Varicose veins of the legs are a disease of the saphenous veins, in which their pathological expansion develops.Varicose veins are bulging 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 continue to develop 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 in the legs
- Heaviness in legs, fatigue at night
- 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
- Edible skin ulcers
Varicose veins causes and risk factors
- Complex inheritance - congenital insufficiency of the valvular apparatus
- Heavy physical work while standing
- Frequent pregnancies and deliveries
- Walking in high heels
Modern methods of treating varicose veins of the lower extremities in our clinics make it possible to solve 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 aesthetically and reliably.The first signs of varicose veins should be a reason to contact a phlebologist.Varicose veins of the lower extremities involve a complete disappearance of the tone of the venous wall, so it is useless to affect the transformation of varicose veins with tablets and leeches as a treatment.
Diagnostics
Complaints and symptoms
Varicose veins begin with the appearance of individual nodules of dilated veins and progress steadily.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:
Aesthetic discomfort
Most patients with varicose veins only complain of unsightly varicose veins that alter the appearance of their legs.Such complaints are especially often caused by varicose veins in women.Quite often, aesthetic discomfort is caused by small varicose veins and varicose veins, which do not threaten health, but force you to close your legs.Such patients need treatment for cosmetic reasons, so only minimally invasive methods (no incisions) are recommended.
Chronic venous insufficiency
About 30% of patients with varicose veins complain of heaviness in the legs, swelling at night and night cramps in the calves.These are signs of chronic venous insufficiency.Gradually, its symptoms worsen and painful sensations may appear in the varicose veins.Skin changes and pigmentation develop.With severe venous insufficiency, the skin on 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.
Examination by a phlebologist
Consultation with a phlebologist is essential if your varicose veins are causing you any discomfort.The examination is performed lying down and standing up.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.A double-sided ultrasound is always necessary after the examination.As a rule, such a diagnosis will be sufficient.However, if a secondary varicocele is suspected, examination of the deep venous system is necessary.
Ultrasound scan of veins
In the case of varicose veins, ultrasound of the veins is tasked with detecting incompetence of the 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 while standing.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 inspiration, a sign of impotence is reverse blood flow).Perforator veins in standard locations and their viability during the Valsalva maneuver are then studied.
After evaluating the superficial veins, it is necessary to assess the patency of the deep ones.For this purpose, while lying down, the popliteal and femoral veins are examined, their patency and the consistency of the valves are also evaluated.
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 system, especially in 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 X-ray machine screen and all necessary tests and projections are made.Currently, venography for varicose veins is used very rarely.
Treatment
The "classic" operation for varicose veins under anesthesia with incisions in the groin and along the legs, used to remove superficial varicose veins at the beginning of the last century, is a thing of the past.Patient suffering, long hospitalization and leg pain after such operations aimed at improving blood flow are completely unjustified.Serious varicose veins can be treated without resorting to "research methods".Today, the treatment of advanced varicose veins can be performed without anesthesia and hospitalization.The work of a phlebologist becomes a doctor's office, without the characteristics of major surgery.
Knowing what causes varicose veins in the legs has allowed us to develop hemodynamic principles of treatment.Their application is possible by removing or disabling the vein from the blood circulation.Modern technologies are based on the principle of fusing the walls of the veins in the area of inadequate venous valves.The method of influencing the venous circulation may be different, but its goal is the same - to stop the pathological discharge of blood through the affected vein (reflux).
How can you 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 many 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 varicose veins - degenerated superficial vessels (varicose veins).
- Compression therapy using special socks and stockings.
Capabilities of the vascular center
Thermal methods for the treatment of varicose veins are intravenous laser coagulation (EVLC) and radiofrequency ablation (RFO) of the veins of the lower extremities.
Intravenous 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.With laser coagulation, the damaged vein is heated by a laser beam, which provides a strong effect of destroying the collagen of the vein wall, causing an inflammatory process in the vein and its overgrowth.Advanced varicose veins on the legs, treated with this method, subside 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 in the lumen of a varicose vessel through a skin puncture, which is guided along the affected vein to the location of the incompetent valve.For the patient, this method is a safe, painless and reliable way to prevent further development of the disease and its complications.Complete elimination of varicose veins is observed in 98% of patients with proper use of the EVLT method.The possibilities of this method make it possible both to treat varicose veins on the legs in women and to correct the venous outflow in trophic ulcers.
Radio Frequency Elimination (RFO)
The treatment of varicose veins with the method of radio frequency elimination (RFO) is a similar thermal method, but the heating of the tissue of the vein wall is done according to different physical principles due to radio wave energy.Radio frequency elimination allows you to remove varicose veins and eliminate their symptoms.such a treatment in its immediate and long-term effects does not differ from EVLT, but it is more laborious for a venologist.
