Varicose veins or varicose veins in everyday life are often called "tired leg disease". But in fact, the factors that cause it are much more complex. And the disease itself is by no means just a harmless cosmetic flaw. Varicose veins of the lower extremities lead to the appearance of chronic venous insufficiency - a condition whose end result can be the appearance of a venous trophic ulcer.
Of course, in the vast majority of cases we are dealing with varicose veins of moderate severity, which are now effectively and practically not treated for recurrence. But first first.
Why are varicose veins dangerous?
It is difficult to say how common varicose veins are: many patients consider it a cosmetic defect and do not go to the doctor. According to Western scientists, at least a quarter of the population in the United States and Europe suffers from it. In our country, pathology has been recorded in more than 30 million people. At the same time, according to some research, no more than 18% know about their disease, and no more than 8% are being treated.
Varicose veins of the lower extremities are a disease in which the structure of the vein wall changes. The vessels become longer, curved, in areas of thinning of the walls, the lumen expands, forming knots.
Statistics
Varicose veins are a disease with a hereditary predisposition. The probability of this happening in those in whose family no one has suffered from venous pathology is not more than 20%. If one of the parents is ill, the risk increases: for men - up to 25%, for women - up to 62%. In the presence of disease in both parents, the probability of varicose veins in the offspring is 90%.
In varicose veins, the ratio of the two main structural proteins of the venous walls is disturbed:collagenielastin. . . If collagen creates stiffness, then elastin, as its 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 venous wall is reduced. Collagen itself changes: instead of the predominant type III collagen, which is responsible for elasticity, the content of type I collagen - rigid, increases, retaining the residual deformation. In addition, the number of smooth muscle cells that regulate the lumen of the blood vessel changes, and the ability to interact with each other is impaired. These pathological changes are hereditary in nature. Then the game enters the gameexternal factors:
- prolonged static loads - the need to stand or sit still;
- overweight;
- pregnancy and childbirth.
Some experts point to chronic constipation, tight clothing that increases intra-abdominal pressure, and high heels that interfere with the normal functioning of the muscle pump in the legs as a predisposing factor.
Individually or in combination, these factors increase the pressure in the venous system of the lower extremities. The altered venous wall ceases to "retain" pressure, the vein lumen expands. As a result of the dilation of the vein lumen, the valves that ensure blood flow in only one direction stop working. He gets upreflux- reverse outflow. The pressure inside the affected vein rises even more, and the vicious circle closes.
Increased venous pressure, combined with changes in wall structure over time, triggerinflammatory response- at first only on the surface of the valve and the inner wall of the vessel. Gradually, inflammatory proteins and blood cells begin to "penetrate" through the damaged venous wall into the surrounding tissue. There they are destroyed, releasing active substances -inflammatory mediators. . . They damage the surrounding cells and attract themlymphocyteswhose function is to remove damaged tissue. As a result, edema, induration (induration) of the skin of the foot and hyperpigmentation developed. These processes can cause venous trophic ulcers. Prolonged inflammation of the venous wall also increases blood clotting. In combination with venous congestion, this leads to the fact that blood clots begin to form in the varicose veins. He gets upthrombophlebitis- another dangerous complication of varicose veins.
Manifestations of varicose veins are divided into objective and subjective.Subjective symptoms- these are the patient's complaints on:
- weight in the legs;
- rapid fatigue;
- paresthesias - unpleasant feelings of "goose", changes in sensitivity;
- tingling in the muscles;
- pain in the legs, whose characteristic feature is that the intensity decreases after walking;
- swelling in the evening;
- restless legs syndrome - a condition in which discomfort in the legs prevents you from falling asleep;
- nocturnal cramps in the lower extremities.
The combination of these symptoms and their severity are individual and do not always correlate with changes in the venous wall and surrounding tissues.
