Impaired blood flow and stagnation of blood in the venous bed lead to pathological changes in blood vessels - varicose veins. The reasons for the development of the disease can be different, including genetic predisposition (most often), excess weight, hormonal imbalance, pregnancy, high blood pressure, constipation, lifestyle and professional activity (for example, work that requires long periods of standing). ).
In all these cases, the development of the disease follows the same scenario and is associated with two factors: weakness of the vascular wall and functional insufficiency of the venous valves.
Vascular valves prevent blood from returning. If they are unable to fulfill their task, the blood stagnates and accumulates (deposits) in the veins. As a result, the vessels not only dilate, but also lengthen, become tortuous and intertwine into varicose veins.
Most often, this disease affects the superficial veins (large and small) of the lower extremities. They ensure the outflow of venous blood from the subcutaneous tissue and skin, which together make up no more than 1/10 of the total circulatory system. The main work is carried out by the deep veins, connected to the superficial veins through perforating venous channels.
The modern clinic uses all modern methods of treating varicose veins, including minimally invasive ones (endovasal laser coagulation, sclerotherapy, miniphlebectomy) and classic phlebectomy with complete removal of the affected vein and its tributaries.
The treatment of varicose veins always means the removal or reabsorption of the vein, that is, its exclusion from the general venous circulation system. But as these ships play a minor role, their elimination does not have any negative consequences. Its function is easily taken over by the remaining veins.
Symptoms and stages of the disease
Varicose veins are one of the most common vascular diseases. According to statistics, 10-20% of men and 30-40% of women suffer from it.
The first signs of pathology are the appearance of a blue or red vascular pattern on the skin. It may be a capillary network or asterisks (telangiectasia). Most often they appear on the legs and thighs, but they can also be found on the face, lips (in women), feet and hands. Spider veins on the face are called rosacea.
The symptoms of varicose veins depend on the stage of the disease. At first it's just heaviness, increased tiredness in the legs, moderate swelling at night, which disappears after rest and sleep. Nocturnal leg cramps are possible.
A characteristic symptom of the disease is pain. Leg pain may occur or intensify when walking, standing for a long time, or be constant, accompanied by a feeling of fullness, burning and heat. Enlarged veins are painful when pressed.
In international phlebology, the classification of the disease ranges from class 0 to class 6.
At stage zero, there are no obvious symptoms; the only complaint may be heaviness in the legs.
In stage 1, a vascular pattern (telangiectasia) appears and muscle cramps occur at night.
Class 2 disease is manifested by dilated and thickened veins that protrude under the skin.
In stage 3, swelling of the legs (ankles, legs, feet) no longer disappears after a night's sleep, prolonged rest and becomes persistent.
In stage 4, the skin over the dilated veins turns red or blue, areas of hyperpigmentation appear, itchy skin, dryness, peeling and inflammation appear.
Furthermore, in stages 5 and 6, the development of pre-ulcers and trophic skin ulcers follows.
Thus, varicose veins, which begin as an aesthetic problem, can lead to serious health problems over time.
Complications
Stagnation of venous blood and its accumulation (deposition) in the vessels of the lower extremities causes a decrease in blood pressure, hypotension and associated dizziness, fainting and headaches.
The skin over the affected vessels becomes thinner, inflamed, peeling, itching, development of congestive dermatitis and varicose eczema, followed by the formation of trophic ulcers.
Blood clots appear in vessels filled with stagnant venous blood, which can rupture at any time and, traveling through the general circulatory system, obstruct a vital artery and lead to death.
In the later stages of varicose veins, complications such as phlebitis and thrombophlebitis develop.
The later treatment of the disease begins, the greater the risk of complications and the more radical methods must be used to prevent them. Therefore, when symptoms of varicose veins appear, one should not rely on self-medication, as they can be good for prevention. But only a doctor can provide real help.
In the clinic, the treatment of varicose veins is carried out by a qualified phlebologist and angiosurgeon with extensive experience in the conservative, minimally invasive and surgical treatment of this disease. Depending on the stage and characteristics of varicose veins in your particular case will determine the ideal treatment.
Diagnosis and treatment
As usual, the medical consultation begins with raising complaints, collecting anamnesis and external examination. The main method for diagnosing varicose veins is Doppler ultrasound, duplex or triplex ultrasound of blood vessels.
As a rule, this method provides a comprehensive picture of the disease to determine the most appropriate treatment tactics.
If additional data is needed, to clarify the diagnosis, the doctor may prescribe an x-ray with contrast (radiocontrast venography), magnetic resonance imaging of blood vessels (magnetic resonance venography) or multispiral computed angiography.
Before carrying out surgical interventions, both minimally invasive and extensive, a standard set of examinations is prescribed - a general urine test, general clinical and biochemical blood tests, a coagulability test (coagulogram), tests for HIV, syphilis, viral hepatitis , fluorography, ECG .
