Varicose veins of the legs are a disease of the saphenous veins, which leads to their pathological expansion.Varicose veins are swollen varicose veins that usually develop on the legs.Varicose veins occur more often in women than in men.For a long time, varicose veins were only a cosmetic problem (spider veins), but if left untreated, varicose veins continue to progress and can lead to complications over time.The main complications - trophic ulcers, thrombophlebitis, changes in skin color without treatment - occur in 70% of patients with varicose veins.
Symptoms of varicose veins
- Swollen dilated veins in the legs
- Feeling of heaviness in the legs, tiredness 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 ulcers of the skin
Causes of varicose veins and risk factors
- Aggravated heredity – congenital failure of the valve apparatus
- Heavy physical work while standing
- Frequent pregnancies and births
- 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 serious surgical interventions, without pain, cuts and hospitalization.
The modern level of phlebology makes it possible to treat varicose veins painlessly, very aesthetically and reliably for the patient.The first signs of varicose veins should be a reason to see a phlebologist.Varicose veins of the lower extremities mean a complete disappearance of the tone of the venous wall, so it is pointless to influence varicose vein transformation with tablets and leeches as treatment.
diagnosis
Complaints and symptoms
Varicose veins begin with the appearance of individual nodules of enlarged veins and progress steadily.Varicose veins do not initially cause any problems, 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 complaints
Most patients with varicose veins simply complain about unsightly varicose vein nodes that affect the appearance of their legs.Such complaints are particularly often caused by varicose veins in women.Cosmetic problems are often caused by small varicose veins and spider veins, which do not endanger your health but force you to close your legs.Such patients require treatment for cosmetic reasons, so only minimally invasive (no incisions) 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 leg cramps at night.These are signs of chronic venous insufficiency.Gradually, the symptoms worsen and painful sensations in varicose veins may appear.Skin changes and pigmentation occur.With severe venous insufficiency, damage to the skin in the lower third of the leg can occur with the formation of a difficult-to-treat trophic ulcer.Patients with advanced varicose veins often experience inflammation of the skin – eczema.
Examination by a phlebologist
If varicose veins cause discomfort, consultation with a phlebologist is necessary.The examination is carried out lying down and standing.The patient must open his legs completely.
Varicose veins are diagnosed as part of a routine examination, which should be carried out while standing with the veins full.After the examination, an ultrasound duplex examination 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 examination of veins
In the case of varicose veins, the purpose of ultrasound examination of the veins is to determine the insufficiency of the venous trunks, detect non-functioning venous valves and detect blood clots in the superficial and deep venous system.
The examination begins with examining the saphenous veins while standing.The diameter and patency of the large and small saphenous veins are examined, the consistency of the valves is determined (Valsalva maneuver - tension of the abdominal muscles during full inhalation, a sign of incompetence is reverse blood flow).The perforating veins at typical locations and their viability during the Valsalva maneuver are then examined.
After assessing the superficial veins, the patency of the deep veins must be assessed.To do this, the popliteal and thigh veins are examined while lying down and their patency and the condition of the valves are assessed.
Contrast velography
Usually, an ultrasound examination is sufficient for a complete diagnosis of venous pathology.However, in some cases it is necessary to study the connection between the condition of the deep and superficial venous systems, especially in cases of relapses of varicose veins and secondary varicose veins.
To solve these problems, a contrast X-ray examination is used.The saphenous veins are punctured and contrast medium is administered.The movement of the contrast medium is observed on the monitor of the X-ray machine and all necessary tests and projections are carried out.Venography is currently only used very rarely for varicose veins.
Treatment
The “classic” varicose vein operation under anesthesia with incisions in the groin and legs, which was carried out at the beginning of the last century to remove superficial varicose veins, is a thing of the past.The suffering of patients, long hospital stays and pain in the legs after such operations to improve blood circulation are completely unjustified.Severe varicose veins can be treated without the use of “inquisition methods”.Today, treatment of advanced varicose veins can be carried out without anesthesia and hospitalization.The work of a phlebologist becomes a practice, without the features of a major operation.
