Varicose veins are a vascular disease when, against a weak background of connective tissue, stretching of the venous wall occurs. The diameter of the vein increases, and its wall becomes thinner.
The large diameter of the veins leads to decreased blood flow velocity, venous congestion and 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. Visible external cones along the vessels allow you to recognize varicose veins in the legs. Varicose veins of the lower extremities (ICD code I83) is a very remarkable disease that is easily cured.
Esophageal varices are included in the symptoms of portal hypertension, and varicose nodes secondary to the female perineum show varices of the pelvis that are small and difficult to bleed from the veins. main.
Varicose veins (varicose veins) are manifested by secondary pelvic hypertension and can lead to male infertility. The etiology and pathogenesis of varicose veins are diverse depending on the localization of the process. The increase in the diameter of the veins itself is not dangerous, but the complications of varicose veins bring great risks to health, sometimes affecting the patient's life. The cause of the onset of varicose veins of the legs can be due to the patient's exertion, childbirth, and a sedentary lifestyle.
To understand what varicose veins look like, just go to the summer beach. Although many people with varicose veins are embarrassed to show up there, you will certainly see how varicose veins manifest themselves in men and women. This disease is so widespread that you will surely encounter it. After reading this article, you will understand how to treat varicose veins easily. Don't be afraid to go to the phlebotomist.
Can we reverse varicose veins?
Many people ask this question with the desire to be able to cure varicose veins in the early stages with the support of drugs or traditional medicine methods. If we are talking about varicose veins in the legs, then the phlebologist can clearly answer this question - the degenerative destruction of the vein wall cannot go away without shutting off the affected veinfrom the bloodstream or remove it.
What this happens is that the dilated veins can remain functional and increase in volume due to blood spilling from the lower parts, and the muscle pumps of the legs help blood flow into the deep veins.
Depending on the stage of varicose veins, many different surgical and conservative treatments can be applied to stop the progression of varicose veins at different stages. The order here is: if the affected vein is irreversible, it must be removed or coagulated, or re-glued.
Why can't even the initial varicose veins be reversed without surgical intervention? To effectively treat varicose veins of the legs, it is necessary to recognize where the pathological venous bleeding is coming from and remove it with minimal trauma. However, enlarged varicose veins can restore their function on their own and do not require surgical intervention if the radiologist removes pathological discharges, causes of varicose veins, and damaged veins. irreversible change.
Modern treatments for varicose veins have advanced tremendously since the first surgeries for varicose veins in men and women in the 19th century. disease classification and appropriate treatment.
Innovative Vascular Center clinics know how to treat varicose veins with minimal medical, psychological and aesthetic inconvenience. We do not need to remove the vein according to the classical scheme. In the arsenal of veniologists, the hemodynamic concept of the treatment of the major causes of varicose veins, a technique that involves the correction of outflow of only pathologically altered veinsand remove only the affected veins.
Treatment cannot be directed at the cause of the disease, but the pathogenesis of the problem is known, so it can be stopped. In women, the presence of varicose veins on the legs can be an unpleasant cosmetic symptom, but men are not ready to change the ugly appearance of varicose veins under the skin. neglected to have large scars. Therefore, clinics that offer both cosmetic and radical treatments are best appreciated by patients.
Some anatomy and physiology
The definition of varicose veins is primary dilatation of the subcutaneous venous lines of the lower extremities, due to congenital, contributing and reproductive factors. 40% of adults on the planet are at risk of varicose veins. In developed countries, signs of varicose veins are detected in half of the population.
The hemispheric veins in the legs are represented by two large venous systems - the system of large and small hemispheric veins. The great hemispheric vein originates in the foot, from where it runs along the medial surface of the leg to the inguinal region, where it empties into the deep vein of the thigh, from the medial surface of the common femoral artery.
Along the way from the trunk and branches of the great hemispheric veins, short venous branches can be identified - water-generating machines that connect it to the deep veins of the legs and thighs, causing varicose veinsaway from the main bodies. These perfumers are designed to facilitate the passage of blood into the deep venous system.
The small hemispherical vein is formed in the external vessel, it is characterized by several curving segments along the posterior surface of the lower leg and confluence with the popliteal vein. Between them, the large and small hemispheric veins are connected by separate overflows. In the subcutaneous trunks there are many venous valves that ensure the movement of blood to the heart and prevent backflow of blood.
