Varicose veins of the legs are diseases of the saphenous veins, in which their pathological expansion develops.Varicose veins are swollen varicose veins that usually develop in the legs.Varicose veins develop more often in women than in men.For a long time, varicose veins are only a cosmetic problem (spider veins), but if varicose veins are not treated, they will grow continuously and can lead to complications over time.The main complications - trophic ulcers, thrombophlebitis, skin discoloration without treatment develop in 70% of patients with varicose veins.
Symptoms of varicose veins
- Swollen veins in the legs
- Heaviness in the legs, fatigue in the evening
- Swelling of legs in the evening after physical activity
- Skin discoloration on the bottom of the leg
- Inflammation of the saphenous vein - thrombophlebitis
- Trophic ulcers on the skin
Varicose veins causes and risk factors
- Compound heredity - congenital failure of the valve apparatus
- Heavy physical work while standing
- Often pregnant and giving birth
- Walk in high heels
Modern methods of treating varicose veins on the lower legs in our clinic make it possible to solve this problem without the use of serious surgical intervention, without pain, incisions and hospitalization.
The level of modern phlebology makes it possible to treat varicose veins without pain for the patient, very aesthetic and reliable.The first signs of varicose veins should be a reason to contact a phlebologist.Varicose veins on the lower legs imply a complete loss of vein wall tone, therefore, it is not useful to influence the transformation of varicose veins with tablets and leeches as treatment.
Diagnostics
Complaints and symptoms
Varicose veins begin with the appearance of a single vein nodule that is dilated and continues to grow.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 varicose vein patients:
Cosmetic discomfort
Most patients with varicose veins only complain about unsightly varicose nodes that spoil the appearance of their legs.Such complaints are often 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 cover your legs.Such patients require treatment for cosmetic reasons, so only minimally invasive methods (no incisions) are recommended for them.
Chronic venous insufficiency
About 30% of varicose vein patients complain of heaviness in the legs, swelling in the evening, and night cramps in the calves.These are signs of chronic venous insufficiency.Gradually, the phenomenon worsens, and painful sensations may appear in the varicose nodes.Skin changes and pigmentation develop.With severe venous insufficiency, the skin on the lower third of the leg can be damaged by the formation of trophic ulcers, which are difficult to treat.Often, patients with advanced varicose veins experience skin inflammation - eczema.
Examination by a phlebologist
Consultation with a phlebologist is necessary if varicose veins cause you discomfort.The examination is carried out lying down and standing up.The patient must fully open the legs.
Varicose veins are diagnosed during a routine examination, which should be done standing up when the veins are full.After the examination, a duplex ultrasound scan 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, venous ultrasound has the task of identifying the inefficiency of the venous trunk, identifying malfunctioning venous valves and identifying blood clots in the superficial and deep venous system.
The examination begins with an examination of the saphenous vein while standing.The diameter and patency of the great and small saphenous veins are studied, valve consistency is determined (Valsalva maneuver - tension of the abdominal muscles with full inhalation, a sign of inefficiency is backflow of blood).Then the vein is perforated in the usual location and its viability during the Valsalva maneuver is studied.
After evaluating the superficial veins, it is necessary to evaluate the deep patency.For this purpose, lying down, the popliteal and femoral veins are examined, their patency and valve consistency are also evaluated.
Contrast venography
Usually, an ultrasound scan is sufficient for a full 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 cases of recurrent varicose veins and secondary varicose veins.
To solve this problem, a contrast X-ray examination is used.The saphenous vein is punctured and contrast 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 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 patient's suffering, long hospitalization and pain in the legs after such an operation aimed at increasing blood flow is completely unjustified.Severe varicose veins can be treated without using the "inquisition method."Today, advanced varicose vein treatment can be carried out without anesthesia and hospitalization.The phlebologist's work becomes office-based, without the characteristics of major surgeries.
Knowledge of what causes varicose veins in the legs allows us to develop the principles of hemodynamic treatment.Its implementation is possible by removing or shutting off the veins from the blood circulation.Modern technology is based on the principle of fusion of the venous wall in the area of insufficient venous valves.Methods of influencing venous circulation can be different, but the goal is the same - to stop the pathological discharge of blood through the affected veins (anti-reflux).