In most cases, the treatment of varicose veins in a modern clinic is carried out on an outpatient basis or in a day hospital. It does not require a break from everyday life and after just 1-2 hours you can return to your normal activities. Minimally invasive procedures are performed under local anesthesia or without any anesthesia.
And only radical surgical intervention (phlebectomy) may require short-term hospitalization in the clinic's inpatient unit.
Drug treatment
At an early stage in the development of the disease or for its prevention, the doctor may prescribe drug therapy, including antibiotics and antiseptics (in the presence of inflammation), phleboprotectors, anticoagulants (to prevent thrombosis), phleboprotectors, heparin ointment and other heparins -containing drugs.
Hirudotherapy can be used as an alternative treatment method.
Conservative therapy includes the use of compression stockings (tights, knee socks) and elastic bandages. It has a limited scope.
Endovasal laser vascular coagulation (EVLC)
This method refers to minimally invasive methods of treating varicose veins. The procedure is performed under local anesthesia on an outpatient basis. Under ultrasound control, a flexible fiber optic light guide connected to an emitting device is inserted into the vascular bed.
Laser light of a certain wavelength is absorbed by blood cells and vein walls and converted into heat.
As a result, the vessel is sealed and turns into a thin bundle of connective tissue that dissolves on its own.
Laser coagulation is commonly used to treat varicose veins of small and medium-sized veins, especially on the face. But with its help you can also eliminate large varicose veins, including the meager and large saphenous veins of the legs.
Radiofrequency removal
This method, like EVLC, is based on thermal coagulation, only radiofrequency radiation, rather than laser, is used to seal the vessel. Otherwise, the procedure is similar. Under local anesthesia, a radio wave emitter is introduced into the venous bed, which is absorbed by the blood and vascular walls, converted into heat and providing a clotting effect. The procedure is performed under ultrasound guidance.
Like laser coagulation, radiofrequency ablation can be used as the main, sole and sufficient method or as part of a complex treatment as an additional method. For example, after surgical removal of the main trunk to eliminate smaller vascular tributaries.
Sclerotherapy
In this case, the varicose vein is sclerosed – glued from the inside with the help of a sclerosant. This medicine is given into a vein through an injection. It can be liquid or foamy.
The procedure is completely painless, during which a slight burning and tingling sensation is possible. To eliminate these sensations, as well as to further compress the vessel, a flow of cold air can be used. This is called cryosclerotherapy.
The use of foam sclerosants has several advantages. They have better contact with the vascular wall, which increases the effectiveness of the procedure. To achieve the result, a significantly smaller amount of sclerosing agent is required, since it does not dissolve in the blood.
Furthermore, it does not spread beyond the procedure area, making it easier to control its volume.
Liquid sclerosants are generally used to eliminate small varicose veins, while foam preparations allow even large veins to be sclerosed.
Sclerosis of small veins and capillaries is usually carried out under visual control, and the introduction of sclerosing foam into large vessels is carried out under ultrasound control.
Miniphlebectomy
This is a minimally invasive surgical method for excising varicose veins. It does not require incisions, anesthesia or epidurals.
Treatment for this operation is carried out in a day hospital. The doctor performs an ultrasound of the vessel and marks it with a marker on the skin. Then he makes a puncture (incision no more than 1-2 mm), through which he removes part of the vein with a special hook. This area is compressed and cut.
Then, the doctor moves to the next area, makes a puncture, removes a section of the vein and cuts it. This way, it removes the entire affected vessel.
Punctures in the skin heal quickly and leave no marks, thus achieving an ideal cosmetic effect. The absence of incisions makes the rehabilitation period minimal. The cut vessels are not sewn together and the punctures do not require sutures - they are simply sealed with medical tape.
Phlebectomy
This is a classic surgical operation, used less and less recently. It consists of the radical removal of a varicose vein in its entirety. To do this, an incision is made in the groin or under the knee, through which a probe is inserted into the vessel.
With the help of a probe, the vessel is separated from the surrounding tissues and removed. The operation is performed under general anesthesia or epidural anesthesia.
Rehabilitation
After treating varicose veins, it is necessary to wear compression stockings. In the first few days it must be used 24 hours a day, in the following weeks only during the day, and can be removed at night. General restrictions for the rehabilitation period include the exclusion of hot baths, steam baths and saunas.
After minimally invasive operations (laser coagulation, radiofrequency ablation, sclerotherapy, miniphlebectomy), it is recommended to get up and walk. In the future, walking will be recommended as a mandatory part of the rehabilitation course (at least 1 hour per day), while all other physical activities should be limited.
The duration of the rehabilitation period depends on the volume of treatment and surgical intervention.
Thanks to highly qualified medical professionals and the use of modern techniques, varicose vein treatment is usually well tolerated by patients, does not cause complications and provides maximum results.