted the absence of recurrence of varicose veins in 98% after EVLK and in 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 1970s, surgeons began to show a growing 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 is why doctors were afraid to use thermal methods with varicose veins for a long time. The chemical methods used for the obliteration of the veins have proved to be safe and quite effective. These include sclerotherapy in various variations 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 begins in the 19th century and has an interesting development path. In the vascular center, specialists use the most advanced technology - a form of sclerotherapy foam. Persistent treatment for six months allows you to get rid of varicose veins of the lower limbs for a long time. Although the relapse rate is around 50% in 5 years. With sclerotherapy, the treatment does not have a precise 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 - clot at the site of the sclerotic veins, which resolve up to six months.
Gluing of varicose veins with special glue
The venaseal technology is the name of a non-thermal method of obliteration of the varicose trunks of the 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 it to block. The idea seems interesting and developed over the last decade, but there are several pitfalls. First, the glue remains inside the affected veins like a foreign body, it does not dissolve. Secondly, there are risks of periplebitis around a sealed vein, as the body's reaction to a foreign body. Third, it is an expensive treatment method.
The cost of treating varicose veins with this method is about double that of laser photocoagulation. There are no long-term studies on the long-term results of such treatment. The benefits of this technology have not yet been identified, but research is being actively conducted and it is possible for varicose veins to become a disease in which the entire treatment regimen will turn into a single "magic" injection. It is characteristic that this method has not yet been taken into consideration in the latest clinical guidelines, but is already actively proposed 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 superficial veins on the legs and the prevention of complications since the middle of the 19th century. The history of the fight against swollen veins makes us understand how from the first large incisions that disfigure the legs, we have moved on to microperforation surgery, which allows us to deal with varicose veins without aesthetic defects.
Advanced phlebologists use elements of classical surgery in the form of puncture microflebectomy to remove individual varicose and tributary veins. This may be the most cosmetic method of removing varicose veins in thin skin. A month after such an operation, there is no redness on the skin either.
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 allow the doctor to prevent the further development of varicose veins and treat the patient 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 pronounced varicose veins on the legs without incisions.
Using a 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 vase, this glue cures 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. That said, half an hour is enough for the procedure to clear the varicose veins in the legs. Venasil is the only technology for the treatment of varicose veins that does not require the use 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 actively promoting this glue on the phlebology market is expected to begin in the near future. However, there are some disadvantages: The presence of a foreign body in the human body. The curled glue stays 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 stuck vessel may appear.
The use of glue in the trunk of the great saphenous vein does not eliminate the need to address the elimination of varicose tributaries, which is why doctors will have to remove the signs of subcutaneous varicose veins with sclerotherapy or miniflebectomy. 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 bonding 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 have good local anesthesia than to treat varicose veins in the legs with an expensive and untested method. Furthermore, the result is at best the same. In the event that a relapse occurs, the patient will have to perform a complex operation to remove the sealed vessel, as other methods will no longer be applicable.
The modern method of combined treatment of reflux along the subcutaneous venous trunks adds additional weight to conventional sclerotherapy. Mechanochemical 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 an ultrasound-guided puncture. After installing the catheter in the right place, the device is connected. The sharp rotating head of the catheter makes up to 3. 5 thousand revolutions per minute, causing pronounced damage to the inner layer of the venous wall. At the same time, a sclerosing agent 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 vascular wall causing inflammation and gluing.
This is a modern microsurgical aesthetic method for removing varicose tributaries. It involves a gentle technique of piercing and pulling the varicose tributaries with the help of special tools. This operation is not for a novice phlebologist, it is necessary to master the skills of delicate operations. Miniflebectomy 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 almost invisible.