How can you cure 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:
- Termination of pathological discharge in a vertical position through an inefficient saphenous vein in the lower part of the leg.
- Elimination of reflux between deep and superficial veins - perforators - the main mechanism for the development of varicose trophic ulcers.
- Removal of varicose veins - degenerate superficial veins (varixes).
- Compression therapy using stockings and special stockings.
Vascular center capacity
Thermal methods to treat varicose veins are endovenous laser coagulation (EVLC) and radiofrequency obliteration (RFO) of veins on the lower leg.
Endovenous laser coagulation is an effective treatment for varicose veins, its principle is based on the thermal effect of laser energy.This treatment was introduced in 2001 and is still the best method.With laser coagulation, damaged veins are heated by laser beams, which have a strong effect on damaging the collagen of the vein walls, causing an inflammatory process in the veins and their excessive growth.Advanced varicose veins on the legs, treated with this method, recede completely and without a trace, and the 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 the varicose vessel through a skin puncture, which is guided along the affected vein to the site of the incompetent valve.For patients, this method is 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 the correct use of the EVLT method.The ability of this method makes it possible to treat varicose veins on the legs in women and correct venous outflow in trophic ulcers.
Radio frequency elimination (RFO)
Varicose vein treatment using the radiofrequency obliteration (RFO) method is the same thermal method, but the heating of vein wall tissue occurs according to different physical principles due to radio wave energy.Radio frequency destruction allows you to remove varicose veins and eliminate their symptoms;such treatment in its immediate and long-term results does not differ from EVLT, but is more thorough for phlebologists.
Other thermal methods
When deciding how to treat varicose veins, phlebologists often use exotic methods.Varicose veins are treated with thermal effects using superheated steam and bipolar electrocoagulation.However, modern thermal methods are more effective and they allow doctors to prevent the further development of varicose veins, and patients are treated on an outpatient basis without interfering with their lifestyle.In the hands of a novice phlebologist, the thermal ablation method 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 laser and RFO methods make it possible to eliminate not only the initial form but also severe varicose veins on the legs without incisions.In the pictures from the "Treatment Results" section you can see the view before and after the minimally invasive treatment.
A non-thermal method to eliminate reflux
For years, phlebologists have been thinking about how to cure varicose veins on the lower legs without incisions and pain.The loss of the saphenous vein in the arm after frequent injections gives rise to the idea that some substances can cause inflammation of the vein wall - thrombophlebitis and subsequent adhesion with the loss of the vein lumen.After the appearance 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, 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 using the injection of a special substance (sclerosant) has reached perfection.The main point of sclerotherapy is to inject drugs into the varicose veins, which cause inflammation and subsequent adhesion of the varicose veins.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.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 rely on the long-term effect of sclerotherapy, because relapse is sure to occur due to reflux.
Sclerotherapy can be performed if there is no allergy to tetradecyl sulfate or polidocanol.These substances are the main sclerosants.During sclerosing treatment, manifestations of thrombophlebitis may occur, especially if the liquid form of the drug is used.Sclerotherapy of perforated veins is very effective in the treatment of venous trophic ulcers.It is possible to eliminate the manifestations of varicose veins on the lower legs at any stage with the help of sclerotherapy, but the recurrence rate is about 40% in the next 5 years.
The advantages of sclerotherapy are good immediate effects and low treatment costs.Injection of sclerosant leads to adhesion of the vein and cessation of the pathological process - blood reflux through the saphenous vein.This medicine is usually injected in the form of foam into the varicose veins.Spasm of the dilated subcutaneous vessels is formed, prolonged contact of the sclerosant foam with the vein wall and subsequent inflammation and adhesion.This process happens unevenly and the level of vein destruction is not the same, so 40% of patients after sclerotherapy experience recurrence of varicose veins.After sclerotherapy, the affected venous area on the lower leg is closed and over time completely heals, and blood flow in the opposite direction stops.To prevent the occurrence of skin necrosis due to the penetration of the sclerosant foam into the subcutaneous tissue, the administration is carried out strictly under ultrasound control.
