Varicose veins of the leg is a disease of the saphenous veins, in which their abnormal expansion develops.Varicose veins are swollen 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 continue to progress and can lead to complications over time.The main complications - trophic ulcers, thrombophlebitis, changes in skin color develop in 70% of varicose veins patients without treatment.
Symptoms of varicose veins
- Swollen varicose veins in the legs
- Heaviness in the legs, fatigue in the evening
- Swelling of the legs in the evening after physical activity
- Change in skin color on the leg
- Inflammation of the saphenous veins - thrombophlebitis
- Trophic ulcers of the skin
Causes and risk factors of varicose veins
- Complex inheritance - congenital malfunction of the valve apparatus
- Hard physical work while standing
- Frequent pregnancies and births
- Walking in high heels
In our clinic, modern methods of treating varicose veins of the lower limbs allow solving this problem without serious surgical interventions, pain, incisions and hospitalization.
The modern level of phlebology enables painless, aesthetic and reliable treatment of varicose veins for the patient.The first signs of varicose veins are a reason to see a phlebologist.Varicose veins of the lower limbs means the complete disappearance of the tone of the venous wall, so it is unnecessary to treat the transformation of varicose veins with tablets and leeches.
Diagnostics
Complaints and symptoms
Varicose veins begin with the appearance of individual nodules of dilated veins and continue to develop.Varicose veins do not cause problems at first, but over time they become a risk factor for serious health risks.So, let's look at the main problems that concern patients with varicose veins:
Cosmetic discomfort
Most patients with varicose veins only complain of unsightly varicose veins that detract from the appearance of their legs.Such complaints are especially often caused by varicose veins in women.Cosmetic discomfort is often caused by small varicose veins and spider veins, which do not threaten health, but force you to close your legs.Such patients require treatment for cosmetic reasons, so only minimally invasive (non-incision) methods are recommended for them.
Chronic venous insufficiency
About 30% of patients with varicose veins complain of heaviness in the legs, swelling in the evening 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.In case of severe venous insufficiency, the skin in the lower third of the leg can be damaged by the formation of a trophic ulcer, which is difficult to treat.Often, patients with advanced varicose veins develop skin inflammation - eczema.
Examination of a phlebologist
A consultation with a phlebologist is necessary if varicose veins cause any discomfort.The examination is performed lying down and standing up.The patient should fully open his legs.
Varicose veins are diagnosed during a routine examination, which must be done while standing while the veins are full.After the examination, an ultrasound duplex examination is always necessary.Usually, such a diagnosis is sufficient.However, in case of suspicion of secondary varicose veins, examination of the deep venous system is necessary.
Ultrasound examination of the veins
In the case of varicose veins, the task of the ultrasound of the veins is to identify the incompetence of the venous trunks, to identify non-functioning venous valves, and to identify blood clots in the superficial and deep venous system.
The examination begins with an 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 incompetence is the reverse flow of blood).We then examine perforating veins in typical locations and their viability during the Valsalva maneuver.
After assessing the superficial veins, the patency of the deep veins must be assessed.For this purpose, we examine the popliteal and femoral veins lying down, assess their patency and the consistency of the valves.
Contrast venography
In general, ultrasound scanning is sufficient for the full diagnosis of venous pathology, but in some cases it is also necessary to examine the relationship between the state of the deep and superficial venous systems, especially in the case of varicose veins and secondary varicose veins.
Contrast X-rays are used to solve these problems.The saphenous veins are punctured and contrast is injected.The movement of the contrast is monitored on the monitor of the X-ray machine, and all necessary examinations and projections are performed.Currently, venography of varicose veins is used very rarely.
Treatment
At the beginning of the last century, the "classic" anesthetic varicose vein surgery involving incisions in the groin area and along the legs, used to remove superficial varicose veins, is a thing of the past.Patient suffering, long hospitalization and leg pain after such operations aimed at improving blood flow are completely unjustified.Severe varicose veins can be treated without the use of "inquisition methods".Today, advanced varicose veins can be treated without anesthesia or hospitalization.The phlebologist's work becomes office-based, without the characteristics of major surgeries.
Knowing what causes varicose veins in the legs has allowed us to develop the hemodynamic principles of treatment.Their implementation is possible by removing or turning off the vein from the blood 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 the purpose is the same - to stop the abnormal discharge of blood through the affected vein (anti-reflux).
