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 just a cosmetic problem (spider veins), but if left untreated, they continually 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 dilated veins in the legs
- Heaviness in the legs, fatigue in the evening
- Swelling of the feet in the evening after physical activity
- Change in skin color on the lower leg
- Inflammation of the saphenous veins - thrombophlebitis
- Trophic skin ulcers
Causes of varicose veins and risk factors
- Compound heredity - congenital failure of the valve apparatus
- Intense physical work while standing
- Frequent pregnancies and childbirths
- 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, without incisions and without 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 imply a complete disappearance of the tone of the vein wall, therefore it is useless to influence the varicose transformation with tablets and leeches as treatment.
Diagnosis
Complaints and symptoms
Varicose veins begin with the appearance of single nodules of dilated veins and progress steadily.Varicose veins pose no problem at first, but over time they become a serious health risk factor.So, let's look at the main problems that worry patients with varicose veins:
Cosmetic discomfort
Most patients suffering from varicose veins only complain of unsightly varicose nodes that spoil 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 spider veins, which do not threaten health, but force the legs to be closed.These patients require treatment for aesthetic reasons, which is why only minimally invasive methods (no incisions) are recommended for them.
Chronic venous insufficiency
Around 30% of patients suffering from varicose veins complain of heavy legs, swelling in the evening and nighttime cramps in the calves.These are signs of chronic venous insufficiency.Gradually, these phenomena worsen and painful sensations may appear in the varicose veins.Skin changes and pigmentation develop.In cases of severe venous insufficiency, the skin of the lower third of the leg may be damaged with the formation of a trophic ulcer, which is difficult to treat.Often, patients with advanced varicose veins develop inflammation of the skin - eczema.
Examination by a phlebologist
A consultation with a phlebologist is necessary if varicose veins cause you any discomfort.The examination is carried out lying and standing.The patient should open their legs completely.
Varicose veins are diagnosed during a routine examination, which should be carried out standing up, when the veins are full.After the examination, a duplex ultrasound 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 of veins
In case of varicose veins, the purpose of ultrasound of the veins is to identify the incompetence of the venous trunks, to identify non-functional venous valves and to identify blood clots in the superficial and deep venous systems.
The examination begins by examining the saphenous veins in a standing position.The diameter and patency of the large and small saphenous vein are studied, the consistency of the valves is determined (Valsalva maneuver - tension of the abdominal muscles with full inspiration, a sign of incompetence is reverse blood flow).Next, perforator veins in typical locations and their viability during the Valsalva maneuver are studied.
After assessing the superficial veins, it is necessary to assess the patency of the deep veins.For this purpose, in the supine position, the popliteal and femoral veins are examined, their patency and the consistency of the valves are also assessed.
Contrast venography
Usually, ultrasound 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 cases of relapses of varicose veins and secondary varicose veins.
To resolve these problems, a contrast X-ray examination is used.The saphenous veins are pierced and contrast material is administered.The movement of the contrast is observed on the monitor of the X-ray machine and all necessary tests and projections are carried out.Currently, venography of varicose veins is used very rarely.
Treatment
The “classic” varicose vein operation under anesthesia with incisions in the groin and along the legs, used at the beginning of the last century to eliminate superficial varicose veins, is an atavism of the past.The suffering of patients, long hospitalization and pain in the legs after such operations aimed at improving blood circulation are completely unjustified.Severe varicose veins can be treated without resorting to “inquisition methods.”Today, treatment of advanced varicose veins can be carried out without anesthesia or hospitalization.The work of a phlebologist becomes that of an office setting, without the trappings of major surgery.
Knowledge of the causes of varicose veins in the legs has allowed us to develop hemodynamic principles of treatment.Their implementation is possible by removing or cutting the vein from blood circulation.Modern technologies are based on the principle of fusion of the vein walls at the level of insufficient venous valves.The method of influencing venous circulation may be different, but its goal is the same: to stop the pathological flow of blood through the affected vein (anti-reflux).
