Varicose veins are a disease of the saphenous veins, 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 in men. For a long time varicose veins are just a cosmetic problem (varicose veins), but if varicose veins are not treated then it progresses continuously and over time can lead to complications. The main complications - trophic ulcers, thrombophlebitis, skin discoloration without treatment develop in 70% of patients with varicose veins.
Symptoms of varicose veins
- Swollen dilated veins in the legs
- Heaviness in the legs, fatigue in the evening
- Swelling of the feet in the evening after exercise
- Discoloration of the skin in the lower leg
- Inflammation of the saphenous veins - thrombophlebitis
- Trophic skin ulcers
The causes of varicose veins and risk factors
- Complicated inheritance - congenital failure of the valve apparatus
- Heavy physical work in a standing position
- Frequent pregnancy and childbirth
- Walking with high heels
Modern methods of treating varicose veins of the lower limbs in our clinics allow us to solve this problem without resorting to serious surgery, without pain, incisions and hospitalization.
The modern level of phlebology allows the treatment of varicose veins in a painless way 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 imply a complete disappearance of the tone of the venous wall, so it is useless to treat varicose veins with compresses and leeches as a treatment.
Complaints and symptoms
Varicose veins begin with the appearance of individual varicose vein nodules and progress steadily. Varicose veins do not cause any problems at first, but over time they become a risk factor for serious health threats. So, let's take a look at the main issues of concern for patients with varicose veins:
Most patients with varicose veins only complain of ugly varicose veins that spoil the appearance of the legs. Especially often such complaints are caused by varicose veins in women. Most often, aesthetic discomfort is caused by a thin varicose web and spider veins, which do not threaten health, but force the legs to close. Such patients need treatment for aesthetic reasons, therefore only minimally invasive methods (no incisions) are shown.
Chronic venous insufficiency
About 30% of patients with varicose veins develop leg discomfort, swelling in the evening and nocturnal calf cramps. These are signs of chronic venous insufficiency. Gradually, its phenomena are aggravated, painful sensations may appear in the varicose nodes. Skin changes and pigmentation develop. In the case of severe venous insufficiency, the skin in the lower third of the leg can be damaged with the formation of a trophic ulcer, which is difficult to treat. Often, patients with advanced varicose veins develop inflammation of the skin - eczema.
Visit of the phlebologist
Consultation with a phlebologist is necessary if varicose veins cause you discomfort. The exam is performed while lying down and standing. The patient must fully open his legs.
Varicose veins are diagnosed by a routine examination, which must be performed standing up when the veins are full. An ultrasonic duplex scan is always required after inspection. As a rule, such a diagnosis will suffice. However, if secondary varicose veins are suspected, the deep venous system should be examined.
Ultrasound of the veins
In case of varicose veins, the ultrasound of the veins has the task of discovering the subsidence of the venous trunks, identifying non-operative venous valves and detecting blood clots in the superficial and deep venous systems.
The examination begins with a standing examination of the saphenous veins. The diameter and permeability of large and small saphenous veins are studied, the consistency of the valves is determined (Valsalva test - the tension of the abdominal muscles with a full breath, a sign of insolvency is reverse blood flow). Then the perforating veins in typical locations and their consistency in the Valsalva maneuver are examined.
After evaluating the superficial veins, it is necessary to evaluate the patency of the deep veins. For this, lying down, a study of the popliteal and femoral veins is performed, their patency and the consistency of the valves are also evaluated.
Usually, 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 system, especially in relapses of varicose veins, with secondary varicose veins.
X-ray examination with contrast is used to solve these problems. The saphenous veins are punctured and the contrast is injected. The contrast movement is observed on the monitor of the X-ray machine, all necessary tests and projections are performed. Currently, venography for varicose veins is used very rarely.
The "classic" operation for varicose veins under anesthesia with incisions in the groin and along the legs, which at the beginning of the last century was used to remove the varicose veins of the superficial veins, is an atavism of the past. Patient suffering, prolonged hospitalization and pain in the legs after such operations aimed at improving blood outflow are completely unjustified. You can cure severe varicose veins without resorting to "Inquisition methods". Today, the treatment of advanced varicose veins can be done without anesthesia and without a hospital. The job of a phlebologist becomes an office job, without the attributes of major surgery.