How to cure varicose veins on the legs?
Understanding the cause of varicose veins allows you to choose the right treatment method.Modern treatment of varicose veins aims to solve several problems:
- Elimination of pathological discharge in an upright position through the incompetent saphenous veins of the lower limbs.
- The elimination of reflux between deep and superficial veins - perforators - is the main mechanism for the development of varicose trophic ulcers.
- Removal of varicose veins - degenerated superficial blood vessels (varices).
- Compression therapy with special stockings and socks.
Capabilities of the vascular center
The thermal methods of treating varicose veins are endovenous laser coagulation (EVLC) and radiofrequency obliteration (RFO) of the veins of the lower limbs.
Endovenous 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 with a laser beam, which severely damages 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 regress completely and without a trace, and the main symptoms disappear: swelling, heaviness in the legs, hyperpigmentation of the skin.
EVLT begins with the insertion of a laser fiber into the lumen of the varicose vein 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 further development of the disease and its complications.With the proper use of the EVLT method, complete elimination of varicose veins can be observed in 98% of patients.The possibilities of this method allow both the treatment of varicose veins on the legs of women and the correction of the venous outflow of trophic ulcers.
Radio Frequency Obliteration (RFO)
The treatment of varicose veins with the radio frequency obliteration (RFO) method is a similar thermal method, but the heating of the tissue of the vein wall is done according to different physical principles due to the energy of the radio waves.Radiofrequency obliteration makes it possible to remove varicose veins and eliminate symptoms;In terms of immediate and long-term results, such treatment does not differ from EVLT, but it is more laborious for a phlebologist.
Other thermal methods
When deciding on the treatment of 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 to carry out outpatient treatment of the patient without disturbing the lifestyle.In the hands of a novice phlebologist, thermal ablation methods can cause unpleasant complications: reduced sensitivity, burns, seals.The efficiency 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 not only of the initial form, but also of severely pronounced varicose veins on the legs without incisions.The photos in the "Treatment Results" section show 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 limbs without incisions and without pain.The disappearance of the saphenous veins in the arms after frequent injections raised the idea that some substances can cause inflammation of the vein walls - thrombophlebitis, followed by the disappearance of the lumen of the vein.After the appearance of the Fegan method, when treatment began to be performed based on the causes of varicose veins, the development of non-thermal scleroobliteration methods began.Since then, varicose veins on the legs, especially in women, have been treated not only with a scalpel, but also with a syringe.
Sclerotherapy
Sclerotherapy appeared in medical practice at the end of the 19th century.In recent years, the method of treating varicose veins has been perfected by injecting a special substance (sclerosant).The essence of sclerotherapy is that a drug is injected into the varicose vein, which causes inflammation and then adhesion of the varicose vein.Sclerotherapy does not eliminate the cause of venous insufficiency and is more suitable for certain forms of varicose veins or the initial stages of the disease.Advanced varicose veins of the lower limbs are treated with more complex methods;damage to the trunk of the great or small saphenous vein does not make it possible to count on the long-term effect of sclerotherapy, since a relapse will definitely occur due to reflux.
Sclerotherapy can be performed in the absence of allergy to tetradecyl sulfate or polidocanol.These substances are the main sclerosants.Manifestations of thrombophlebitis may occur during sclerosing treatment, especially when liquid forms of the drug are used.Sclerotherapy of perforating veins is highly effective in the treatment of venous trophic ulcers.With the help of sclerotherapy, the manifestations of varicose veins of the lower limbs can be eliminated at any stage, but the relapse rate in the next 5 years is approximately 40%.
The advantage of sclerotherapy is a good immediate effect and low treatment costs.Sclerosant injections lead to the adhesion of the veins and the stopping of the pathological process - the backflow of blood through the saphenous veins.The drug is usually injected into the varicose veins in the form of a foam.A spasm of the dilated subcutaneous vessels is formed, the long-term contact of the sclerosing foam form with the vein wall, followed by their inflammation and adhesion.This process takes place unevenly, and the degree of vein elimination is not the same, so 40% of patients have a recurrence of varicose veins after sclerotherapy.After sclerotherapy, the affected area of the veins of the lower limbs is closed and completely heals over time, and blood flow in the opposite direction stops.In order to avoid skin necrosis due to the penetration of the sclerosing foam form into the subcutaneous tissue, the dosage is carried out under strict ultrasound control.
