Impaired blood circulation and blood congestion in the venous bed lead to pathological changes in the blood vessels - varicose veins. The reasons for the development of the disease can be different, including genetic predisposition (most common), excess weight, hormonal imbalance, pregnancy, arterial hypertension, constipation, lifestyle and professional activity (for example, work that requires long standing on your feet). ).
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 flowing back. If they don't do their job, the blood stagnates and builds up in the veins. As a result, the vessels not only expand, but also lengthen, become tortuous and intertwine to form 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 account for no more than 1/10 of the entire circulatory system. The main work is done by the deep veins, which are connected to the superficial veins via perforating venous canals.
The modern clinic uses all modern methods for the treatment of varicose veins, including minimally invasive methods (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 resorption of the vein, i. e. its exclusion from the general venous circulatory system. However, since such vessels only play a minor role, their removal does not have any negative consequences. Their function is easily taken over by the other 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. This can be a capillary network or asterisks (telangiectasia). They most commonly appear on the legs and thighs, but can also be found on the face, labia (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 is just a feeling of heaviness, increased fatigue in the legs, moderate swelling in the evening, which disappears after rest and sleep. Night cramps in the legs are possible.
A characteristic symptom of the disease is pain. Pain in the legs may occur when walking, standing for long periods, or may increase or be persistent, accompanied by a feeling of fullness, burning and warmth. Enlarged veins become painful when pressed.
In international phlebology, the disease is classified into classes 0 to 6.
In stage zero there are no obvious symptoms; the only complaint may be a feeling of heaviness in the legs.
In stage 1, a vascular pattern (telangiectasia) occurs and muscle cramps occur at night.
Class 2 disease presents with dilated, thickened veins that expand under the skin.
In stage 3, the swelling of the legs (ankles, legs, feet) no longer disappears after a night's sleep and a longer period of rest and persists.
In stage 4, the skin over the enlarged veins turns red or blue, areas of hyperpigmentation appear, skin itching, dryness, peeling and inflammation occur.
In addition, in stages 5 and 6, pre-ulcers and trophic skin ulcers develop.
Varicose veins, which begin as an aesthetic problem, can lead to serious health problems over time.
Complications
The stagnation of venous blood and its accumulation (deposition) in the vessels of the lower extremities lead to a decrease in blood pressure, hypotension and associated dizziness, fainting and headaches.
The skin over the affected vessels becomes thinner, becomes inflamed, peels, itches, stasis dermatitis and varicose eczema occur, followed by the formation of trophic ulcers.
Blood clots form in vessels filled with stagnant venous blood, which can break off at any time and travel through the general circulation, blocking a vital artery and causing death.
In the late stages of varicose vein disease, complications such as phlebitis and thrombophlebitis occur.
The later the treatment of the disease is started, the higher the risk of complications and the more radical methods must be used to prevent them. That's why you shouldn't rely on self-medication if varicose vein symptoms occur; they can be helpful for prevention. But only a doctor can really help.
In the clinic, treatment of varicose veins is carried out by a qualified phlebologist and angiosurgeon who has extensive experience in conservative, minimally invasive and surgical treatment of this disease. Depending on the stage and characteristics of varicose veins in your particular case, the optimal treatment will be determined.
Diagnosis and treatment
As usual, a visit to the doctor begins with a complaint, an anamnesis and an external examination. The main method for diagnosing varicose veins is Doppler ultrasound, duplex or triplex ultrasound examination of blood vessels.
As a rule, this method provides a comprehensive picture of the disease in order to determine the most appropriate treatment tactics.
If additional data is required to clarify the diagnosis, the doctor may prescribe an X-ray with contrast (X-ray contrast venography), MRI 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, varicose veins are treated in a modern clinic on an outpatient basis or in a day clinic. There is no need to take a break from everyday life and you can return to your normal activities after just 1-2 hours. Minimally invasive procedures are performed under local anesthesia or without anesthesia.
