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 often develop on the legs.Varicose veins develop more frequently in women than in men.For a long time, varicose veins were just a cosmetic problem (vein veins), but if varicose veins are 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
- Dilated and swollen veins on the legs
- Heaviness in the legs, tiredness at night
- Swelling of the feet at night 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
- Aggravated heredity - congenital failure of the valve apparatus
- Heavy physical work while standing
- Frequent pregnancy and childbirth
- 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 consult a phlebologist.Varicose veins of the lower extremities imply the complete disappearance of the tone of the venous wall, therefore, it is useless to influence the transformation of varicose veins with pills 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 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 worry patients with varicose veins:
Cosmetic discomfort
Most patients with varicose veins only complain of unsightly varicose nodules that spoil the appearance of their legs.These complaints are especially caused by varicose veins in women.Often, cosmetic discomfort is caused by small varicose veins and spider veins, which do not threaten health, but force you to close your legs.These patients require treatment for aesthetic reasons, therefore, only minimally invasive methods (without incisions) are recommended for them.
Chronic venous insufficiency
Approximately 30% of patients with varicose veins complain of heaviness in the legs, swelling at night and nocturnal cramps in the calves.These are signs of chronic venous insufficiency.Gradually, its phenomena worsen and painful sensations may appear in varicose veins.Skin changes and pigmentation develop.In severe venous insufficiency, the skin of the lower third of the leg can be damaged with the formation of a trophic ulcer that is difficult to treat.Often, patients with advanced varicose veins develop skin inflammation - eczema.
Examination by a phlebologist
Consultation with a phlebologist is necessary if varicose veins cause you any discomfort.The examination is performed lying down and standing up.The patient must open their legs completely.
Varicose veins are diagnosed during a routine exam, which should be done standing up while the veins are full.After the examination, a duplex ultrasound is always required.As a rule, such a diagnosis will be sufficient.However, if secondary varicose veins are suspected, examination of the deep venous system is necessary.
Ultrasound scanning of veins
In the case of varicose veins, ultrasound of the veins has the function of identifying the incompetence of the venous trunks, identifying non-functioning venous valves and identifying blood clots in the superficial and deep venous systems.
The examination begins with examination of the saphenous veins in a standing position.The diameter and permeability of the great and small saphenous vein are studied, the consistency of the valves is determined (Valsalva maneuver - tension of the abdominal muscles with complete inspiration, a sign of incompetence is the reverse flow of blood).Next, the perforating veins in typical locations and their viability during the Valsalva maneuver are studied.
After evaluating the superficial veins, it is necessary to evaluate the patency of the deep veins.To do so, while lying down, the popliteal and femoral veins are examined, also evaluating their patency and the consistency of the valves.
Contrast venography
Typically, 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 systems, especially in the case of recurrences of varicose veins and secondary varicose veins.
To resolve these problems, contrast X-ray examination is used.The saphenous veins are punctured and contrast is administered.The movement of the contrast is observed on the x-ray machine monitor, and all necessary tests and projections are performed.Currently, venography for varicose veins is used very rarely.
Treatment
The “classic” operation for varicose veins under anesthesia with incisions in the groin area and along the legs, which was used to remove superficial varicose veins at the beginning of the last century, is an atavism of the past.The suffering of patients, the long hospital stay and the pain in the legs after operations aimed at improving blood flow are completely unjustified.Severe varicose veins can be treated without resorting to “inquisition methods”.Today, the treatment of advanced varicose veins can be carried out without anesthesia and hospitalization.The phlebologist's work becomes an office-based one, without the attributes of major surgery.
Knowledge of the causes of varicose veins in the legs allowed us to develop hemodynamic principles of treatment.Its implementation is possible by removing or disconnecting the vein from blood circulation.Modern technologies are based on the principle of fusion of vein walls in the area of insufficient venous valves.The method of influencing venous circulation may be different, but its goal is the same - to stop the pathological discharge of blood through the affected vein (antireflux).
How can you cure varicose veins in your legs?
Understanding the cause of varicose veins allows you to choose the correct method of treatment.The goal of modern varicose vein treatment is to solve several 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 with special stockings and stockings.
Capabilities of the vascular center
Thermal methods for 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, 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 damaging the collagen of the venous wall, causing an inflammatory process in the vein and its excessive growth.Advanced varicose veins in the legs, treated with 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 puncture in the skin, 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 the development of the disease and its complications.Complete elimination of varicose veins is observed in 98% of patients with adequate use of the EVLT method.The capabilities of this method make it possible to treat varicose veins on the legs in women and correct venous outflow in trophic ulcers.
Radio Frequency Obliteration (RFO)
Treatment of varicose veins by radiofrequency obliteration (RFO) method is a similar thermal method, but heating of the venous wall tissue occurs according to different physical principles due to radio wave energy.Radiofrequency obliteration allows you to remove varicose veins and eliminate their symptoms;This treatment in its immediate and long-term results does not differ from EVLT, but it 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 with thermal effects using superheated steam and bipolar electrocoagulation.However, modern thermal methods are more effective and allow the doctor to prevent the development of varicose veins and the patient to be treated on an outpatient basis without disrupting their 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 make it possible to eliminate not only the initial form, but also 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 to eliminate stem reflux
For many years, phlebologists have been thinking about how to cure varicose veins of the lower extremities without incisions and without pain.The disappearance of the saphenous veins on the arms after frequent injections gave rise to the idea that some substances can cause inflammation of the walls of the veins - thrombophlebitis and their subsequent gluing with the disappearance of the lumen of the vein.After the advent of the Fegan method, when treatment began to be carried out based on the cause 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 the practice of doctors at the end of the 19th century.In recent years, the method of treating varicose veins using injections of a special substance (sclerosing agent) has reached perfection.The main point of sclerotherapy is to inject a medication into the varicose vein, which causes inflammation and subsequent gluing of the varicose vein.Sclerotherapy does not involve eliminating the cause of venous insufficiency and is more indicated for certain forms of varicose veins or in the early 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 for the long-term effect of sclerotherapy, as recurrence due to reflux will certainly occur.
