Varicose veins of the lower extremities

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 only a cosmetic problem (spider veins), but if varicose veins are not treated, then it continuously progresses 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.

Varicose veins of the lower extremities

Varicose veins symptoms

  • Swollen dilated veins in the legs
  • Heaviness in the legs, tiredness in the evening
  • Swelling of the feet in the evening after exercise
  • Skin discoloration on the lower leg
  • Inflammation of the saphenous veins - thrombophlebitis
  • Trophic skin ulcers

The causes of varicose veins and risk factors

  • Aggravated heredity - congenital failure of the valve apparatus
  • Heavy physical work in a standing position
  • 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 interventions, without pain, incisions and hospitalization.

The modern level of phlebology allows for the treatment of varicose veins painless 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 implies a complete disappearance of the tone of the venous wall, therefore it is useless to influence varicose transformation with tablets and leeches as a treatment.

Diagnostics

Complaints and Symptoms

Varicose veins begin with the appearance of single nodules of the varicose veins and progresses steadily. At first, varicose veins do not cause any problems, but over time they become a risk factor for serious health threats. So, let's take a look at the main problems of concern for patients with varicose veins:

Cosmetic discomfort

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. Quite often, cosmetic discomfort is caused by a fine varicose mesh and spider veins, which do not threaten health, but force the legs to close. Such patients need treatment for cosmetic reasons, therefore, they are shown only minimally invasive (no incisions) methods.

Chronic venous insufficiency

Approximately 30% of patients with varicose veins develop complaints of heaviness in the legs, swelling in the evening, and nocturnal cramps in the calves. These are signs of chronic venous insufficiency. Gradually, its phenomena are aggravated, painful sensations in varicose nodes may appear. Skin changes and pigmentation develop. In 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 skin inflammation - eczema.

Phlebologist's examination

Consultation with a phlebologist is necessary if varicose veins cause you any discomfort. The examination is carried out lying and standing. The patient must open his legs completely.

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

Ultrasonic vein scanning

In case of varicose veins, ultrasound of the veins has the task of finding out the failure of the venous trunks, identifying inoperative 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 patency of the great 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 the reverse blood flow). Then the perforating veins in typical places and their consistency in the Valsalva maneuver are examined.

After evaluating superficial veins, it is necessary to assess the patency of deep veins. For this lying down, a study of the popliteal and femoral veins is carried out, their patency and the consistency of the valves are also assessed.

Contrast phlebography

Usually, ultrasound scanning 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 systems, especially in relapses of varicose veins, with secondary varicose veins.

Ultrasound scan

Contrast X-ray examination is used to solve these problems. The saphenous veins are punctured and contrast is injected. Contrast movement is observed on the monitor of the X-ray machine, all necessary tests and projections are carried out. Currently, phlebography for varicose veins is used very rarely.

Treatment

The "classic" operation for varicose veins under anesthesia with incisions in the groin and along the legs, which was used to remove varicose veins of the superficial veins at the beginning of the last century, is an atavism of the past. The suffering of patients, prolonged hospitalization and pain in the legs after such operations aimed at improving the outflow of blood are completely unjustified. You can treat severe varicose veins without resorting to the "methods of the Inquisition. "Today, the treatment of advanced varicose veins can be carried out without anesthesia and a hospital. The work of a phlebologist becomes office work, without the attributes of major surgery.

Knowledge of what causes varicose veins on the legs allowed to develop 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 veins in the area of ​​insufficient venous valves. The method of influencing the 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 leg varicose veins be cured?

Understanding the cause of varicose veins allows you to choose the correct method of treatment. The goal of modern treatment of varicose veins is to solve several problems:

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

Vascular Center Capabilities

  • Thermal treatments for varicose veins - endovenous laser coagulation (EVLK) and radiofrequency obliteration (RFO) of the veins of the lower extremities.

    Thermal treatments

    Endovenous 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 effect of damage to the collagen of the venous wall, an inflammatory process occurs in the vein and its overgrowth. Launched varicose veins on the legs, which is treated with this method, completely and without a trace regresses, its main symptoms pass: 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 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 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 obliteration (RFO)

    Treatment of varicose veins using the method of radiofrequency obliteration (RFO) is a similar thermal method, but the tissue of the venous wall is heated according to different physical principles due to radio wave energy. Radiofrequency 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, 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 exposure using superheated steam and bipolar electrocoagulation. However, modern thermal methods are more effective and they allow the doctor to prevent the further development of varicose veins, and the patient to be treated on an outpatient basis, without disrupting 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 method and RFO make it possible to get rid of not only the initial form but also severe pronounced varicose veins on the legs without incisions. In the photos from the section "Treatment Results" you can see the view before and after minimally invasive treatment.