And only radical surgical intervention (phlebectomy) may require short-term hospitalization in the inpatient department of the clinic.
Medication
At an early stage of 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 heparin-containing medicines.
Hirudotherapy can be used as an alternative treatment method.
Conservative therapy includes wearing compression stockings (tights, knee socks) and elastic bandages. The scope is limited.
Endovascular laser vascular coagulation (EVLC)
This method is a minimally invasive method for treating varicose veins. The procedure is carried out on an outpatient basis under local anesthesia. Under ultrasound control, a flexible fiber-optic light guide connected to a transmitter is inserted into the vascular bed.
Laser light of a specific wavelength is absorbed by blood cells and vein walls and converted into heat.
This closes the vessel and turns it into a thin bundle of connective tissue that dissolves on its own.
Laser photocoagulation is often used to treat varicose veins of small and medium-sized veins, especially on the face. But large varicose veins, including the small and large saphenous veins of the legs, can also be eliminated with their help.
Radiofrequency ablation
Like EVLC, this method is based on thermal coagulation, using only high-frequency radiation and no laser to close the vessel. Otherwise the procedure is similar. Under local anesthesia, a radio wave transmitter is inserted into the venous bed, which is absorbed by the blood and the vessel walls, converted into heat and thus achieves a coagulation effect. The procedure is carried out under ultrasound control.
Like laser coagulation, radiofrequency ablation can be used as the main, only and sufficient method or as an additional method as part of complex treatment. For example, after surgical removal of the main trunk to eliminate smaller vascular tributaries.
Sclerotherapy
The varicose vein is destroyed, i. e. glued together from the inside with the help of a sclerosing agent. This medication is given by injection into a vein. It can be liquid or foamy.
The procedure is completely painless; a slight burning and tingling sensation is possible. To eliminate these sensations and further compress the vessel, a stream of cold air can be used. This is called cryosclerotherapy.
The use of foam sclerosants has a number of advantages. You have better contact with the vessel wall, which increases the effectiveness of the procedure. To achieve the result, a significantly smaller amount of sclerosing agent is required because it does not dissolve in the blood.
In addition, it does not spread beyond the intervention area, making volume easier to control.
Liquid sclerosing agents are usually used to eliminate small varicose veins, while foam preparations enable the sclerotherapy of even large veins.
Sclerosis of small veins and capillaries is usually carried out under visual control, and the introduction of foam sclerosant into large vessels is carried out under ultrasound control.
Miniphlebectomy
This is a minimally invasive surgical method for removing varicose veins. No incisions, anesthesia or epidural are required.
This operation is treated in a day clinic. The doctor conducts an ultrasound scan of the vessel and marks it on the skin with a marker. He then makes a puncture (incision no more than 1-2 mm), through which he pulls out part of the vein using a special hook. This area is pinched and cut off.
The doctor then moves on to the next area, punctures, pulls out part of the vein and cuts it off. In this way he removes the entire affected vessel.
Skin punctures heal quickly and leave no trace, thus achieving an ideal cosmetic effect. Because there are no incisions, the rehabilitation time is minimal. Severed vessels are not sutured and punctures do not require sutures - they are simply closed with an adhesive plaster.
Phlebectomy
This is a classic surgical procedure that has recently become less and less common. This involves the radical removal of a varicose vein along its entire length. To do this, an incision is made in the groin or below the knee through which a probe is inserted into the vessel.
Using a probe, the vessel is separated from the surrounding tissue and pulled out. 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 should be worn around the clock, in the following weeks only during the day and it can be removed at night. General restrictions for the rehabilitation period include the exclusion of hot baths, steam rooms and saunas.
After minimally invasive operations (laser coagulation, radiofrequency ablation, sclerotherapy, miniphlebectomy), it is recommended to get up and walk around. In the future, walking is 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 extent of treatment and surgical intervention.
Thanks to highly qualified specialists and the use of modern techniques, the treatment of varicose veins is usually well tolerated by patients, does not cause complications and provides maximum results.