How to treat varicose veins on 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:
- Stoppage of pathological flow in an upright position through the incompetent saphenous veins of the lower extremities.
- Elimination of reflux between deep and superficial veins - perforator - the main mechanism of development of varicose trophic ulcers.
- Removal of varicose veins - degenerated superficial vessels (varixes).
- Compression therapy using special stockings and socks.
Capacities of the vascular center
Thermal methods of treating varicose veins are endovenous laser coagulation (EVLC) and radiofrequency obliteration (RFO) of lower extremity veins.
Endovenous laser coagulation is an effective treatment for varicose veins whose principle is based on the thermal effect of laser energy.This treatment was introduced in 2001 and still remains the best method.With laser coagulation, the damaged vein is heated by a laser beam, which has the powerful effect of damaging the collagen in the vein wall, causing an inflammatory process in the vein and its proliferation.Advanced varicose veins of the legs, treated by this method, regress completely and without a trace, and their main symptoms disappear: swelling, heaviness in the legs, hyperpigmentation of the skin.
EVLT begins with the installation of 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 provides a safe, painless and reliable way to prevent the 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 capabilities of this method make it possible both to treat varicose veins of the legs in women and to correct venous outflow in trophic ulcers.
Radio Frequency Obliteration (RFO)
Treatment of varicose veins by the radiofrequency obliteration (RFO) method is a similar thermal method, but heating of the vein wall tissues occurs according to different physical principles due to radio wave energy.Radiofrequency obliteration makes it possible to eliminate varicose veins and eliminate its symptoms;such treatment in its immediate and long-term results does not differ from EVLT, but is more laborious for a phlebologist.
Other thermal methods
When deciding how to treat varicose veins, phlebologists often used exotic methods.Varicose veins were treated by 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 lead to 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 and RFO method make it possible to get rid of not only the initial shape but also severely pronounced varicose veins on the legs without incisions.In the photographs in the “Treatment Results” section you can see the view before and after the minimally invasive treatment.
Non-thermal methods for eliminating 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 in the arms after frequent injections gave rise to the idea that certain substances can cause inflammation of the vein walls - thrombophlebitis and their subsequent sticking with disappearance of the venous lumen.After the advent of the Fegan method, when treatment began to be carried out depending on the cause of varicose veins, the development of non-thermal scleroobliteration methods began.Since then, varicose veins of 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 by injection of a special substance (sclerosing) has reached perfection.The main point of sclerotherapy is to inject medicine 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 early stages of the disease.Advanced varicose veins of the lower limbs are treated with more complex methods;lesions of the trunk of the large or small saphenous vein do not allow counting on a long-term effect of sclerotherapy, since a relapse will surely 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 therapy, 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 using sclerotherapy, but the relapse rate is about 40% over the next 5 years.
The advantage of sclerotherapy is good immediate effect and low cost of treatment.Sclerosant injections lead to sticking of veins and cessation of the pathological process - reflux of blood into the saphenous veins.The medication 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 sticking.This process occurs unevenly and the degree of obliteration of the vein is not the same, which is why 40% of patients after sclerotherapy experience relapses of varicose veins.After sclerotherapy, the affected area of the veins of the lower extremities closes and, over time, heals completely, and blood flow in the opposite direction stops.To avoid the appearance of skin necrosis due to the penetration of the foam form of the sclerosant into the subcutaneous tissue, administration is carried out strictly under ultrasound control.
Foam sclerotherapy can be used alone or in combination with laser treatment to eliminate varicose veins.The number of sessions for eliminating varicose veins using sclerotherapy depends on the stage of the varicose veins and the condition of the veins.Treatment usually includes 2-3 procedures.The area of skin located above the sclera vessel may take on a dark shade for 2-3 months (hyperpigmentation appears).This can damage a woman's legs for several months, so it is best to perform this treatment during the winter months.Drug treatment and ultrasound-guided vascular punctures can accelerate the process of resorption of accumulations of intravascular fluid (coagulates), the risk of which is approximately 10%.Coagulules form when compression is insufficient, but will certainly 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.This is why sclerotherapy remains one of the most popular treatment methods.
