Varicose veins of the lower extremities

Varicose veins are a disease of the saphenous vein in which their pathological expansion develops. Varices are swollen varicose veins that usually develop on the legs. Varicose veins are more common in women than men. Varicose veins are only a cosmetic problem (spider veins) for a long time, but if left untreated, varicose veins progresses continuously and can become complications over time. The main complications - trophic ulcers, thrombophlebitis, skin discoloration without treatment - occur in 70% of patients with varicose veins.

Varicose veins of the lower extremities

Symptoms of varicose veins

  • Swollen dilated veins in the legs
  • A feeling of heaviness in the legs, tiredness in the evening
  • Swelling of the feet in the evening after training
  • Discoloration of the skin on the lower leg
  • Inflammation of the saphenous vein - thrombophlebitis
  • Trophic skin ulcers

The causes of varicose veins and risk factors

  • Complicated inheritance - congenital failure of the valve apparatus
  • Heavy physical work while standing
  • Frequent pregnancy and childbirth
  • High Heel Walking

Modern methods of treating varicose veins of the lower extremities in our clinics allow us to solve this problem without resorting to serious surgical intervention, pain, cuts and hospitalization.

The modern level of phlebology enables the pain-free treatment of varicose veins for the patient, very aesthetically pleasing and reliable. The first signs of varicose veins should be the reason for contacting a phlebologist. Varicose veins of the lower extremities mean a complete disappearance of the tone of the vein wall. Therefore, there is no point in treating varicose veins with tablets and leeches for treatment.

Diagnosis

Ailments and symptoms

Varicose veins begin with the appearance of individual nodules of varicose veins and continue to develop steadily. Varicose veins don't cause problems at first, but over time they become a risk factor for serious health threats. So let's take a look at the main problems that affect patients with varicose veins:

Cosmetic complaints

Most patients with varicose veins only complain of ugly varicose veins that affect the appearance of the legs. Such symptoms are particularly often caused by varicose veins in women. Cosmetic complaints are often caused by a fine network of varicose veins and spider veins, which do not endanger health, but force the legs to close. Such patients require treatment for cosmetic reasons, so they are only shown minimally invasive methods (no incisions).

Chronic venous insufficiency

About 30% of patients with varicose veins develop symptoms of heaviness in the legs, swelling in the evening and cramps in the calves at night. These are signs of chronic venous insufficiency. Gradually, its phenomena worsen, there may be painful sensations in varicose veins. Skin changes and pigmentation develop. In severe venous insufficiency, the skin on the lower third of the leg can be damaged by the formation of a trophic ulcer that is difficult to treat. Often, patients with advanced varicose veins develop skin inflammation - eczema.

Examination of the phlebologist

If you have varicose veins, a consultation with a phlebologist is required if you feel unwell. The examination is carried out lying down and standing. The patient must fully open their legs.

Varicose veins are diagnosed through a routine examination, which should be done while standing when the veins are full. An ultrasonic duplex scan is always required after the inspection. Such a diagnosis is usually sufficient. However, if secondary varicose veins are suspected, it is necessary to examine the deep venous system.

Ultrasound vein scanning

With varicose veins, the task of ultrasound of the veins is to find out the failure of the venous trunks, to identify inoperative venous valves and to identify blood clots in the superficial and deep venous system.

The examination begins with a standing examination of the saphenous vein. The diameter and patency of the large and small saphenous veins are examined, the consistency of the valves is determined (Valsalva test - the tension of the abdominal muscles with a full breath, a sign of bankruptcy is the reverse flow of blood). The perforation veins are then examined at typical locations and their consistency during the Valsalva maneuver.

After assessing superficial veins, the patency of deep veins must be assessed. The popliteal and femoral veins are also examined for this lying position; their patency and the consistency of the valves are also assessed.

Contrast phlebography

Usually the ultrasound scan is sufficient for a complete diagnosis of venous pathology. However, in some cases, it is necessary to study the relationship between the state of the deep and superficial venous systems, especially with relapses of varicose veins, with secondary varicose veins.

Ultrasound examination

To solve these problems, a contrast x-ray examination is carried out. The saphenous veins are punctured and contrast agent is injected. A contrast movement is observed on the monitor of the X-ray machine, all necessary tests and projections are carried out. At present, venography is very rarely used for varicose veins.

Treatment

The "classic" operation for varicose veins under anesthesia with incisions in the groin and along the legs, with which varicose veins were removed from the superficial veins at the beginning of the last century, is an atavism of the past. The patient's suffering, prolonged hospitalization and leg pain after such operations to improve blood flow are completely unjustified. You can treat severe varicose veins without resorting to the "methods of the inquisition". Today, advanced varicose veins can be treated without anesthesia or hospital. The work of a phlebologist becomes office work without the characteristics of major surgery.