Foam sclerotherapy can be used as a stand-alone method or combined with laser treatment to eliminate varicose veins.The number of sessions to eliminate varicose veins using 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 skin area above the sclerotic duct may take a dark shade for 2-3 months (hyperpigmentation appears).It can damage a woman's legs for several months, so this treatment is best done in winter.Drug treatment and ultrasound-guided vascular puncture can accelerate the absorption process of intravascular fluid accumulation (coagulants), the risk is about 10%.Clots form when compression is not enough, but will definitely disappear over time.Many patients know that within a month after sclerotherapy, the signs of varicose veins on the lower legs disappear for 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.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 dilated vessel lumen.According to the developers, this method does not require any anesthesia, and a "plug" appears in the vessel, which reliably prevents 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 wearing compression stockings.
Most women can return to normal activities immediately.Symptoms of chronic venous insufficiency are relieved immediately after the procedure.The process of active promotion of this glue to the phlebological market should begin in the near future.However, there are certain disadvantages: The presence of foreign bodies in the human body.Curdled glue stays in the vessel forever and can cause chronic allergies;sometimes there is inflammation of the vessel wall or polymer rejection with suppuration.Acute thrombophlebitis from occluded vessels may occur.
The use of glue in the trunk of the great saphenous vein does not eliminate the need to eliminate varicose tributaries, which is why doctors need to remove the signs of subcutaneous varicose veins with sclerotherapy or miniphlebectomy.The visible effect of using glue appears only when combined with other methods to eliminate varicose veins.Patients have to pay more.The unreasonable cost of adhesive kits makes this procedure much more expensive than modern laser or radio frequency methods.
In our clinic, priority is given to thermal methods.We believe that it is better to provide good local anesthesia than to treat saphenous vein varicose veins in the legs with expensive and untested methods.Moreover, the results are the same.If a relapse occurs, the patient will have to undergo a complex operation to remove the closed vessels, because other methods will no longer be used.
Mechano-chemical removal technology
The modern method of combined treatment of reflux along the trunk of the subcutaneous vein adds additional weight to conventional sclerotherapy.Mechano-chemical procedures mean a combination of mechanical damage to the inner surface of the vein wall and the introduction of sclerosing drugs.A catheter is inserted into the great saphenous vein through 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 rotations per minute, causing severe damage to 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, using the rotating part of the catheter, acts on the vascular wall, causing inflammation and adhesion.
To date, the only advantage of this technology is the absence of the need for tumescent anesthesia.Mechanical-chemical elimination should, according to its creators, trigger a stronger destruction effect than foam sclerotherapy, although for some reason convincing data has not yet been presented.It is clear that such varicose veins can be treated with other minimally invasive methods, so the advantages are not clear.We have to wait for further studies from Europe or the United States to determine the exact place of this technology.
Miniphlebectomy
This is a modern microsurgical aesthetic method to remove varicose veins.It involves the delicate technique of puncturing and pulling out varicose veins using a special tool.This operation is not for novice phlebologists;you need to have fine surgical skills.Miniphlebectomy is surgery without the use of a scalpel and is performed under local anesthesia.The puncture is done towards the skin line, so after 2 months it is almost invisible.
Miniphlebectomy has replaced the classic operation for varicose veins, which involves the use of a 1-3 cm incision, because it is perfectly aesthetic, painless and very effective.Assuming how varicose veins manifest, the doctor can clearly plan the micropuncture and survive with minimal intervention.Patients can go home on their own right after surgery.Miniphlebectomy can be an effective independent method to treat varicose veins, or used in combination after laser coagulation of varicose veins.Varicose vein removal 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 on the legs - an effective treatment regardless of the cause.
Treatment results
Varicose vein treatment results
The results of modern therapy for varicose veins can be considered very good.Any technology, if done 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.An innovative vascular center is ready to help you face any venous disease without incisions or pain.We know how to cure varicose veins and have extensive experience.Varicose vein treatment should not be a problem in the modern world of high technology.