Due to the congenital weakness of the venous wall and the load on it, the development of the internal valve apparatus of the veins, the blood begins to move in the opposite direction, causing an omental venous effusion, which further prolongs anddevelop. of severe varicose veins. Therefore, without eliminating the pathological discharge of blood, a cure for chronic varicose veins cannot be achieved.
The classification of varicose veins in the legs is formed from the name and developmental cause of the disease, the venous pool affected, and the stage of chronic venous insufficiency. Varicose veins of the lower extremities are formed by a combination of several factors:
- Congenital inattention and weakening of the venous wall and increased venous pressure.
- Increased pressure on the veins due to a long lifestyle, physical exertion, pregnancy and childbirth.
- Congenital and acquired obstructions to venous outflow (compression syndrome, tumors, and bone formation that press against the vein).
- Sequelae of deep vein thrombosis in the past
Modern principles of varicose veins treatment
Many patients often ask the question - is treatment of varicose veins necessary, if only the first signs of it appear. Varicose veins of the legs is a disease that progresses continuously and is prone to complications, so without medical intervention, the possibility of recovery cannot be trusted. Review of the main indications for the treatment of varicose veins in the legs.
Reduce symptoms of chronic venous insufficiency
Venous hypertension is an unpleasant subjective consequence of impaired venous outflow, but varicose veins themselves are not compromised. Symptoms of varicose veins that need to be prevented and treated include a feeling of heaviness in the legs, swelling at night, increased leg fatigue and even calf muscle pain. With disease progression, stagnation develops in the venous vasculature and deep veins, which can lead to hyperpigmentation, cause varicose eczema, and worsen in the calves.
The most popular and overtly advertised method of treating the symptoms of varicose veins in the legs is taking various varicose veins medications, using ointments and creams, making contact withspecialists were late. It is important to understand that such remedies do not affect the course of varicose veins, which is why they can only alleviate complaints and symptoms in the early stages. It is unreliable on the fact that varicose veins disappear after treatment with such drugs.
Treatment of complications of varicose veins (trophic ulcers, thrombophlebitis, venous bleeding)
In about 50% of cases, varicose veins are complicated by local inflammatory processes, which broadens the indications for aggressive surgical tactics. Usually, patients come to the treatment of varicose veins when its complications develop - thrombophlebitis (ICD code I80), severe pain or the appearance of trophic ulcers. Sometimes disturbed by night cramps in the calves, redness of the skin, pain.
Treatment of thrombophlebitis can be carried out with caution (heparin ointment, lyoton, compression bandages) or more aggressively - excision of the affected vein or laser coagulation. Clinical recommendations do not give a definite answer to this question, but with an active approach, together with thrombophlebitis, its cause is also eliminated, and this is varicose veins.
Nutritional ulcers are an extreme manifestation of chronic venous insufficiency and represent a great danger. It looks like a skin defect in the area of intermediate melanoma with active purulent discharge, soft granules, and is accompanied by ongoing damage to the surrounding subcutaneous tissue.
Varicose veins start to progress easily and respond very poorly to conservative treatment. The current optimal treatment is the venous out-of-the-way laser (EVLK) for large or small hemispheric varicose veins and precise local treatment (special dressings, ulcer washing). One doesn't work without the other, so it's not necessary to count on healing trophic ulcers from ointments alone. An obligatory component of treatment is compression therapy with the help of special compression stockings. They significantly reduce patient complaints.
Cosmetic indications for varicose veins
Varicose veins are a disease that rarely leads to dangerous complications, but often requires you to see a specialist. Varicose veins bring a lot of cosmetic problems to their owners. Usually young patients are embarrassed by these knots and hide their feet. If men are not afraid of varicose veins and they can constantly walk in their pants, women want to walk with their feet.
The good news is that varicose veins in the legs of women and men can now be eliminated in just one laser photocoagulation procedure without any trace. Modern interventions are performed without incision, through minimal perforations, completely invisible 3-4 weeks after the intervention. The patient was put on the operating table under local anesthesia, the operation lasted 40-50 minutes. The laser offers amazing cosmetic results and stable recovery from the manifestations of varicose veins, which is why EVLT is so popular among young doctors and patients with varicose veins in the legs. any stage.
Prevention of the development of complications of varicose veins
The solution of these problems can be achieved by conservation and operational methods. The main goal of modern vein surgery is to minimize surgical trauma in the treatment of varicose veins with the longest possible therapeutic and esthetic effect. To solve the first problem, it is necessary to block the venous vessels working in the opposite direction, through which a pronounced discharge occurs, to solve the second problem, it is necessary to remove or shut down the blocked veins. dilate from the circulatory system.
