Disturbance of blood flow and stagnation of blood in the venous bed cause pathological changes in blood vessels - varicose veins. The reasons for the development of the disease can be different, including genetic predisposition (most often), overweight, hormonal imbalance, pregnancy, high blood pressure, constipation, lifestyle and professional activity (for example, work that requires standing for long periods). ).
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 fail to cope with their task, the blood stagnates and accumulates (deposits) in the veins. As a result, the vessels not only dilate, but also elongate, become tortuous and intertwine, forming 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 constitute no more than 1/10 of the total circulatory system. The main work is performed by deep veins, connected to superficial veins through perforating venous channels.
In modern clinic, all modern methods are used for the treatment of varicose veins, including minimally invasive (endovasal laser coagulation, sclerotherapy, miniphlebectomy) and classic phlebectomy with complete removal of the affected vein and its tributaries.
The treatment of varicose veins always involves the elimination or resorption of the vein, that is, its exclusion from the general venous circulation system. But since these vessels play a minor role in it, their removal has no negative consequences. Its function is easily assumed by the remaining veins.
Symptoms and stages of the disease
Varicose veins are one of the most common vascular diseases. According to statistics, between 10 and 20% of men and between 30 and 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 can be a capillary network or asterisks (telangiectasia). They appear most frequently on the legs and thighs, but 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 is simply heaviness, increased leg fatigue, moderate swelling at night, which disappears after rest and sleep. Nighttime leg cramps may occur.
A characteristic symptom of the disease is pain. Pain in the legs may appear or intensify when walking, standing for a long time, or be constant, accompanied by a feeling of fullness, burning, and heat. Enlarged veins become painful when pressed.
In international phlebology, the classification of the disease is from class 0 to class 6.
In 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, the swelling of the legs (ankles, legs, feet) no longer goes away 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, itchy skin, dryness, peeling and inflammation appear.
Additionally, in stages 5 and 6, the development of preulcers 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 thins, becomes inflamed, peels, itches, congestive dermatitis and varicose eczema develop, followed by the formation of trophic ulcers.
Blood clots appear in vessels filled with stagnant venous blood, which can break loose at any time and, traveling through the general circulatory system, block a vital artery and cause death.
In the later stages of varicose veins, complications such as phlebitis and thrombophlebitis develop.
The later the treatment of the disease is started, the greater the risk of complications and it will be necessary to use more radical methods to prevent them. Therefore, when the symptoms of varicose veins appear, it is not advisable to self-medicate, 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 who has extensive experience in the conservative, minimally invasive and surgical treatment of this disease. Depending on the stage and characteristics of the varicose veins in your particular case, the optimal treatment will be determined.
Diagnosis and treatment
As usual, a visit to the doctor begins with an examination of complaints, a history and an 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 complete picture of the disease in order to determine the most appropriate treatment tactics.
If additional data are needed to clarify the diagnosis, the doctor may prescribe an X-ray with contrast (radiocontrast venography), MRI of blood vessels (magnetic resonance venography), or multispiral computed angiography.
Before performing surgical interventions, both minimally invasive and extensive, a standard set of examinations is prescribed: a general urinalysis, general clinical and biochemical blood tests, a coagulability test (coagulogram), tests for HIV, syphilis, viral hepatitis , fluorography, ECG. .
In most cases, varicose vein treatment 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 anesthesia.
And only a radical surgical intervention (phlebectomy) may require a short hospitalization in the clinic's inpatient unit.
Pharmacotherapy
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 ointments and others. heparins. -containing drugs.
Hirudotherapy can be used as an alternative treatment method.
Conservative therapy includes the use of compression stockings (stockings, knee-high 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 ultrasonic control, a flexible fiberoptic 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 to heat.
As a result, the vessel seals 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 remove large varicose veins, including small and large saphenous veins in the legs.
radiofrequency ablation
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, an emitter of radio waves is introduced into the venous bed, which are absorbed by the blood and vascular walls, converted into heat and giving a coagulation effect. The procedure is performed under ultrasound guidance.
Like laser coagulation, radiofrequency ablation can be used as the primary, 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, that is, glued from the inside with the help of a sclerosant. This medicine is given into a vein by injection. It can be liquid or foamy.
The procedure is completely painless, during it a slight burning and tingling sensation is possible. To eliminate these sensations, as well as to further compress the glass, a stream 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.
Additionally, it does not extend beyond the procedure area, making it easy to control its volume.
Liquid sclerosants are usually used to eliminate small varicose veins, while foam preparations allow even larger 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 ultrasonic control.
Miniphlebectomy
This is a minimally invasive surgical method for varicose vein excision. 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. After that, a puncture is made (an incision of no more than 1-2 mm), through which part of the vein is removed with a special hook. This area is pinched and cut.
The doctor then moves to the next area, makes a puncture, removes a section of the vein and cuts it. In this way, the entire affected vessel is removed.
Skin punctures heal quickly and do not leave marks, thus achieving an ideal cosmetic effect. The absence of incisions makes the rehabilitation period minimal. Cut vessels are not sutured and punctures do not require sutures; They are simply sealed with an adhesive strip.
Phlebectomy
This is a classic surgical operation, which has been used less and less lately. It consists of 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.
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 treatment of varicose veins, it is necessary to wear compression stockings. During the first days it must be worn 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 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 volume of treatment and surgical intervention.
Thanks to highly qualified professional doctors and the use of modern techniques, varicose vein treatment is usually well tolerated by patients, does not cause complications and provides maximum results.