Knowledge of the causes of varicose veins on the legs made it possible to develop hemodynamic treatment principles. It can be implemented by removing the vein from the circulation or by turning it off. Modern technologies are based on the principle of fusing the vein walls in the area of ​​insufficient venous valves. The method of influencing the venous circulation may be different, but the goal is the same - to stop the pathological release of blood through the affected vein (antireflux).

How can leg varicose veins be cured?

Knowing 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 the pathological discharge in an upright position along the incompetent saphenous vein of the lower extremities.
  • Elimination of reflux between deep and superficial veins - perforants - the main mechanism for the development of convulsive trophic ulcers.
  • Removal of varicose veins - degenerated superficial vessels (varix).
  • Compression therapy with special stockings and golf.

Vascular Center Skills

  • Thermal treatment of varicose veins - endovenous laser coagulation (EVLK) and high frequency obliteration (RFO) of the veins of the lower extremities.

    Heat treatments

    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 appeared in 2001 and is still the best method. With laser coagulation, the modified vein is heated by a laser beam, which severely damages the collagen in the vein wall. An inflammatory process occurs in the vein and its overgrowth. Triggered varicose veins on the legs, which are treated completely and without a trace with this method, recede. The main symptoms disappear: edema, heaviness in the legs, hyperpigmentation of the skin.

    EVLK begins with the fact that a laser fiber is inserted into the lumen of the varicose vein through a puncture of the skin carried out 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 further development of the disease and its complications. Complete elimination of varicose vein syndrome is observed in 98% of patients with correct application of the EVLK method. The possibilities of this method make it possible to treat both varicose veins on the legs in women and to correct venous discharge in trophic ulcers.

    RFO (Radio Frequency Obliteration)

    The treatment of varicose veins with the method of radio frequency obliteration (RFO) is a similar thermal method, but the tissue of the vein wall is heated according to different physical principles due to the radio wave energy. Radiofrequency obliteration allows you to remove varicose veins and eliminate their symptoms. Such treatment is no different from EVLK in its immediate and long-term results, 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 heat 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 treat the patient on an outpatient basis without affecting his lifestyle. In the hands of an inexperienced 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%. With the laser method and RFO, you can remove not only the original shape, but also severe, pronounced varicose veins on the legs without cuts. The photos from the "Treatment results" area show the view before and after the minimally invasive treatment.

    Non-thermal methods of eliminating trunk backflow

    Phlebologists have been thinking about how to cure varicose veins of the lower extremities without cuts and pain for many years. The disappearance of the saphenous vein in the arms after frequent injections suggested that some substances can cause inflammation of the walls of the veins - thrombophlebitis and its subsequent sticking together with the disappearance of the venous lumen. After the advent of the Fegan method, when treatment began due to the cause of the appearance of varicose veins, the development of non-thermal methods of sclerobliteration 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 with the help of injections of a special substance (sclerosant) has reached its perfection. The main point of sclerotherapy is to inject into the varicose vein a drug that causes inflammation and subsequent adhesion of the varicose vein. Sclerotherapy does not mean eliminating the cause of venous insufficiency and is more suitable for certain types of varicose veins or in the early stages of the disease. Started 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 allow counting on the long-term effects of sclerotherapy, since reflux necessarily causes relapse.

    Sclerotherapy can be done if you are not allergic to tetradecyl sulfate or polidocanol. These substances are the main sclerosing agents. Against the background of sclerosing treatment, manifestations of thrombophlebitis can appear, especially if liquid forms of the drug are used. Sclerotherapy of perforation veins is highly effective in treating venous trophic ulcers. With the help of sclerotherapy, the manifestations of varicose veins of the lower extremities can be eliminated at any stage, but the rate of recurrence in the next 5 years is about 40%.

    The advantage of sclerotherapy is a good immediate effect and low treatment costs. Sclerosing injections lead to the sticking of veins and the termination of the pathological process - backflow of blood through the saphenous vein. The drug is usually injected into the varicose veins as a foam. A spasm of the enlarged subcutaneous vessels forms, a prolonged contact of the foam form of the sclerosant with the vein wall, and its subsequent inflammation and adhesion. This process is uneven and the degree of vein obliteration is not the same. Therefore, 40% of patients have relapses of varicose veins after sclerotherapy. After sclerotherapy, the affected area of ​​the veins of the lower extremities closes and over time the blood flow in the opposite direction is completely overgrown. In order to prevent the appearance of skin necrosis due to the entry of the foam form of the sclerosant into the subcutaneous tissue, its introduction is carried out strictly under ultrasound control.

