Varicose veins in the legs are a disease of the saphenous veins, in which their pathology develops.Varicose veins are swollen varicose veins that often develop in the legs.Varicose veins develop more often in women than men.For a long time, varicose veins were just a cosmetic problem (spider veins) but if left untreated, varicose veins will continuously 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
- Swollen veins in the legs
- Heavy legs, tired in the evening
- Swollen feet in the evening after physical activity
- Changes in skin color on the lower legs
- Saphenous phlebitis - thrombosis
- Nutritional ulcers in the skin
Causes of varicose veins and risk factors
- Complex genetics - congenital insufficiency of the valve apparatus
- Heavy manual labor while standing
- Get pregnant and give birth regularly
- Wear high heels
Modern methods of treating varicose veins of the lower limbs in our clinics can solve this problem without resorting to serious surgical interventions, without causing pain, incisions and hospitalization.
Modern levels of phlebology make 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 contact a phlebologist.Varicose veins of the lower limbs indicate a complete disappearance of the tone of the vein walls, therefore, influencing the transformation of varicose veins with pills and leeches as a method of treatment is useless.
Diagnose
Complaints and symptoms
Varicose veins begin with the appearance of dilated veins and progress steadily.Varicose veins do not cause any problems at first, but over time they become risk factors for serious health risks.So, let's consider the main issues that worry patients with varicose veins:
Aesthetically unpleasant
Most patients with varicose veins complain only about unsightly varicose veins that spoil the appearance of their legs.Such complaints are especially common due to varicose veins in women.Quite 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 cosmetic reasons, so only minimally invasive (no incisions) methods should be used for them.
Chronic venous insufficiency
About 30% of patients with varicose veins complain of a feeling of heaviness in the legs, swelling in the evening, and nighttime cramps in the calves.This is a sign of chronic venous insufficiency.Gradually, its symptoms become more severe and painful sensations may appear in the dilated lymph nodes.Skin changes and pigmentation develop.With severe venous insufficiency, the skin in the lower third of the legs can be damaged, leading to the formation of trophic ulcers, which are very difficult to treat.Usually, patients with progressive varicose veins will develop dermatitis - eczema.
Examination by a phlebologist
It is necessary to consult a phlebologist if varicose veins cause you discomfort.The examination is performed in lying and standing positions.The patient must fully extend his legs.
Varicose veins are diagnosed during a routine examination, which should be done in a standing position while the veins are full.After the examination, a duplex ultrasound is always necessary.As a rule, such a diagnosis is enough.However, if secondary varicose veins are suspected, examination of the deep venous system is necessary.
Ultrasound scan of veins
In the case of varicose veins, venous ultrasound is responsible for determining the weakening of the venous trunks, identifying inactive venous valves and identifying blood clots in the superficial and deep venous system.
The examination begins with examining the saphenous veins in a standing position.The diameter and patency of the large and small saphenous veins are studied, the consistency of the valves is determined (Valsalva maneuver - tension of the abdominal muscles when fully inhaling, a sign of impotence is the backflow of blood).The perforating veins in typical locations and their viability during the Valsalva procedure are then studied.
After evaluating the superficial veins, patency of the deep veins should be assessed.For this purpose, while lying down, the popliteal and femoral veins are examined, and the strength and consistency of the valves are also assessed.
Contrast venography
Usually, ultrasound is enough to fully diagnose 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 these problems, contrast x-ray examination is used.The saphenous vein is punctured and contrast medium is injected.Movement of the contrast is observed on the screen of the X-ray machine and all necessary tests and projections are performed.Currently, venography for varicose veins is rarely used.
Treatment
The “classical” surgical treatment of varicose veins under anesthesia with incisions in the groin area and along the legs, used to eliminate superficial varicose veins at the beginning of the last century, is an anachronism of the past.Patient suffering, long hospital stays and pain in the legs after surgeries aimed at improving blood flow are completely unjustified.Severe varicose veins can be treated without resorting to “investigative methods”.Today, treatment of progressive varicose veins can be performed without anesthesia and hospitalization.The job of a phlebotomist becomes office-based, without the nature of major surgery.
Knowledge of the causes of varicose veins in the legs allowed us to develop the principles of hemodynamic treatment.Their implementation is possible by removing or shutting off the veins 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 can be different, but its goal is the same - to prevent pathological discharge of blood through the affected veins (anti-reflux).
How can you cure varicose veins in your legs?