Knowledge of the causes of varicose veins in the legs allowed us to develop hemodynamic treatment principles.Their implementation is possible by removing or switching off the vein from the bloodstream.Modern technologies are based on the principle of fusing venous walls in the area of insufficient venous valves.The method of influencing venous circulation may be different, but the goal is the same: to stop the pathological outflow of blood through the affected vein (anti-reflux).
How to cure varicose veins on the legs?
Understanding the cause of varicose veins will help you 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 the insufficient saphenous veins of the lower extremities.
- Elimination of reflux between deep and superficial veins – perforating veins – 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 socks.
Capabilities of the vascular center
Thermal methods for the treatment of varicose veins are endovenous laser coagulation (EVLC) and radiofrequency obliteration (RFO) of the veins of the lower extremities.
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.During laser coagulation, the damaged vein is heated by a laser beam, which leads to severe damage to the collagen of the vein wall and causes an inflammatory process in the vein and its overgrowth.Advanced varicose veins on the legs treated with this method disappear 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 vein through a skin puncture that 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 proper use of the EVLT method, complete elimination of varicose veins is observed in 98% of patients.The possibilities of this method allow both the treatment of varicose veins on the legs in women and the correction of venous outflow in trophic ulcers.
Radiofrequency obliteration (RFO)
Treatment of varicose veins using the radiofrequency obliteration method (RFO) is a similar thermal method, but the heating of the tissue of the vein wall occurs according to other physical principles due to radio wave energy.Radiofrequency obliteration allows you to remove varicose veins and eliminate their symptoms;Such treatment does not differ from EVLT in its immediate and long-term results, but is more complex for a phlebologist.
Other thermal methods
When deciding how to treat varicose veins, phlebologists often resorted to 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 further development of varicose veins and treat the patient on an outpatient basis without disrupting his lifestyle.In the hands of an inexperienced phlebologist, thermal ablation methods can cause unpleasant complications: reduced sensitivity, burns, seals.The effectiveness of this method in the hands of an experienced phlebologist is over 98%, and the laser method and RFO make it possible to eliminate not only the original form, but also pronounced varicose veins on the legs without cuts.In the photos from the “Treatment Results” section you can see the view before and after the minimally invasive treatment.
Non-thermal methods for eliminating trunk reflux
For many years, phlebologists have been thinking about how to cure varicose veins of the lower extremities without cuts and pain.The disappearance of the saphenous veins in the arms after frequent injections suggested that some substances can cause inflammation of the vein walls - thrombophlebitis - and their subsequent adhesion with the disappearance of the vein lumen.After the advent of the Fegan method, when the treatment of varicose veins was carried out based on the cause, 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 doctors' offices at the end of the 19th century.In recent years, the method of treating varicose veins by injecting a special substance (sclerosant) has reached perfection.The main purpose of sclerotherapy is to inject a drug into a varicose vein, causing inflammation and subsequent adhesion of the varicose vein.Sclerotherapy is not about eliminating the cause of venous insufficiency, but is more suitable for certain types 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 large or small saphenous vein does not mean that sclerotherapy will have a long-term effect, as a relapse is certain to occur due to reflux.
Sclerotherapy can be performed if there is no allergy to tetradecyl sulfate or polidocanol.These substances are the most important sclerosing agents.Manifestations of thrombophlebitis may occur during sclerotherapy treatment, especially when using liquid forms of the drug.Sclerotherapy of perforating veins is highly effective in the treatment of venous trophic ulcers.With the help of sclerotherapy it is possible to eliminate the manifestations of varicose veins of the lower extremities at any stage, however, the relapse rate in the next 5 years is about 40%.
The advantage of sclerotherapy is a good immediate effect and low treatment costs.Injections of sclerosing agents lead to the sticking of the veins and the cessation of the pathological process - the backflow of blood through the saphenous veins.The medication is usually injected into varicose veins in the form of foam.There is a spasm of dilated subcutaneous vessels, prolonged contact of the foam form of the sclerosant with the venous wall and its subsequent inflammation and adhesion.This process proceeds unevenly and the degree of obliteration of the vein is not the same, so 40% of patients experience relapses of varicose veins after sclerotherapy.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 prevent the occurrence 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 as an independent method or in combination with laser treatment to eliminate varicose veins.The number of sessions to eliminate varicose veins using sclerotherapy depends on the stage of varicose veins and the condition of the veins.The course of treatment usually consists of 2-3 procedures.The skin area over the sclerotic vessel may acquire a dark shade for 2-3 months (hyperpigmentation occurs).It can ruin a woman's legs for several months, so this treatment is best done in the winter months.Drug treatment and ultrasound-guided vascular punctures can accelerate the process of resorption of intravascular fluid accumulations (coagulation), the risk of which is around 10%.If compression is insufficient, blood clots form, but these disappear over time.Many patients know that the signs of varicose veins of the lower extremities disappear within a month after sclerotherapy for many years, which is why sclerotherapy is still one of the most popular treatment methods.