Foam sclerotherapy can be used as an independent method 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 varicose veins and the condition of the veins.The treatment process usually consists of 2-3 procedures.The skin surface above the sclerotic vessel may take on a dark shade for 2-3 months (hyperpigmentation appears).It can wreak havoc on a woman's legs for months, so this treatment should be done in the winter months.Medication and ultrasound-guided venipuncture can accelerate the resorption of intravascular fluid accumulations (coagulations), with a risk of approximately 10%.Clots form when there is not enough compression, but they will certainly go away with time.Many patients know that within a month after sclerotherapy, the symptoms 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 attracted great interest among phlebologists.This involves gluing the trunk of the great saphenous vein with a special cyanoacrylate glue.In the lumen of the vessel, 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 procedure to eliminate varicose veins on the legs.Venasil is the only technology for the treatment of varicose veins that does not require the wearing of compression stockings.
Most women can return to their normal activities immediately.The symptoms of chronic venous insufficiency subside shortly after the procedure.Active promotion of this glue in the phlebological market should be started in the near future.However, there are certain disadvantages: The presence of a foreign body in the human body.Curd glue stays in the pot 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 glued vessel may occur.
The use of glue in the trunk of the great saphenous vein does not eliminate the elimination of varicose tributaries, so doctors must remove signs of subcutaneous varicose veins with sclerotherapy or miniphlebectomy.The visible effect of using the glue appears only when it is combined with other methods to eliminate varicose veins.The patient has to pay more.The unreasonably high cost of the adhesive kit makes this procedure significantly more expensive than the modern laser or radio frequency method.
In our office, we prefer thermal methods.We believe that it is better to give a good local anesthetic than to treat varicose veins of the saphenous veins in the legs with an expensive and untested method.Moreover, the result is the same at best.If relapse occurs, the patient must undergo complex surgery to remove the blocked vessel, as other methods are no longer available.
The technology of mechanical-chemical erasure
The modern method of combined treatment of reflux along the subcutaneous venous trunks gives extra weight to traditional sclerotherapy.Mechanical-chemical procedures involve a combination of mechanical damage to the inner surface of the vein wall and the introduction of a sclerosing drug.The catheter is inserted into the main saphenous vein under ultrasound guidance.After the catheter is installed in the desired location, the device is connected.The rotating sharp head of the catheter makes up to 3,500 revolutions per minute, which seriously damages the inner layer of the vein wall.At the same time, a sclerosing drug is injected through the catheter, which "mixes" in the lumen of the vessel and uses the rotating part of the catheter to act on the vessel wall, causing its inflammation and adhesion.
To date, the only advantage of this technology is that it does not require tumescent anesthesia.According to its inventors, mechanical-chemical obliteration should produce a stronger obliteration effect than foam sclerotherapy, although convincing data for some reason has not yet been presented.Obviously, such varicosities can be treated with other, minimally invasive methods, so its benefits are not obvious.We have to wait for further studies from Europe or the USA to determine the exact location of the technology.
Miniphlebectomy
This is a modern microsurgical aesthetic method for removing varicose veins.It involves the delicate technique of puncturing and extracting varicose veins using special tools.This operation is not for the novice phlebologist;must have delicate surgical skills.Miniphlebectomy is a scalpel-free operation performed under local anesthesia.The injections are made in the direction of the skin lines, so they are practically invisible after 2 months.
Miniphlebectomy replaced the classic varicose vein surgery, which involves a 1-3 cm incision, because it is aesthetically flawless, painless and very effective.Assuming how varicose veins manifest, the doctor can clearly plan micropunctures and get by with minimal intervention.The patient can go home on his own feet immediately after the operation.Miniphlebectomy can be an effective independent method of treating varicose veins, or it can be 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 perfectly mastered by our phlebologists and allows the removal of varicose veins in the legs - an effective treatment, regardless of the cause.
Treatment results
Results of treatment of varicose veins
The results of modern therapy of varicose veins can be considered very good.Any technology, if performed well, will eliminate the symptoms of varicose veins in the legs.Almost 95% of patients are free of varicose veins for 5 years or more, and 80% never develop serious problems with venous outflow.The innovative vascular center is ready to help you cope with any venous disease without incisions and pain.We know how to cure varicose veins and we have a lot of experience.Treatment of varicose veins should not be a problem in the modern world of high technology.