Varicose veins or varicose veins are often referred to as "leg troubles" in daily life. But in fact, the factors that cause it are much more complicated. And the disease itself is not just a harmless beauty defect. Varicose veins of the lower extremities lead to the occurrence of chronic venous insufficiency-the end result of this situation may be the occurrence of venous trophic ulcers.
Of course, in the vast majority of cases, we are dealing with moderately severe varicose veins, which are now effective and there is actually no recurrence treatment. But first.
Why are varicose veins dangerous?
It's hard to tell how common varicose veins are: Many patients think it is a cosmetic defect and do not see a doctor. According to Western scientists, at least a quarter of the population in the United States and Europe suffers from the disease. In our country, more than 30 million people have suffered from the disease. At the same time, according to some studies, no more than 18% know their condition and no more than 8% receive treatment.
Varicose veins of the lower extremities are diseases in which the structure of the vein wall changes. The blood vessels become longer and coiled, and in areas where the walls are thinned, the lumen expands to form nodes.
Statistical data
Varicose veins is a disease with a genetic predisposition. The probability of its occurrence in people who have no one in the family with venous disease does not exceed 20%. If one of the parents gets sick, the risk increases: men-up to 25%, women-up to 62%. If both parents have the disease, there is a 90% chance that the offspring will develop varicose veins.
For varicose veins, the ratio of the two main structural proteins of the vein wall is disturbed:collagenandElastin. . . If collagen is stiff, then elastin, as the name suggests, is responsible for elasticity-the ability of the vein wall to return to its original state. In patients with varicose veins, the amount of this protein in the vein wall is reduced. The collagen itself has also changed: instead of the main type III collagen responsible for elasticity, the content of type I collagen-rigidity, retains residual deformation, increases. In addition, the number of smooth muscle cells that regulate the vascular cavity will also change, and their ability to interact with each other will also be impaired. These pathological changes are genetic in nature. Then the game startedExternal factor:
- Long-term static load-need to stand still or sit still;
- overweight;
- Pregnancy and childbirth.
Some experts point out that chronic constipation, tights that increase intra-abdominal pressure, and high heels that interfere with the normal function of leg muscle pumps are predisposing factors.
These factors alone or in combination can increase the pressure in the venous system of the lower extremities. The changed vein wall no longer "holds" pressure, and the venous cavity expands. As the venous cavity expands, the valve that provides blood flow in only one direction stops working. appearBackflow-Reverse flow. The pressure in the affected vein rises further and the vicious circle is closed.
Increased venous pressure, coupled with changes in wall structure over time, triggersInflammation-Initially only on the surface of the valve and the inner wall of the container. Gradually, inflammatory proteins and blood cells begin to "infiltrate" the surrounding tissues through the damaged vein wall. They are destroyed there, releasing active substances——Inflammatory mediators. . . they destroy the surrounding cells and attractLymphocytesIts function is to remove damaged tissue. As a result, the leg skin appears edema, induration (induration), and hyperpigmentation. These processes can lead to venous trophic ulcers. Long-term inflammation of the vein wall can also increase blood clotting. Combined with venous congestion, this can cause blood clots to begin to form in varicose veins. appearThrombophlebitis-Another dangerous complication of varicose veins.
The performance of varicose veins is divided into objective performance and subjective performance.Subjective symptoms-These are the complaints of patients about:
- Heavy legs;
- Rapid fatigue
- Paresthesias-unpleasant feelings of "goose bumps", changes in sensitivity;
- Burning sensation in muscles;
- Leg pain, characterized by weakened strength after walking;
- Swelling at night;
- Restless legs syndrome-a condition in which leg discomfort prevents you from falling asleep;
- Spasms of lower limbs at night.
The combination of these symptoms and their severity vary from person to person and are not always related to changes in the vein wall and surrounding tissues.
The combination of subjective complaints and objective changes in lower extremity tissue forms the basis for the modern classification of varicose veins and chronic venous insufficiency:
- C0-There are complaints, but there is no change in appearance. Venous lesions can only be found through special inspections and tests;
- C1-"Spiders" appear (scientific name-telangiectasia) or intradermal venous networks (varices) become visible;
- C2-Dilated saphenous veins are more than 3 mm in diameter, and varicose veins appear;
- C3-Constant swelling of the affected leg;
- C4-Changes in surrounding tissues: darkening of the skin (hyperpigmentation), development of eczema, hardening of the subcutaneous tissue;
- C5-Ulcer healing stage;
- C6-The stage of open ulcers.