Sclerotherapy can be performed in the absence of allergy to tetradecyl sulfate or polidocanol.These substances are the main sclerosants.During sclerosing treatment, manifestations of thrombophlebitis may occur, especially if liquid forms of the medication are used.Perforating vein sclerotherapy is highly effective in treating venous trophic ulcers.It is possible to eliminate the manifestations of varicose veins in the lower limbs at any stage with the help of sclerotherapy, but the recurrence rate is around 40% in the next 5 years.
The advantage of sclerotherapy is the good immediate effect and the low cost of the treatment.Sclerosing injections lead to gluing of the veins and the cessation of the pathological process - backflow of blood through the saphenous veins.The drug 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 its subsequent inflammation and sticking.This process occurs unevenly and the degree of vein obliteration is not the same, therefore 40% of patients after sclerotherapy experience recurrences of varicose veins.After sclerotherapy, the affected area of the lower extremity veins closes and heals completely over time, and blood flow in the opposite direction stops.To prevent the occurrence of skin necrosis due to the penetration of the foamy form of the sclerosant into the subcutaneous tissue, 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 with sclerotherapy depends on the stage of the varicose veins and the condition of the veins.The course of treatment usually consists of 2-3 procedures.The area of skin over the sclerotic vessel may acquire a dark shade for 2 to 3 months (hyperpigmentation appears).It can ruin a woman's legs for several months, so it is best to carry out this treatment in the winter months.Drug treatment and ultrasound-guided vascular punctures can accelerate the process of reabsorption of accumulations of intravascular fluid (clots), the risk of which is around 10%.Clots form when there is insufficient compression, but they will certainly disappear over time.Many patients know that within a month after sclerotherapy, signs of varicose veins in 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 aroused 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, reliably blocking blood flow.Taking this into account, half an hour is enough for the procedure to eliminate varicose veins in the legs.Venasil is the only technology for treating 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 shortly after the procedure.The process of actively promoting this glue 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.Curdled glue stays in the container forever and can cause chronic allergies;sometimes there is inflammation of the vessel wall or polymer rejection with suppuration.Acute thrombophlebitis of the glued vessel may occur.
The use of glue on the trunk of the great saphenous vein does not eliminate the need to eliminate varicose tributaries, so doctors will have to remove signs of subcutaneous varicose veins with sclerotherapy or miniphlebectomy.The visible effect of using glue only appears when combined with other methods of eliminating varicose veins.The patient has to pay more.The excessively high cost of the bonding kit makes this procedure significantly more expensive than the modern laser or radiofrequency method.
In our clinic, thermal methods are preferred.We believe that it is better to apply good local anesthesia than to treat varicose veins of the saphenous veins in the legs with an expensive and untested method.Furthermore, the result is, at best, the same.If a relapse occurs, the patient will have to undergo a complex operation to remove the sealed vessel, as other methods will no longer be applicable.
Mechanochemical obliteration technology
The modern method of combined treatment of reflux along subcutaneous venous trunks adds extra weight to conventional sclerotherapy.Mechanochemical procedures mean a combination of mechanical damage to the inner surface of the venous wall and the introduction of a sclerosing drug.A catheter is inserted into the main saphenous vein using an ultrasound-guided puncture.After installing the catheter in the desired location, the device is connected.The rotating, pointed head of the catheter makes up to 3,500 rotations per minute, causing serious damage to the inner layer of the venous wall.At the same time, through the catheter, a sclerosing medication is injected, which “mixes” in the lumen of the vessel and, through 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.Mechanochemical obliteration should, according to its inventors, trigger a stronger obliteration effect than foam sclerotherapy, although for some reason no convincing data has yet been presented.Of course, these varicose veins can be treated with other minimally invasive methods, so their advantages are not obvious.We have to wait for more studies from Europe or the USA to precisely determine the place of this technology.
Miniphlebectomy
This is a modern microsurgical aesthetic method for removing varicose veins.It involves a delicate technique of puncture and removal of varicose veins using special tools.This operation is not for a novice phlebologist;you need to have skills for delicate surgery.Miniphlebectomy 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.
Miniphlebectomy has replaced the classic operation for varicose veins, which involves the use of 1 to 3 cm incisions, as it is aesthetically impeccable, painless and very effective.By assuming how varicose veins manifest, the doctor can clearly plan micropunctures and survive with minimal intervention.The patient can go home alone immediately after the operation.Miniphlebectomy can be an independent and effective method of treating varicose veins or used in combination after laser varicose vein coagulation.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 on the legs - an effective treatment regardless of their cause.
Treatment results
Varicose vein treatment results
The results of modern therapy for varicose veins can be considered very good.Any technology, if well executed, eliminates the symptoms of varicose veins in the legs.Almost 95% of patients have been free from varicose veins for 5 years or more, and 80% of them never have serious venous flow problems.The innovative vascular center is ready to help you deal with any venous disease without incisions or pain.We know how to cure varicose veins and have extensive experience.Treating varicose veins should not be a problem in the modern high-tech world.