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), overweight, hormonal imbalance, pregnancy, high blood pressure, constipation, lifestyle and professional activity (e. g. example, a job that requires standing for long periods). ).
In all these cases, the progression 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 backward. If they fail to accomplish their task, blood stagnates and accumulates (deposits) in the veins. As a result, the vessels not only expand, but also lengthen, become tortuous and intertwine into varicose veins.
Most often, this disease affects the superficial veins (large and small) of the lower limbs. They provide 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 carried out by deep veins, connected to superficial veins by perforating venous channels.
The modern clinic uses all modern methods for treating 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 ablation or resorption of the vein, that is to say its exclusion from the general venous circulation system. But as these ships only play a minor role, their elimination has no negative consequences. Their 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 to 20% of men and 30 to 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). They appear most often 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 just heaviness, increased fatigue of the legs, moderate swelling in the evening, which disappears after rest and sleep. Nighttime leg cramps are possible.
A characteristic symptom of the disease is pain. Pain in the legs may occur or intensify when walking, with prolonged standing or be constant, accompanied by a feeling of fullness, burning and heat. Dilated veins become 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 problem may be heaviness in the legs.
In stage 1, a vascular pattern (telangiectasia) appears and muscle cramps occur at night.
Class 2 disease manifests itself as enlarged and thickened veins that protrude under the skin.
In stage 3, the swelling of the legs (ankles, legs, feet) no longer disappears after a night's sleep or prolonged rest and becomes persistent.
In stage 4, the skin over the enlarged veins turns red or blue, areas of hyperpigmentation appear, skin itching, dryness, peeling and inflammation appear.
Additionally, at stages 5 and 6, the development of pre-ulcers and trophic ulcers of the skin follows.
So, varicose veins, which start as a cosmetic 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, congestive dermatitis and varicose eczema develop, followed by the formation of trophic ulcers.
Blood clots occur in vessels filled with stagnant venous blood, which can break loose at any time and, traveling through the general circulatory system, obstruct a vital artery and lead to death.
In later stages of varicose veins, complications such as phlebitis and thrombophlebitis develop.
The later the treatment of the disease is started, the higher the risk of complications and the more radical methods will have to be used to prevent them. Therefore, when symptoms of varicose veins appear, you should not rely on self-medication: they can be useful as a preventative measure. 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 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 a doctor begins with an investigation of complaints, taking an anamnesis and an external examination. The main method of 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 is 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 computer 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, 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 daily 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 hospitalization unit.
Medical treatment
At an early stage of the development of the disease or for its prevention, the doctor may prescribe drug treatment, including antibiotics and antiseptics (in the presence of inflammation), phleboprotectors, anticoagulants (to prevent thrombosis), phleboprotectors, heparin ointment and other heparins. -containing medicines.
Hirudotherapy can be used as an alternative treatment method.
Conservative treatment includes wearing compression stockings (tights, knee-length socks) and elastic bandages. Its scope is limited.
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 guidance, a flexible fiber optic light guide connected to a transmitter 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 in small and medium-sized veins, particularly on the face. But with its help you can also eliminate large varicose veins, including small and large saphenous veins of the legs.
Radiofrequency ablation
This method, like EVLC, is based on thermal coagulation; only radiofrequency radiation, rather than a laser, is used to seal the container. Otherwise the procedure is similar. Under local anesthesia, a transmitter of radio waves is introduced into the venous bed, which are absorbed by the blood and vascular walls, transformed into heat and giving a clotting effect. The procedure is carried out under ultrasound guidance.
Like laser coagulation, radiofrequency ablation can be used as the main, sole and sufficient method or as part of complex treatment as a complementary method. For example, after surgical removal of the main trunk to eliminate small vascular tributaries.
Sclerotherapy
In this case, the varicose vein is sclerosed, stuck from the inside using a sclerosant. This medicine is given into a vein by 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 container, a flow of cold air can be used. This is called cryosclerotherapy.
The use of sclerosing foams has many advantages. They have better contact with the vessel wall, which increases the effectiveness of the procedure. To achieve this result, a significantly lower amount of sclerosing agent is needed, as it does not dissolve in the blood.
In addition, it does not extend beyond the intervention area, which makes its volume easier to control.
Liquid sclerosants are usually 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 excision of varicose veins. It does not require any incision, anesthesia or epidural.
The 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, he makes a puncture (incision no more than 1-2 mm), through which he removes part of the vein using a special hook. This area is pinched 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 ship.
Skin bites heal quickly and leave no traces, achieving an ideal cosmetic effect. The absence of incisions makes the rehabilitation period minimal. The cut vessels are not sewn up, and the punctures do not require sutures - they are simply sealed with an adhesive bandage.
Phlebectomy
This is a classic surgical operation, used less and less recently. 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.
Using a probe, the vessel is separated from the surrounding tissues and removed. The operation is performed under general or epidural anesthesia.
Rehabilitation
After treatment for varicose veins, wearing compression stockings is mandatory. The first days it must be worn around the clock, 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 around. 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 professional doctors and the use of modern techniques, the treatment of varicose veins is usually well tolerated by patients, does not lead to complications and gives optimal results.