Starting from the fourth stage, the nutritional skin changes described can no longer be completely eliminated. Even if the varicose veins are cured at this stage, it will not lead to the complete absorption of hyperpigmentation or induration. In addition, it is necessary to remember a rather dangerous complication——Thromboembolism. . .
On notes
30% to 60% of deaths occur due to sudden deep vein thrombosis and further thromboembolism. These deaths occur in the context of varicose veins, accompanied by undetected and uncured thrombosisPhlebitis.
Therefore, the treatment of varicose veins should not be postponed until later, especially in the context of the achievements of modern phlebology.
Modern methods for the treatment of varicose veins
Methods and techniques that meet several criteria can be considered modern: minimally invasive (traumatic), high efficiency, low possibility of recurrence and complications, and short recovery period.
- Conservative treatment.This includes the use of compression stockings, ointments, and intravenous injections (oral medications). Current clinical guidelines indicate that venotonics can reducesubjectiveEarly manifestations of the disease (main complaint) and reduce edema, but never affect the state of the vein wall itself. Different kinds of ointments have the same effect. Compression stockings are considered to be a very effective method for the treatment of varicose veins, because it can reduce the performance of venous insufficiency, alleviate the subjective complaints of patients, and prevent the progression of varicose veins. However, compression stockings cannot cure varicose veins-dilated veins will not work properly.
- Traditional surgical resection.The affected saphenous vein or small saphenous vein is tied up where it flows into the deep venous system, and then it is removed with a special metal probe. This kind of surgery is very effective, but it is very traumatic and it takes a long time to recover. The possibility of postoperative complications is high-hematoma, postoperative paresthesia, and neuralgia.
- Sclerotherapy.A special medicine is injected into the varicose veins to "stick" the vein. This operation is less traumatic and is recommended for the treatment of small diameter veins. However, it is rarely used to remove the ineffective stems of the large and small saphenous veins because it is characterized by a high recurrence rate. In addition, within the framework of hardening, unpleasant complications such as hyperpigmentation are possible.
- Intravenous Laser Coagulation (EVLK)-Minimally invasive, safe, modern and effective type of varicose vein treatment. It has synonyms: intracavitary laser ablation, intravenous coagulation of the lower limbs, and intracavitary laser occlusion (EVLO). Regardless of the name, the laser coagulation technology remains the same. The radial fiber optic light guide is inserted into the vein through the puncture. Then, with the help of a special pump, the anesthetic solution is pumped around the vein, which not only can anesthetize the operation, but also compress the vein and reduce its diameter, thereby preventing the surrounding tissue from overheating. A modern vascular laser is used during the operation. It produces two waves: one is absorbed by hemoglobin, and the other is absorbed by the blood vessel wall. Vienna is "brewing". All stages (the position of the light guide, the penetration of the solution around the vein, the process of "brewing") are monitored in real time by ultrasonic equipment. The duration of EVLK surgery on one limb is 30-60 minutes.
The important thing is to know!
The only effective way to treat varicose veins is to remove the altered veins that cannot perform their functions.
Advantages of laser removal method:
- Minimal trauma, allowing surgery in outpatient clinics and under local anesthesia;
- You can go home immediately after the operation;
- Quick recovery
- Good cosmetic effect: leaving no traces and scars;
- High efficiency and low recurrence rate.
Since intravenous laser coagulation is currently considered to be one of the most advanced, low-invasive and minimally invasive treatments for varicose veins, we will consider this technique in more detail.
Indications for laser coagulation
The main indication is varicose veins, regardless of the diameter of the vein trunk and the choice of anatomical structure. Due to the improvement of modern equipment-two-wave laser and radial fiber, it is possible to expand the scope of indications for EVLK.
Surgical contraindications
In most cases, they are attributed to the patient’s severe physical illness:
- Deep vein thrombosis (obstruction, occlusion, obstruction);
- Decompensated type 1 diabetes;
- Severe atherosclerosis and lower limb ischemia;
- Severe cardiovascular diseases: ischemic heart disease, especially angina pectoris at rest, extensive myocardial infarction with reduced cardiac output, severe arrhythmia, stroke;
- Severe blood coagulation disorder, downward and upward;
- Pregnancy and breastfeeding;
- Personal intolerance to the anesthetics used;
- Inability to engage in physical activity immediately after the operation;
- Cannot use compression stockings.