Diagnosis of varicose veins
For an accurate diagnosis of superficial venous disease, an examination by an experienced specialist and ultrasound of the jugular and deep veins from the abdomen to the legs is necessary. Information from these study methods is sufficient to accurately make this diagnosis in the vast majority of patients. The main signs of varicose veins of the legs can be identified with the naked eye and the cause can be determined using ultrasound.
In some cases, doctors perform invasive tests of phlebography on an angiogram unit. After treatment, the patient should be periodically monitored for the condition of the operated veins, which is carried out by doctors using diagnostic ultrasound. If at the diagnostic stage, the doctor has questions about the condition of the deep veins, then the diagnosis of MRI or CT with contrast will accurately determine the extent of their disease.
Treatment of central varicose veins in the blood vessels
A vascular surgeon can cure varicose veins of the lower extremities simply by eliminating the cause of its appearance. It is necessary to combat the causes of the development of varicose veins and the progression of the disease. Review of key technologies with proven effectiveness.
Varicose vein laser treatment (EVLT)
Endovenous laser coagulation is based on heating the vein wall with a coherent light beam. Varicose veins can be effectively treated without incisions and general anesthesia. A light guide is inserted into the vein through an ultrasound-guided perforation. The laser energy of a certain wavelength at the time of its appearance is absorbed by the vein wall, resulting in heating and destruction of the connective tissue. As a result, the wall of the vein turns into scar tissue and blood flow through the affected vein stops completely. The effect is similar to varicose vein surgery, but only without the incision, under general anesthesia, and painless.
In its efficacy, EVLK exceeds the open surgery of varicose veinectomy. 98% of all patients who undergo surgery recover from varicose veins, regardless of the extent of node growth. Rare side effects include skin numbness in the area where the vein clots, inflammation, and blood clots in the clotted vein. The overall rate of such complications does not exceed 1%. At the Creative Vascular Center, EVLK is the "gold standard", it can cure any varicose veins, both in the early and advanced stages. Patients leave the best reviews right after laser treatment.
Radiofrequency eradication of varicose veins (RFO)
In terms of its impact and effectiveness, RFO, like laser, is known as heat therapy for varicose veins, but a different physical principle is used there. Radiosonde is also given into a vein through a puncture. The intervention is performed under local anesthesia. The principle of RFO is based on generating thermal energy in the probe, which is then transferred to the circuit wall. Heating 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 thermoacoustic (thermal) technology. In terms of efficiency, they are similar, however, the laser itself heats the vein wall, while the RFO heats the working surface of the transducer and the heat is transferred to the wall through the fluid portion of the blood.
According to experts, EVLT destroys more thoroughly the structure of the affected vein, so after laser, the frequency of recurrence is less than radio-ablation. Physicians noted no recurrence of varicose veins in 98% after EVLK and 86% after RFO. Based on 20 years of work experience, vascular specialists conclude that heat treatment of varicose veins is more effective than conventional varicose vein removal surgery.
Methods of removing veins without heat
In the 70s of the twentieth century, surgeons became more interested in minimally invasive surgical methods of varicose veins and began to use coagulation machines. Great idea, but poorly implemented in practice. The patient suffers from skin burns, which may be the reason why doctors are reluctant to use heat for long periods of time with varicose veins. The chemical methods used to remove veins have been shown to be safe and quite effective. These include sclerotherapy in different variations and adhesive removal.
Therapeutic therapy
Sclerotherapy is the intravenous administration of special drugs that damage the vein wall, followed by clogging (overgrowth) of the varicose vein. The history of this method goes back to the 19th century and has an interesting development path. At the vascular center, specialists use the most advanced technology - foam sclerotherapy. Stick to the treatment for six months and you can get rid of the varicose veins of the lower extremities in the long run. Although the recurrence rate is about 50% in 5 years. With sclerotherapy, the treatment does not focus precisely on the cause of varicose veins but on removing the venous nodes themselves, so it can be used in combination with other minimally invasive methods (EVLK, RFO). A feature of sclerotherapy is the appearance of dense cones - coagulation at the site of sclerosing veins, the resolution of which lasts up to six months.