Use special glue
Since its beginnings, this method has aroused great interest among phlebologists.This involves gluing the trunk of the great saphenous vein with a special cyanoacrylate glue.In the vessel lumen, this glue polymerizes and fills the dilated vessel lumen.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 eliminate varicose veins on the legs.Venasil is the only varicose vein treatment technology that does not require the wearing of compression stockings.
Most women can return to normal activities immediately.Symptoms of chronic venous insufficiency are relieved shortly after the procedure.The process of active promotion of this glue in the phlebological market is expected to start in the near future.However, there are certain disadvantages: The presence of a foreign body in the human body.The curdled glue remains in the container forever and can cause chronic allergies;sometimes there is inflammation of the vascular 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 varicose tributaries, therefore doctors will have to eliminate signs of subcutaneous varicose veins by sclerotherapy or miniphlebectomy.The visible effect of using glue appears only in combination with other methods of removing varicose veins.The patient has to pay more.The unreasonably high cost of the bonding kit makes this procedure significantly more expensive than the modern laser or radio frequency method.
In our clinic, preference is given to thermal methods.We believe that it is better to give good local anesthesia rather than treating varicose veins of the saphenous veins of the legs with an expensive and untested method.Moreover, the result is at best the same.In case of relapse, the patient will have to undergo a complex operation to remove the sealed vessel, since other methods will no longer be applicable.
Mechanical-chemical obliteration technology
The modern method of combined treatment of reflux along the subcutaneous venous trunks adds additional weight to conventional sclerotherapy.Mechanochemical procedures involve a combination of mechanical damage to the inner surface of the vein wall and the introduction of a sclerosing drug.A catheter is inserted into the main saphenous vein by a puncture under ultrasound guidance.After installing the catheter in the desired location, the device is connected.The sharp, rotating 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” into the lumen of the vessel and, with the help of the rotating part of the catheter, acts on the vascular wall, causing its inflammation and sticking.
To date, the only advantage of this technology is the absence of the need for tumescent anesthesia.Mechanical-chemical obliteration should, according to its inventors, trigger a stronger obliteration effect than foam sclerotherapy, although for some reason convincing data have not yet been presented.It is clear that these varicose veins can be treated with other minimally invasive methods, so their benefits are not obvious.We will have to wait for additional studies in Europe or the USA to precisely determine the place of this technology.
Miniphlebectomy
This is a modern microsurgical aesthetic method for eliminating varicose veins.This is a delicate technique of perforating and extracting varicose veins using special tools.This operation is not intended for a beginner phlebologist;you must have the skills of delicate surgery.Miniphlebectomy is an operation without a scalpel and carried out under local anesthesia.The punctures are made in the direction of the skin lines, so they are practically invisible after 2 months.
Miniphlebectomy has replaced the classic varicose vein operation, which involves the use of 1 to 3 cm incisions, because it is aesthetically perfect, painless and very effective.Assuming how varicose veins manifest themselves, the doctor can clearly plan micropunctures and get by with minimal intervention.The patient can go home immediately after the operation.Miniphlebectomy can be an effective and independent method of treating varicose veins, or used in combination after laser coagulation of varicose veins.Removal of varicose veins is carried out using a special technique developed by Professor Varadi.This technique, perfectly mastered by our phlebologists, eliminates varicose veins in the legs, an effective treatment whatever the cause.
Treatment results
Results of varicose vein treatment
The results of modern varicose vein therapy can be considered very good.Any technology, if performed correctly, eliminates the symptoms of varicose veins in the legs.Nearly 95% of patients have been free of varicose veins for 5 years or more, and 80% of them never have serious problems with venous discharge.The innovative vascular center is ready to help you deal with any venous disease without incision and pain.We know how to treat varicose veins and have extensive experience.The treatment of varicose veins should no longer be a problem in the modern high-tech world.