The age of the patient is not a contraindication is its characteristic.
How does vein laser coagulation work?
Shortly before operation, you should buy compression stockings with level 2 compression (25-32 mmHg). The doctor will tell you in detail what size you need. Intravascular laser coagulation itself does not require any special preparation.
All stages of intravenous laser occlusion are performed under continuous ultrasound control.
- Before the operation starts, "mark" the veins: the doctor marks the skin where the blood returns and the tributaries flow into the veins.
- At the beginning of the procedure, local anesthesia occurs and the vein is punctured (puncture). It feels no different from the usual intravenous injection. A special catheter is used to insert the radial light guide into the vein.
- Next, a protective "sleeve" of anesthetics is formed around the vein. Under ultrasound control, the doctor uses a special pump to inject local anesthetic into the space around the blood vessel. This not only relieves pain, but also protects surrounding tissues from excessive laser heat.
- The operation itself is EVLO varicose veins. In modern optical fibers, laser radiation is evenly distributed over the entire circumference of the device, heating the vein evenly from the inside. After the light guide is removed, the patient undergoes ultrasound monitoring of the condition of the treated blood vessels and the deep veins of the limbs.
- Put the patient on a compression suit.
After the operation, the patient should take a walk immediately for at least 40 minutes.
Possible complications
They are rare, they are temporary, and the possibility of complications is mainly related to the use of outdated medical equipment and the low qualifications of doctors.
- Deep vein thrombosis-It may appear in patients who are prone to thrombosis. Therefore, in order to prevent this complication, the patient was prescribed drugs to reduce blood clotting. Usually, they are used within 4-5 days after the intervention.
- Thrombophlebitis-Usually related to insufficient laser exposure intensity.
- Treatment of pigmentation along veinsSubside within 1. 5-2 months.
- Feel the "stretched" veins-Passed within 1. 5 months.
In order to prevent the development of any complications as much as possible, you should follow some simple rules, which are necessary for successful recovery.
recovery
On the first day, there may be soreness and pain in the veins. To eliminate them, traditional painkillers are sufficient. The temperature may increase in the first few days. It is enough to reduce it by traditional means.
Generally speaking, for successful recovery, 2 main conditions must be observed-wearing pressure underwear and maintaining adequate physical activity.
- Compression underwear——During the first 5 days, it will not be removed even during night sleep. This is necessary in order for the veins to "glue" and heal completely. In addition, compression stockings are only worn during the day. Wearing elastic clothing for 2. 5-3 months is enough, but if there are risk factors (sedentary, standing work, taking female sex hormones), you need to wear elastic stockings preventively.
- physical activity-It is recommended to walk for at least one hour a day. But you will have to give up about a month of high-intensity exercise.
During this month, you should avoid hot baths, baths and saunas.
Evaluate the effectiveness of the method
The analysis of domestic and foreign literature shows that the effective rate of laser coagulation of varicose veins is between 93% and 100%. The failure can be attributed to several groups of factors:
- The anatomical features of the surgical vein;
- Violation of the technical performance of EVLK (insufficient laser power, insufficient compression of veins with anesthetic solution);
- The patient does not follow the postoperative rules (usually-refusal to pressurize).
The immediate and long-term effects of laser coagulation of lower extremity veins are better than radiofrequency ablation and sclerotherapy, and are comparable to traditional surgical techniques. At the same time, compared with classic surgery, laser treatment of varicose veins has better tolerance, shorter recovery time and fewer complications.
What is the price of EVLK?
The intravascular laser coagulation process requires high-tech equipment and expensive disposable consumables (light guides), which explains its cost. The total amount will depend on the number and complexity of the procedures, the medical equipment used and the qualifications of the doctor.
Therefore, intravenous laser coagulation is a modern and effective method for the treatment of varicose veins. It provides excellent clinical results and, in fact, leaves no residue. The minimal trauma exposed allows you to return to a normal life (with slight restrictions) on the day of the operation, without hospitalization and any special rehabilitation conditions.
How to choose a clinic
A vascular surgeon and phlebologist said:
"The effect of laser coagulation of veins in the lower extremities largely depends on the professional level of the medical staff and the technical characteristics of the equipment used. This means that the equipment used must be modern and the doctors must be qualified. Therefore, I recommendChoose a clinic that specializes in this particular type of service, which has been in operation for many years and has been tried and tested. "