    Foam sclerotherapy can be used both as an independent method and in combination with laser treatment to remove varicose veins. The number of sessions for the elimination of varicose veins using sclerotherapy depends on the stage of the varicose veins and the condition of the veins. As a rule, the course of treatment consists of 2-3 procedures. The area of ​​the skin over the sclerosed vessel may take on a dark shade for 2-3 months (hyperpigmentation occurs). It can ruin women's legs for several months, so this treatment is best done during the winter months. Drug treatment and vascular puncture under ultrasound guidance can accelerate the process of resorption of intravascular accumulations of fluid (coagulate), the risk of which is about 10%. Coaguli are formed with insufficient compression, but over time they will necessarily pass. The fact that in a month after sclerotherapy, the signs of varicose veins of the lower extremities disappear for many years, many patients know, which is why sclerotherapy is still one of the most popular treatments.

  • Use of special glue

    Since its introduction, this method has aroused great interest among phlebologists. The trunk of the great saphenous vein is glued with a special cyanoacrylate adhesive. This adhesive polymerizes in the lumen of the vessel and fills the lumen of the expanded vessel. As designed by the developers, this method does not require anesthesia, and a "plug" appears in the vessel, reliably blocking the flow of blood. In view of this, half an hour is enough to get rid of varicose veins on the legs. Venasil is the only varicose vein treatment technology that does not require compression stockings.

    Most women can return to normal activities immediately. Symptoms of chronic venous insufficiency stop shortly after the procedure. The process of actively promoting this glue in the phlebological market should begin in the near future. But there are certain disadvantages: Presence of a foreign object in the human body. The coagulated adhesive stays in the vessel forever and can cause chronic allergies. Sometimes there is inflammation of the vessel wall or rejection of the polymer with suppuration. Acute thrombophlebitis of a glued vessel can occur.

    The use of glue in the trunk of the great saphenous vein does not eliminate the need to deal with varicose vein elimination, which is why doctors must eliminate the signs of subcutaneous varicose veins through sclerotherapy or miniflebectomy. The visible effect of using glue is evident only when combined with other methods of eliminating varicose veins. The patient has to pay more. The inappropriately high cost of the adhesive kit makes this process much more expensive than the modern laser or radio frequency process.

    In our clinic, thermal methods are preferred. We believe that having good local anesthesia is better than treating varicose veins in the legs using an expensive and untested method. Furthermore, the result is the same at best. In the event of relapse, the patient will have to undergo complex surgery to remove the sealed vessel, since other methods are no longer applicable.

  • Mechano-chemical obliteration technology

    The modern method of combined treatment of subcutaneous venous reflux gives additional weight to conventional sclerotherapy. Mechanochemical processes are understood as a combination of mechanical damage to the inner surface of the vein wall and the introduction of a sclerosing drug. A catheter is inserted into the main saphenous vein through a puncture under ultrasound guidance. After placing the catheter in place, connect the device. The rotating sharp head of the catheter makes up to 3, 5 thousand revolutions per minute and causes severe damage to the inner layer of the vein wall. In parallel, a sclerosing drug is injected through the catheter, which is "mixed" in the lumen of the vessel and, with the help of the rotating part of the catheter, acts on the vessel wall and causes its inflammation and adhesion.

    Today the only advantage of this technology is that it does not require tumescent anesthesia. Mechanochemical obliteration, according to the idea of ​​its inventors, should trigger a stronger obliteration effect than foam sclerotherapy, although for some reason no convincing data have yet been presented. It is clear that such varicose veins can be treated using other minimally invasive methods, so their benefits are not obvious. We have to wait for the next studies from Europe or the USA to determine the location of this technology.

  • Miniflebectomy

    This is a modern microsurgical-aesthetic method for removing varicose veins. This implies a delicate technique of piercing and pulling out varicose veins with special tools. This operation is not suitable for beginners. You need to master the skills of delicate surgery. The miniflebectomy 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 that they are almost invisible after 2 months.

    Miniflebectomy

    The mini phlebectomy has replaced the classic operation for varicose veins, in which incisions of 1 to 3 cm are used, as it is aesthetically perfect, painless and very effective. Assuming how varicose veins will manifest, the doctor can clearly plan microdots and do it with minimal intervention. The patient can go home on their own two feet immediately after the operation. The miniflebectomy can be an independent effective method for the treatment of varicose veins or it can be used in combination after the laser coagulation of varicose veins. Varicose veins are removed using a special technique developed by Professor Varadi. This technique, perfectly mastered by our phlebologists, allows the removal of varicose veins in the legs - an effective treatment, regardless of their cause.

Treatment results

Results of the treatment of varicose veins

The results of modern therapy for varicose veins can be considered very good. Any technology with good performance will eliminate the symptoms of varicose veins of the legs. Almost 95% of patients are varicose vein free for 5 years or more, and 80% of them never have serious problems with venous discharge. The innovative vascular center will help you treat venous diseases without cuts or pain. We know how to cure varicose veins and have a lot of experience. Treating varicose veins shouldn't be a problem in today's high-tech world.