Understanding the cause of varicose veins allows you to choose the right treatment.The goal of modern varicose vein treatment is to solve several problems:
- Termination of pathological discharges in a vertical position through the weak saphenous veins of the lower limbs.
- Eliminates reflux between deep and superficial veins - perforation - the main mechanism for the development of varicose trophic ulcers.
- Eliminate varicose veins - degenerated superficial blood vessels (varixes).
- Compression therapy with special stockings and socks.
The capacity of the vascular center
Thermal methods for treating varicose veins are endovenous laser coagulation (EVLC) and radiofrequency ablation (RFO) of lower extremity veins.
Endovenous laser coagulation is an effective treatment for varicose veins, the principle of operation is based on the thermal effect of laser energy.This treatment was introduced in 2001 and is still the best.With laser coagulation, the damaged vein will be heated by a laser beam, creating a strong impact that damages the collagen of the vein wall, causing an inflammatory process in the vein and its overgrowth.Severe varicose veins on the legs treated with this method will be completely relieved and leave no traces, and the main symptoms of the disease disappear: swelling, heaviness in the legs, increased skin pigmentation.
EVLT begins with the introduction of a laser fiber into the lumen of the dilated vessel through a puncture in the skin, which is guided along the affected vein to the site of the failed valve.For patients, this method is a safe, painless and reliable way to prevent further development of the disease and its complications.Complete elimination of varicose veins was observed in 98% of patients using the EVLT method correctly.The ability of this method to help both treat varicose veins in the legs in women and regulate venous flow in trophic ulcers.
Radio Frequency Clearance (RFO)
Treatment of varicose veins with radiofrequency ablation (RFO) is a similar thermal method, but the heating of the tissue of the vein wall occurs according to different physical principles due to radio wave energy.Radiofrequency removal allows you to eliminate varicose veins and eliminate its symptoms;Such treatment in terms of immediate and long-term results is no different from EVLT, but for the venous surgeon it is more difficult.
Other thermal methods
When deciding how to treat varicose veins, phlebologists often use exotic methods.Varicose veins are treated by thermal application of superheated steam and bipolar electrocautery.However, modern thermal methods are more effective and they allow the doctor to prevent further development of varicose veins and the patient to receive outpatient treatment without affecting his lifestyle.In the hands of a novice phlebologist, thermal ablation can cause unpleasant complications: decreased sensitivity, burns, sealing.The effectiveness of this method in the hands of an experienced phlebologist is more than 98%, and the laser and RFO method helps to eliminate not only the original form, but also severe varicose veins on the legs without the need for incisions.In the photos from the “Treatment Results” section you can see before and after images of minimally invasive treatment.
Non-heat method to eliminate root reflux
For many years, phlebologists have been thinking about how to cure varicose veins of the lower limbs without incisions and pain.The disappearance of the saphenous veins in the arm after frequent injections gave rise to the idea that certain substances can cause inflammation of the vein walls - thrombophlebitis and that they then stick together with the disappearance of the vein lumen.After the advent of the Fegan method, when treatment began to be based on the cause of varicose veins, the development of non-thermal sclerosing methods began.Since then, varicose veins in 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 by injecting a special substance (sclerotherapy) has reached perfection.The main purpose of sclerotherapy is to inject medication into the varicose veins, causing inflammation and then occluding 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.Progressive lower limb varicose veins are treated with more complex methods;lesions in the trunk of the greater or lesser saphenous vein do not allow one to rely on the long-term effects of sclerotherapy, since relapses due to reflux will certainly occur.
Sclerotherapy can be performed in the absence of an allergy to tetradecyl sulfate or polidocanol.These substances are the main sclerosing agents.During sclerotherapy, manifestations of thrombophlebitis may occur, especially if liquid forms of the drug are used.Perforated venous sclerotherapy is highly effective in treating 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% in the next 5 years.
The advantages of sclerotherapy are good immediate results and low treatment costs.Injection of sclerosant leads to venous adhesion and cessation of the pathological process - blood reflux through the saphenous vein.The medication is usually injected as a foam into the varicose veins.A spasm of dilated subcutaneous vessels, prolonged contact of the foamy form of the sclerosant with the walls of the veins and their subsequent inflammation and adhesion.This process takes place unevenly and the degree of vein rupture is not the same, so 40% of patients after sclerotherapy have recurrence of varicose veins.After sclerotherapy, the affected lower limb vein area will close and over time will heal completely, and the blood flow in the opposite direction will stop.To prevent the occurrence of skin necrosis due to the penetration of the foam form of the sclerosant into the subcutaneous tissue, use 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 for treating varicose veins with sclerotherapy depends on the stage of varicose veins and the condition of the veins.The treatment course usually includes 2-3 procedures.The skin over the sclerotic vessels may darken for 2-3 months (hyperpigmentation appears).It can destroy a woman's legs in a matter of months, so this treatment is best done during the winter months.Medical treatment and ultrasound-guided angioplasty can speed up the reabsorption of fluid accumulated in the blood vessels (coagulation), this risk is about 10%.Coaguli forms when not compressed enough, but will certainly disappear over time.Many patients know that within a month after sclerotherapy, signs of varicose veins of the lower extremities will disappear for many years, which is why sclerotherapy remains one of the most popular treatment methods.