Use of special glue
Since its introduction, this method has attracted great interest among phlebologists.The trunk of the large saphenous vein is glued together with a special cyanoacrylate adhesive.This glue polymerizes in the lumen of the vessel and fills the lumen of the dilated vessel.According to the developers, this method does not require anesthesia and creates a “plug” in the vessel that reliably blocks blood flow.Given this, half an hour is enough for the procedure to eliminate varicose veins on the legs.Venasil is the only technology for treating varicose veins that does not require wearing 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 should begin in the near future.However, there are certain disadvantages: The presence of a foreign body in the human body.The coagulated glue remains in the vessel forever and can trigger chronic allergies;sometimes there is inflammation of the vascular wall or rejection of the polymer with suppuration.Acute thrombophlebitis of the adhered vessel can occur.
The use of glue in the trunk of the great saphenous vein does not relieve the need to remove varicose veins, so doctors have to remove signs of subcutaneous varicose veins using sclerotherapy or miniphlebectomy.The visible effect of using glue occurs only in combination with other methods of eliminating varicose veins.The patient has to pay more.Due to the disproportionately high cost of the adhesive set, this process is significantly more expensive than the modern laser or radio frequency method.
Thermal methods are preferred in our clinic.We believe that it is better to use good local anesthesia than to treat varicose veins of the saphenous veins on the legs with an expensive and unproven method.Beyond that, the result is the same at best.If a relapse occurs, the patient must undergo a complex operation to remove the blocked vessel because other methods can no longer be used.
Technology of mechanical-chemical destruction
The modern method of combined treatment of reflux along the subcutaneous vein trunks gives additional weight to conventional sclerotherapy.Mechanochemical interventions are understood as 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 vein through a puncture under ultrasound control.After installing the catheter in the desired location, the device is connected.The rotating sharp head of the catheter makes up to 3.5 thousand revolutions per minute and causes serious 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 acts on the vessel wall through the rotating part of the catheter, causing its inflammation and adhesion.
The only advantage of this technology so far is that it does not require tumescent anesthesia.Mechanochemical obliteration, according to its inventors, should cause a stronger obliteration effect than foam sclerotherapy, although for some reason convincing data have not yet been presented.It is clear that such varicose veins can be treated with other minimally invasive methods, so the benefits are not obvious.We will have to wait for further studies from Europe or the USA to accurately determine the place of this technology.
Miniphlebectomy
This is a modern microsurgical aesthetic method for removing varicose veins.This is a delicate technique of puncturing and pulling out varicose veins using special tools.This operation is not for an inexperienced phlebologist;You must have the skills of delicate surgery.Miniphlebectomy is an operation without a scalpel and is performed under local anesthesia.The punctures are made towards the skin lines, so they are practically invisible after 2 months.
Miniphlebectomy has replaced classic varicose vein surgery with 1-3 cm long incisions because it is aesthetically flawless, painless and very effective.By assuming how varicose veins manifest themselves, the doctor can clearly plan micropunctures and get by with minimal interventions.The patient can go home on his or her own feet immediately after the operation.Miniphlebectomy can be an independent effective method of treating varicose veins or 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 is perfectly mastered by our phlebologists and allows the removal of varicose veins on the legs - an effective treatment regardless of the cause.
Treatment results
Results of treatment of varicose veins
The results of modern therapy for varicose veins can be described as very good.Any technology, if performed 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 drainage.The innovative vascular center helps you manage any venous disease without cuts and pain.We know how to cure varicose veins and have extensive experience.Treating varicose veins should not be a problem in the modern world of high technology.