The knowledge of the causes of varicose veins on the legs allowed us to develop the hemodynamic principles of treatment. Their implementation is possible by removing or turning off the vein from the circulation. Modern technologies are based on the principle of fusion of the walls of the veins in the area of insufficient venous valves. The method of influencing venous circulation can be different, but its goal is the same - to stop the pathological discharge of blood through the affected vein (antireflux).
How can varicose veins in the legs be treated?
Understanding the cause of varicose veins allows you to choose the correct treatment method. The goal of modern varicose vein treatment is to solve several problems:
- Cessation of pathological discharge in an upright position along the incompetent saphenous veins of the lower limbs.
- 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 (varices).
- Compression therapy with special socks and golf.
Functionality of the vascular center
Thermal treatments for varicose veins - intravenous laser coagulation (EVLK) and radio frequency obliteration (RFO) of the veins of the lower limbs.
Intravenous laser coagulation is an effective treatment of 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. During laser coagulation, the modified vein is heated by a laser beam, which provides a strong collagen damage effect of the venous wall, an inflammatory process occurs in the vein and its overgrowth. Varicose veins thrown on the legs, which are treated by this method, regress completely and without a trace, pass its main symptoms: 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 vessel through a puncture of the skin, which is performed 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 syndrome is observed in 98% of patients with the correct application of the EVLK method. The possibilities of this method allow both to treat varicose veins on the legs in women and to correct the venous outflow in case of trophic ulcers.
Radio Frequency Cancellation (RFO)
Treatment of varicose veins by the radio frequency obliteration (RFO) method is a similar thermal method, but the tissue of the venous wall is heated according to different physical principles due to the energy of radio waves. Radio frequency obliteration allows you to remove varicose veins and eliminate its symptoms, such treatment in its immediate and long-term results does not differ from EVLK, however, it is more scrupulous for a phlebologist.
Other thermal methods
In deciding how to treat varicose veins, phlebologists often used exotic methods. Varicose veins were treated with heat exposure 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 the patient to be treated on an outpatient basis, without interrupting his 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 and RFO method allow you to get rid of not only the initial form, but also severe pronounced varicose veins on the legs without incisions. In the photos of the "Treatment results" section you can see the view before and after the minimally invasive treatment.
Non-thermal methods to eliminate stem reflux
Phlebologists have been thinking for many years about how to cure varicose veins of the lower limbs without incisions and pain. The disappearance of the saphenous veins in the arms after frequent injections suggested that some substances can cause inflammation of the venous walls - thrombophlebitis and their subsequent gluing together with the disappearance of the venous lumen. After the advent of Fegan's method, when the treatment began to be carried out according 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, are treated not only with a scalpel, but also with a syringe.
Sclerotherapy appears in the practice of doctors at the end of the 19th century. In recent years, the method of treating varicose veins by injections of a special substance (sclerosing) has reached perfection. The main point of sclerotherapy is to inject a drug into the varicose vein which causes inflammation and subsequent adhesion of the varicose vein. Sclerotherapy does not involve eliminating the cause of venous insufficiency and is more indicated for some forms of varicose veins or in the initial phase of the disease. Launched varicose veins of the lower extremities are treated by more complex methods, damage to the trunk of the large or small saphenous vein does not allow to count on the long-term effect of sclerotherapy, since reflux necessarily causes a relapse.
Sclerotherapy can be done if you are not allergic to tetradecyl sulfate or polidocanol. These substances are the main sclerosants. Against the background of sclerosing treatment, manifestations of thrombophlebitis can occur, especially if liquid forms of the drug are used. Perforating vein sclerotherapy is very effective in the treatment of venous trophic ulcers. It is possible to eliminate the manifestations of varicose veins of the lower limbs at any stage with the help of sclerotherapy, but the recurrence rate is about 40% within the next 5 years.
The advantage of sclerotherapy is a good immediate effect, a low cost of treatment. Injections of sclerosing agents lead to gluing of the veins and the end of the pathological process - reflux of blood through the saphenous veins. The drug is usually injected as a foam into the varicose veins. A spasm of dilated subcutaneous vessels is formed, prolonged contact of the sclerosing foam form with the venous wall and their subsequent inflammation and adhesion. This process is not uniform and the degree of obliteration of the vein is not the same; therefore, 40% of patients after sclerotherapy have relapses of varicose veins. After sclerotherapy, the affected area of the veins of the lower extremities closes and over time fully enlarges, the blood flow in the opposite direction stops. For the prevention of skin necrosis, due to the penetration of the foam form of the sclerosant into the subcutaneous tissue, the introduction is carried out strictly under the control of ultrasound.