Paste varicose veins with specialized glue
Venaseal technology is the name of a non-thermal method to remove varicose veins of the hemisphere, which involves the introduction of a special glue into the lumen of the vein, which polymerizes within the lumen of the vein. , causing congestion. The idea looks interesting and developed over the last decade, but there are some pitfalls. First, the colloid remains inside the affected veins as a foreign body, it does not dissolve. Second, there is a risk of nephritis around a blocked vein, as a response of the body to a foreign body. Third, it is an expensive treatment.
The cost of treating varicose veins with this method is twice as expensive as with laser photocoagulation. There are no long-term studies on the long-term outcomes of such treatment. The advantages of this technology are yet to be determined, but research is actively underway and it is possible that varicose veins will become a disease for which the entire treatment regimen will turn into a "ghost injection". art". It is characteristic that this approach has not yet been considered in the latest clinical guidelines, but has been offered by several active venous centers.
Surgical 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 the superficial veins in the legs and prevent complications since the mid-19th century. History of the struggle with open veinsIt clearly shows how from the initial large incisions that deform the leg, the surgery has progressed to micro-perforations, allowing you to deal with varicose veins without cosmetic defects.
Advanced vein surgeons use elements of classical surgery in the form of micro-veinectomy using holes to remove individual veins and vein branches. This may be the most cosmetic method to get rid of varicose veins in thin skin. A month after such surgery, there is not even a redness on the skin.
Other thermal methods
When deciding how to treat varicose veins, veniologists often resort to exotic methods. Varicose veins are treated with heat exposure using superheated steam and bipolar coagulation. However, modern thermal methods are more effective and they allow the physician to prevent further development of varicose veins and the patient to be treated as an outpatient without affecting his or her lifestyle. In the hands of a novice phlebologist, thermal ablation methods can cause unpleasant complications: decreased sensitivity, burns, occlusion. The effectiveness of this method in the hands of an experienced vasculologist is more than 98%, and the laser and RFO methods allow you to get rid of not only the original appearance, but also markedly severe varicose veinsin the leg without an incision.
Use special glue
Since its inception, this method has aroused great interest among veniologists. It involves gluing the stem of the large saphenous vein with a special cyanoacrylate glue. In the lumen, this colloid polymerizes and fills the dilated lumen. According to the developers, this method does not require anesthesia and a "button" appears in the circuit, which reliably blocks the flow of blood. With this, half an hour is enough for the procedure to get rid of varicose veins in the legs. Venasil is the only technology to treat varicose veins without wearing compression stockings.
Most women are able to return to normal activities immediately. Symptoms of chronic venous insufficiency quickly subside after the procedure. The active promotion of this glue in the intravenous drug market will begin in the near future. However, there are certain disadvantages: The presence of foreign bodies in the human body. The curvature remains in the vessel forever and can cause chronic allergic reactions, sometimes vascular inflammation or polymer rejection with adhesions. Acute thrombophlebitis of the pasted vessel may be present.
The use of glue in the trunk of the colonic vein does not eliminate the need to deal with the removal of the dilated branches, which is why doctors will have to remove the signs of varicose veins under the skin with thesclerotherapy or surgery to remove small veins. The visible effect of the use of glue is shown only in the case of a combination with other methods of getting rid of varicose veins. The patient has to pay extra. The unreasonably high cost of gluing kits makes the procedure much more expensive than modern laser or radiofrequency methods.
In the clinic, preference is given to thermal methods. Veterinarians believe that local anesthesia is better than treating varicose veins with an expensive and unproven method. Moreover, the results are the best. In the event of a recurrence, the patient will have to undergo a complex surgery to remove the blocked blood vessel, as other methods will no longer be applicable.
Modern methods of incorporating reflux treatment along subcutaneous venous lines add weight to conventional sclerotherapy. Mechanical procedures are understood as a combination of mechanical damage to the inner surface of the vein wall and the introduction of a sclerosing agent. A catheter is inserted into the major hemispheric vein through an ultrasound-guided perforation. After installing the catheter in the correct position, the device is connected. The rotating sharp tip of the catheter is up to 3. 5 thousand rpm, causing obvious damage to the inner layer of the venous wall. At the same time, a sclerosing agent is injected through the catheter, which "mixes" in the lumen and, with the help of the rotating part of the catheter, acts on the vessel wall, causing inflammation and adhesion.
This is a modern cosmetic microsurgery method to remove the varicose veins of the spermatic cord. It implies a sophisticated technique to puncture and pull the branches of varicose veins with the help of special tools. This operation is not for a novice surgeon, you need to master delicate operating skills. Small eyelid surgery is a surgery that does not use 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 almost invisible.