Impaired blood flow and stagnation of blood 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 often), overweight, hormonal imbalance, pregnancy, arterial hypertension, constipation, lifestyle and professional activity (for example, work requiring 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 flowing back. If they cannot cope with their task, the blood stagnates and accumulates (deposits) in the veins. As a result, the vessels not only dilate, but elongate, become tortuous and intertwined 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 constitute no more than 1/10 of the total circulatory system. The main work is performed by the deep veins, connected to the superficial veins through perforating venous channels.
The modern clinic uses all modern methods for the treatment of varicose veins, including minimally invasive ones (endovascular laser coagulation, sclerotherapy, miniphlebectomy) and classical 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 since such vessels play a minor role in it, 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, 10-20% 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 could be a capillary network or asterisks (telangiectasias). In most cases 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 is just heaviness, increased fatigue in the legs, moderate swelling in the evening, 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 sensation 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 complaint may be heaviness in the legs.
In stage 1, a vascular pattern (telangiectasia) appears and muscle cramps occur at night.
Class 2 disease manifests as dilated, thickened veins that bulge under the skin.
At stage 3, the swelling of the legs (ankles, legs, feet) no longer disappears after a night's sleep, a long rest and becomes persistent.
At stage 4, the skin over the dilated veins turns red or blue, areas of hyperpigmentation, itchy skin, dryness, peeling and inflammation appear.
Furthermore, in stages 5 and 6, the development of preulcers and trophic skin ulcers follows.
Therefore, varicose veins, which begin 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, becomes inflamed, peels, itching, congestive dermatitis and varicose eczema develops, followed by the formation of trophic ulcers.
Blood clots appear in vessels filled with stagnant venous blood, which can break off at any time and, traveling through the general circulatory system, block a vital artery and lead to 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 the more radical methods will have to be used to prevent them. Therefore, when the symptoms of varicose veins appear, one should not rely on self-medication; can be useful for prevention. But only a doctor can provide concrete 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 will determine the optimal treatment.
Diagnosis and treatment
As usual, the visit to the doctor begins with an investigation of complaints, taking anamnesis and an external examination. The main method for diagnosing varicose veins is Doppler ultrasound, duplex or triplex ultrasound scanning of blood vessels.
As a rule, this method provides a complete picture of the disease in order to determine the most appropriate therapeutic tactics.
If additional data is needed to clarify the diagnosis, the doctor may prescribe an X-ray with contrast (radiocontrast venography), an MRI of blood vessels (magnetic resonance venography), or a multispiral computed angiography.
Before performing surgical interventions, both minimally invasive and extensive, a standard set of tests 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 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 radical surgery (phlebectomy) may require short-term hospitalization in the clinic's inpatient department.
Pharmacological treatment
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 others heparin-based drugs. -containing drugs.
Hirudotherapy can be used as an alternative treatment method.
Conservative therapy involves the use of compression stockings (tights, knee-highs) and elastic bandages. It has a limited scope.
Endovascular laser vascular coagulation (EVLC)
This method refers to minimally invasive methods for 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 apparatus 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 small to medium-sized varicose veins, especially 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 is used to seal the vessel, rather than laser. Otherwise the procedure is similar. In local anesthesia, a radio wave emitter 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 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 sclerosated, i. e. glued from the inside with the help of a sclerosant. This medication is given into a vein through an 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 vase, a flow of cold air can be used. This is called cryosclerotherapy.
The use of sclerosing foams has numerous advantages. They have better contact with the vascular wall, which increases the effectiveness of the procedure. A significantly smaller amount of sclerosing agent is needed to achieve the result, since it does not dissolve in the blood.
It also does not spread beyond the procedure area, making its volume easier to control.
Liquid sclerosants are usually used to eliminate small varicose veins, while foam preparations allow you to sclerosing even larger veins.
Sclerosis of small veins and capillaries is usually performed under visual control, and the introduction of sclerosing foam into large vessels is performed under ultrasound control.
Miniphlebectomy
This is a minimally invasive surgical method for excising varicose veins. It does not require incisions, anesthesia or epidurals.
The treatment for this operation is carried out as a day hospital. The doctor performs an ultrasound of the vessel and marks it with a marker on the skin. Next, he performs a puncture (incision no more than 1-2 mm), through which he extracts part of the vein with a special hook. This area is pinched and cut.
Next, the doctor moves to the next area, makes a puncture, extracts a section of the vein and cuts it. In this way he removes the entire affected vessel.
Punctures on the skin heal quickly and leave no marks, thus achieving an ideal cosmetic effect. The absence of incisions minimizes the rehabilitation period. The cut vessels are not sutured and the punctures do not require sutures: they are simply sealed with an adhesive plaster.
Phlebectomy
This is a classic surgical procedure, 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 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 extracted. The operation is performed under general anesthesia or epidural anesthesia.
Rehabilitation
After the treatment of varicose veins it is necessary to wear compression stockings. For the first few days it must be worn 24 hours a day, in the following weeks only during the day, and it can be removed during the night. General restrictions for the rehabilitation period include the exclusion of hot baths, steam rooms and saunas.
After minimally invasive interventions (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 program (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 generally well tolerated by patients, does not cause complications and provides maximum results.