Impaired blood flow and stagnation of blood in the venous bed leads 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, arterial hypertension, constipation, lifestyle and professional activity (for example, work that requires long periods of 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 fail to cope with their task, blood stagnates and accumulates (deposited) 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 constitutes 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 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.
Treatment of varicose veins always means removal or resorption 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 does not have any 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. This may be a capillary network or asterisks (telangiectasia). Most often they 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.
Symptoms of varicose veins depend on the stage of the disease. At first it’s just heaviness, increased fatigue of the legs, moderate swelling in the evening, which goes away after rest and sleep. Night leg cramps are possible.
A characteristic symptom of the disease is pain. Pain in the legs can occur or intensify when walking, standing for a long time, or be constant, accompanied by a feeling of fullness, burning, and warmth. Enlarged veins become painful when pressed.
In international phlebology, the classification of the disease is from class 0 to class 6.
At stage zero, there are no obvious symptoms; the only complaint may be heaviness in the legs.
At stage 1, a vascular pattern (telangiectasia) appears and muscle cramps occur at night.
Class 2 disease is manifested by dilated, thickened veins that bulge under the skin.
At stage 3, swelling of the legs (ankles, legs, feet) no longer goes away after a night's sleep, long rest, and becomes persistent.
At stage 4, the skin over the dilated veins turns red or blue, areas of hyperpigmentation appear, skin itching, dryness, peeling, and inflammation appear.
Further, at 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, 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 off at any time and, traveling through the general circulatory system, clog 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 is started, the higher the risk of its 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 good for prevention. But only a doctor can provide real 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, it will determine the optimal treatment.
Diagnosis and treatment
As usual, a visit to a doctor begins with a survey of complaints, anamnesis collection 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 comprehensive 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 computed angiography.
Before performing 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 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 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 drugs.
Hirudotherapy can be used as an alternative treatment method.
Conservative therapy includes wearing 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 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 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 small and large saphenous veins of 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, 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, only and sufficient method or as part of 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 together from the inside with the help of a sclerosant. This drug 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 vessel, a flow of cold air can be used. This is called cryosclerotherapy.
The use of foam sclerosants has a number of 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.
In addition, it does not spread beyond the area of the procedure, making its volume easier to control.
Liquid sclerosants are usually used to eliminate small varicose veins, while foam preparations make it possible to scleros even large veins.
Sclerosis of small veins and capillaries is usually performed under visual control, and the introduction of foam sclerosant into large vessels is performed under ultrasound control.
Miniphlebectomy
This is a minimally invasive surgical method for excision of varicose veins. It does not require any incisions, anesthesia or epidurals.
Treatment for this operation is carried out in a day hospital setting. The doctor performs an ultrasound scan of the vessel and marks it with a marker on the skin. After this, he makes a puncture (incision no more than 1-2 mm), through which he pulls part of the vein out with a special hook. This area is pinched and cut off.
Next, the doctor moves on to the next area, makes a puncture, pulls out a section of the vein and cuts it off. This way he removes the entire affected vessel.
Skin punctures heal quickly and leave no marks, thereby achieving an ideal cosmetic effect. The absence of incisions makes the rehabilitation period minimal. Cut vessels are not stitched, and punctures do not require sutures - they are simply sealed with an adhesive plaster.
Phlebectomy
This is a classic surgical operation, which has been used less and less recently. It consists of 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 pulled out. The operation is performed under general anesthesia or epidural anesthesia.
Rehabilitation
After treatment of varicose veins, wearing compression stockings is required. For the first few days it should 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 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 the highly qualified professional doctors and the use of modern techniques, treatment of varicose veins is usually well tolerated by patients, does not cause complications and provides maximum results.