    Non-thermal ways to eliminate stem reflux

    Phlebologists have been thinking for many years how to cure varicose veins of the lower extremities without incisions and pain. The disappearance of the saphenous veins in the hands after frequent injections suggested that some substances can cause inflammation of the walls of the veins - thrombophlebitis and their subsequent gluing together with the disappearance of the lumen of the vein. After the advent of Fegan's method, when the treatment began to be carried out based on 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

    Sclerotherapy appears in the practice of doctors at the end of the 19th century. In recent years, the method of treating varicose veins using injections of a special substance (sclerosant) has reached perfection. The main point of sclerotherapy is to inject a drug into the varicose vein that causes inflammation and subsequent adhesion of the varicose vein. Sclerotherapy does not imply elimination of the cause of venous insufficiency and is more suitable for certain forms of varicose veins or in the initial stage of the disease. Launched 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 effect of sclerotherapy, since a relapse necessarily occurs due to reflux.

    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 may occur, especially if liquid forms of the drug are used. Sclerotherapy of perforating veins is highly effective in the treatment of venous trophic ulcers. It is possible to eliminate the manifestations of varicose veins of the lower extremities at any stage with the help of sclerotherapy, however, the recurrence rate is about 40% over the next 5 years.

    The advantage of sclerotherapy is a good immediate effect, low cost of treatment. Sclerosant injections lead to gluing of veins and the termination 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 foam form of the sclerosant with the vein wall and their subsequent inflammation and adhesion. This process is uneven and the degree of vein obliteration 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 is completely overgrown, 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 supervision of an ultrasound examination.

    Foam sclerotherapy can be used both as an independent method and in combination with laser treatment to eliminate varicose veins. The number of sessions for eliminating varicose veins using sclerotherapy depends on the stage of varicose veins, the condition of the veins. The course of treatment usually consists of 2-3 procedures. The area of ​​the skin above the sclerosed vessel may take on 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. Drug treatment and vascular puncture under ultrasound control can accelerate the process of resorption of intravascular fluid accumulations (coagulum), the risk of which is about 10%. Coagules 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 go away for many years, many patients know, therefore 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 lumen of the vessel, this adhesive will polymerize and fill the lumen of the expanded vessel. As conceived by the developers, this method does not require any anesthesia, and a "plug" appears in the vessel, which reliably blocks the 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 hosiery.

    Most women can return to normal activities immediately. The symptoms of chronic venous insufficiency stop shortly after the procedure. The process of active promotion of this glue on the phlebological market should begin in the near future. However, there are certain disadvantages: Presence of a foreign body in the human body. The coagulated glue remains in the vessel forever 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 gluing kit makes this procedure much more expensive than the modern laser or radio frequency method.

    Thermal methods are preferred in our clinic. We believe that it is better to have good local anesthesia than to treat varicose veins in the legs with an expensive and untested method. Moreover, the result is the same at best. In the event that a relapse occurs, the patient will have to perform a complex operation to remove the sealed vessel, since other methods will no longer be applicable.

  • Mechano-chemical obliteration technology

    The modern method of combined treatment 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 a puncture under ultrasound control. After placing the catheter in the right place, connect the device. The rotating sharp head of the catheter makes up to 3. 5 thousand revolutions per minute, causing severe 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 its inflammation and adhesion.

    Today, the only advantage of this technology is that there is no need for tumescent anesthesia. Mechanochemical obliteration, according to the idea of ​​its inventors, should trigger 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 its benefits are not obvious. We have to wait for the next studies from Europe or the USA in order to pinpoint the place of this technology.

  • Miniflebectomy

    This is a modern microsurgical aesthetic method for removing varicose veins. It implies a delicate technique of puncturing and pulling out varicose veins using special tools. This operation is not for a novice phlebologist, you need to master the skills of delicate surgery. Miniflebectomy is an operation without the use of a scalpel and is performed under local anesthesia. The punctures are carried out in the direction of the skin lines, so after 2 months they are almost invisible.

    Miniflebectomy

    Miniphlebectomy has replaced the classic surgery for varicose veins, which involves the use of incisions of 1-3 cm, as it is aesthetically flawless, painless and very effective. Assuming how varicose veins manifests itself, the doctor can clearly plan micro-punctures and do with minimal intervention. The patient can go home on their own feet immediately after the operation. Miniflebectomy can be an independent effective 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 for the removal of varicose veins in the legs - an effective treatment regardless of its cause.

Treatment results

Results of varicose veins treatment

The results of modern therapy for varicose veins can be considered very good. Any technology in good performance eliminates the symptoms of varicose veins of the legs. Almost 95% of patients are free from varicose veins for 5 years or more, and 80% of them never have serious problems with venous outflow. The innovative Vascular Center is ready to help you deal with any venous ailment without incisions or pain. We know how to cure varicose veins and have a lot of experience. Treatment of varicose veins should not be a problem in today's high-tech world.