Use special glue
Since its inception, this method has attracted great attention from vein researchers.It involves gluing the trunk of the great saphenous vein with special cyanoacrylate glue.In the vessel lumen, this colloid polymerizes and fills the dilated vessel lumen.According to the developers, this method does not require anesthesia, and a "button" appears in the vessel that reliably stops blood flow.Taking this into account, half an hour is enough for the procedure to remove varicose veins in the legs.Venasil is the only technology that treats varicose veins without the need for compression stockings.
Most women can return to normal activities immediately.Symptoms of chronic venous insufficiency will subside immediately after the procedure.The process of actively promoting this glue to the phlebological market will begin in the near future.However, there are certain disadvantages: Presence of foreign objects in the human body.The cured glue remains in the vessel forever and can cause chronic allergies;Sometimes there is inflammation of the vessel wall or polymer rejection accompanied by pus.Acute thrombophlebitis of blood vessels may occur.
The use of glue in the trunk of the great saphenous vein does not eliminate the need to remove varicose branches, which is why doctors will have to remove signs of subcutaneous varicose veins with sclerotherapy or small vein excision.The obvious effect of using glue appears only when combined with other methods of removing varicose veins.Patients have to pay extra.The absurdly high cost of the bonding kit makes the procedure significantly more expensive than modern laser or radiofrequency methods.
In our clinic, the use of thermal methods is preferred.We believe that good local anesthesia is better than treating saphenous vein varicose veins in the legs with an expensive and untested method.Furthermore, the best results are the same.If there is a recurrence, the patient will have to undergo a complicated surgery to remove the sealed vessel, because other methods will no longer be applicable.
Mechanical-chemical cleaning technology
Modern methods that combine treatment of reflux along the subcutaneous venous trunks add weight to conventional sclerotherapy.Chemical-mechanical 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 main saphenous vein through a puncture under ultrasound guidance.After inserting the catheter into the desired location, the device is connected.The sharp tip of the catheter rotates at a speed of up to 3.5 thousand revolutions per minute, causing serious damage to the inner layer of the vein wall.At the same time, a sclerosing drug is injected through the catheter, which "mixes" into the lumen of the vessel and, using the rotating part of the catheter, acts on the vessel wall, causing inflammation and adhesion.
Until now, the only advantage of this technology is that it does not require anesthesia.According to the inventors, chemical-mechanical eradication should produce a stronger eradication 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 its benefit is unclear.We must wait for further research from Europe or the US to determine the exact location of this technology.
Removal of small veins
This is a modern microsurgical cosmetic method to remove varicose veins.It involves a delicate technique of puncturing and stretching the veins using special tools.This activity is not for the novice phlebologist;You need to have exquisite surgical skills.Small vein ablation is a surgery that does not use a scalpel and is performed under local anesthesia.The punctures are made in the direction of the skin line so after 2 months they are practically no longer visible.
Miniphlebectomy has replaced classical surgery for varicose veins, which involved the use of incisions of 1-3 cm, because it is cosmetically perfect, painless and very effective.By assuming the appearance of varicose veins, the physician can clearly plan for micropunctures and perform them with minimal intervention.Patients can go home on their own immediately after surgery.Small vein ablation can be an effective stand-alone method for treating varicose veins, or used in combination after laser vein coagulation.The removal of varicose veins is carried out using a special technique developed by Professor Varadi.This technique has been perfectly mastered by our vein doctors and allows eliminating varicose veins in the legs - an effective treatment regardless of its cause.
Treatment results
Results of varicose vein treatment
The results of modern varicose vein therapy can be considered very good.Any technology, if done well, will eliminate the symptoms of varicose veins in the legs.Nearly 95% of patients are varicose-free 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 vein disease without incisions or pain.We know how to treat varicose veins and have a lot of experience.Treatment of varicose veins is no longer a problem in the modern high-tech world.