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 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 make it possible to get rid not only of the original form, but also of strongly 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 strain regression
For many years, phlebologists have been thinking about how to treat varicose veins of the lower extremities without incisions and pain.The disappearance of the saphenous veins in the hands after frequent injections led to the idea that certain 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 scleroapostomy 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 in the late 19th century.In recent years, the method of treating varicose veins with injections of a special substance (hardener) has reached perfection.The main point of sclerotherapy is the injection of a drug into a varicocele, which causes inflammation and subsequent adhesion of the varicocele.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 one to count on a long-term effect of sclerotherapy, since relapse due to reflux is certain to occur.
Sclerotherapy can be done in the absence of allergy to tetradecyl sulfate or polidocanol.These substances are the main hardeners.During sclerotherapy, manifestations of thrombophlebitis may occur, especially if liquid forms of the drug are used.Sclerotherapy of perforated veins is particularly 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 the good immediate result and the low cost of treatment.Injections of sclerosant lead to the adhesion of the veins and the interruption of the pathological process - reflux of blood through the saphenous veins.The drug is usually injected as a foam into varicose veins.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 occurs unevenly and the degree of attenuation 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 extremities is closed and over time it completely heals and the blood flow in the opposite direction stops.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.
Foam sclerotherapy can be used as a stand-alone method or in combination with laser treatment to eliminate varicose veins.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 skin area above the sclerotic vessel may take on a dark shade for 2-3 months (hyperpigmentation occurs).It can damage a woman's legs for several months, so this treatment is best done in the winter months.Medication and ultrasound-guided vascular punctures can speed up the process of resorption of intravascular fluid accumulations (coagulants), the risk of which is about 10%.Clots form when there is insufficient compression, but they will definitely disappear over 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 treatment methods.
Using special glue
Since its inception, this method has generated great interest among phlebologists.It involves gluing the trunk of the great saphenous vein with a special cyanoacrylate glue.In the vessel lumen, this glue polymerizes and fills the lumen of the dilated vessel.According to the developers, this method does not require anesthesia, and a "plug" appears in the vessel, which reliably blocks blood flow.Taking this into account, half an hour is enough for the process of eliminating varicose veins on the legs.Venasil is the only varicose vein treatment technology that does not require you to wear compression stockings.
Most women can return to their normal activities immediately.The symptoms of chronic venous insufficiency are relieved shortly after the operation.The process of actively promoting this adhesive to the phlebological market should begin in the near future.However, there are some 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 swelling.Acute thrombophlebitis of the stuck vessel may occur.
Using glue on the trunk of the great saphenous vein does not eliminate the need to eliminate tributary varices, so doctors should remove signs of subcutaneous varices with sclerotherapy or miniphlebectomy.The visible effect of using glue appears only when it is combined with other methods of eliminating varicose veins.The patient has to pay more.The unreasonably high cost of the bonding kit makes this process 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 in 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 apply.
Mechanochemical elimination technology
The modern method of combined treatment of reflux along subcutaneous venous trunks adds additional weight to conventional sclerotherapy.Mechanochemical procedures mean a combination of mechanical damage to the inner surface of the vein wall and the introduction of a hardening drug.A catheter is inserted into the vena cava through a puncture under ultrasound guidance.After installing the probe 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 severe damage to the inner layer of the vein wall.At the same time, a hardening drug is injected through the catheter, which "mixes" into the lumen of the vessel and, using 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 anesthesia.Mechanical ablation should, according to its inventors, produce a stronger ablation effect than foam sclerotherapy, although for some reason convincing evidence has not yet been presented.It is clear that such varicose veins can be treated with other minimally invasive methods, so their advantages are not obvious.We have to wait for further studies from Europe or the US to precisely determine the position of this technology.
Miniphlectomy
It is a modern microsurgical aesthetic method of removing varicose veins.It involves a delicate technique of puncturing and extracting varicose veins using special tools.This operation is not for a novice phlebologist.you must have the skills of fine surgery.Miniphlectomy is an operation without the use of a scalpel and is performed under local anesthesia.The punctures are made in the direction of the skin lines, so after 2 months they are practically invisible.
The miniphlectomy has replaced the classic operation for varicose veins, which involves the use of 1-3 cm incisions, as it is aesthetically flawless, painless and very effective.Assuming how varicose veins manifest, the doctor can clearly plan micropunctures and get through with minimal intervention.The patient can walk home immediately after the operation.Miniphlectomy can be an independent effective method of treating varicose veins or used in combination 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 the removal of varicose veins in the legs - an effective treatment regardless of its cause.
Treatment results
Results of treatment of varicose veins
The results of modern treatment 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 have serious problems with venous outflow.The innovative vascular center is ready to help you treat any vein disease without incisions or pain.We know how to treat varicose veins and have a lot of experience.Varicose veins treatment should not be a problem in today's high-tech world.