Foam sclerotherapy can be used both as an independent method and in combination 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, the condition of the veins. The course of treatment usually consists of 2-3 procedures. The skin area above the sclerosed vessel may take a dark shade for 2-3 months (hyperpigmentation appears). It can ruin women's legs for several months, so this treatment is best done during the winter months. Pharmacological treatment and vascular puncture under ultrasound control can accelerate the process of reabsorption of accumulations of intravascular fluid (clot), the risk of which is about 10%. Clots are formed with insufficient compression, but over time they will necessarily pass. The fact that a month after sclerotherapy the signs of varicose veins of the lower extremities disappear for many years, many patients know, so sclerotherapy is still one of the most popular methods of treatment.
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 adhesive will cure and fill the lumen of the expanded vessel. As conceived by the developers, this method does not require anesthesia, and a "plug" appears in the vessel that reliably blocks blood flow. Considering this, 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 compression stockings.
Most women can return to normal activities immediately. Symptoms of chronic venous insufficiency disappear soon after the procedure. The process of actively promoting this glue on the phlebology market is expected to begin in the near future. However, there are some disadvantages: Presence of a foreign body in the human body. The coagulated glue remains forever in the vessel and is capable of causing chronic allergies, sometimes there is inflammation of the vessel wall or rejection of the polymer with suppuration. Acute thrombophlebitis of a glued vessel may appear.
The use of glue in the trunk of the great saphenous vein does not eliminate the need to deal with the elimination of varicose tributaries, which is why doctors will have to remove the signs of subcutaneous varicose veins with sclerotherapy or miniflebectomy. The visible effect of the use of glue is manifested only in the case of a combination with other methods of eliminating varicose veins. The patient has to pay more. The unreasonably high cost of the bonding kit makes this procedure much more expensive than the modern laser or radiofrequency method.
Thermal methods are preferred in our clinic. We believe that it is better to have a good local anesthetic than to treat varicose veins in the legs with an expensive and untested method. Furthermore, the result is the same at best. In the event of a relapse, the patient will have to perform a complex operation to remove the sealed vessel, as other methods will no longer be applicable.
Mechano-chemical destruction technology
The modern combined treatment method of subcutaneous venous reflux adds extra weight to conventional sclerotherapy. Mechanochemical procedures 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 saphenous vein through an ultrasound-controlled puncture. After placing the catheter in the right place, connect the device. The sharp rotating head of the catheter performs up to 3. 5 thousand revolutions per minute, causing pronounced damage to the inner layer of the venous 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 vascular wall, causing inflammation and adhesion.
Today, the only advantage of this technology is that tumescent anesthesia is not required. Mechanochemical obliteration should, according to the idea of its inventors, trigger a stronger obliteration effect than foam sclerotherapy, although convincing data has not yet been presented for some reason. It is clear that such varicose veins can be treated with other minimally invasive methods, so its benefits are not obvious. We have to wait for the next studies from Europe or the United States to pinpoint the place of this technology.
This is a modern microsurgical aesthetic method for removing varicose veins. It involves a gentle technique of piercing and extracting varicose veins using special tools. This operation is not for a novice phlebologist, it is necessary to master the skills of delicate surgery. Miniflebectomy is an operation without the use of a scalpel and is performed under local anesthesia. Punctures are performed in the direction of the skin lines, so after 2 months they are almost invisible.
The miniflebectomy has replaced the classic surgery for varicose veins, which involves the use of 1-3 cm incisions, as it is aesthetically flawless, painless and very effective. Assuming how varicose veins manifest themselves, the doctor can clearly plan the micro-punctures and do so with minimal intervention. The patient can go home on their own legs immediately after the operation. Miniflebectomy can be an effective independent method of treating varicose veins or used in combination after laser coagulation of varicose veins. Removal of varicose veins is performed using a special technique developed by Professor Varadi. This technique has been perfectly mastered by our phlebologists and allows the removal of varicose veins in the legs - an effective treatment regardless of its cause.
Treatment results for varicose veins
The results of modern therapy for varicose veins can be considered very good. Any technology in good performance 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 severe venous outflow problems. The innovative Vascular Center is ready to help you deal with any venous disorder without incisions or pain. We know how to cure varicose veins and have a lot of experience. Varicose vein treatment shouldn't be a problem in today's high-tech world.