The combination of subjective complaints and objective changes in the tissues of the lower extremities forms the basis of the modern classification of varicose veins and chronic venous insufficiency:
- C0- there are complaints, but no changes in appearance, vein lesions can be detected only by special examination and tests;
- C1- "spiders" appear (scientific name - telangiectasia) or a network of intradermally varicose veins (reticular varicose veins) becomes visible;
- C2- the diameter of the dilated saphenous veins exceeds 3 mm, dilated nodules appear;
- C3- the affected leg is constantly swollen;
- C4- changes appear in the surrounding tissues: the skin darkens (hyperpigmentation), eczema develops, induction of subcutaneous tissue;
- C5- stage of healed ulcer;
- C6- stage of open ulcer.
Starting from the fourth stage, the described trophic changes of the skin can no longer be completely removed. Even cured varicose veins at this stage will not lead to complete resorption of hyperpigmentation or induration. In addition, it is necessary to remember a rather dangerous complication -thromboembolism. . .
On a side note
30 to 60% of deaths due to sudden deep vein thrombosis and further thromboembolism occur in the background of varicose veins in combination with thrombophlebitis that is undetected and not cured in time.
Therefore, you should not delay the treatment of varicose veins for later, especially against the background of the achievements of modern phlebology.
Modern methods of treating varicose veins
Methods and techniques that meet several criteria can be considered modern: minimal invasiveness (trauma), high efficiency, low probability of recurrence and complications, and a short rehabilitation period.
- Conservative therapy.It includes the use of compression stockings, ointments and venotonics (oral medications). Current clinical guidelines suggest that venotonics may be reducedsubjectivemanifestations (complaints) in the early stages of the disease and reduce edema, but in no way affect the condition of the venous wall itself. Different types of fats have the same effect. Compression stockings are considered a very effective treatment for varicose veins because they reduce the manifestations of venous insufficiency, alleviate the patient's subjective discomfort and prevent the progression of varicose veins. However, compression stockings cannot cure varicose veins - varicose veins will not work properly.
- Traditional surgical removal.The damaged large or small saphenous vein is tied at the site of infusion into the deep venous system, after which it is removed with a special metal probe. This surgery is effective but quite traumatic and requires a long recovery. There is a high probability of postoperative complications - hematomas, postoperative paresthesias and neuralgias.
- Sclerotherapy.Inside the varicose vein, a special drug is injected that "glues" its walls. The procedure is low-traumatic and is recommended for the treatment of small diameter veins. However, it is rarely used to remove the non-operative trunk of the great and small saphenous vein because it is characterized by a higher recurrence rate. In addition, such an unpleasant complication as hyperpigmentation within sclerosis is possible.
- Endovenous laser coagulation (EVLK)- a minimally invasive, safe, modern and effective type of treatment for varicose veins. It has synonymous names: endovenous laser ablation, endovascular coagulation of lower extremity veins, endovenous laser obliteration (EVLO). But regardless of the name, the laser coagulation technique remains the same. A radial light guide with optical fibers is inserted through a puncture into a vein. Then, with the help of a special pump, an anesthetic solution is pumped around the vein, which not only anesthetizes the procedure, but also compresses the vein, reducing its diameter and thus protecting the surrounding tissues from overheating. Modern vascular lasers are used for the procedure, which generate two waves: one of them absorbs hemoglobin in the blood, the other - the vascular wall. Vienna is "getting ready". All phases (position of the light guide, infiltration of the solution around the vein, the process of "cooking" itself) are monitored in real time by ultrasonic devices. The EVLK procedure on one limb takes 30-60 minutes.
It is important to know!
The only effective method of treating varicose veins is to remove the altered vein that cannot perform its functions.
Advantages of the laser removal method:
- Minimal trauma, which allows the procedure to be performed on an outpatient basis and under local anesthesia;
- you can go home immediately after surgery;
- rapid recovery;
- good cosmetic result: no traces and scars;
- high efficiency, low recurrence rate.
Since endovenous laser coagulation is currently considered one of the most advanced, low-trauma, and minimally invasive types of varicose vein treatment, we will consider this technique in more detail.
Indications for laser coagulation
The main indicator is varicose veins, regardless of the diameter of the venous trunk and the possibilities of its anatomical structure. It was possible to expand the range of EVLK indications due to the perfection of modern equipment - two-cylinder lasers, radial fibers.
Contraindications to the procedure
In most cases, they are reduced to severe somatic conditions of the patient:
- deep vein thrombosis (obstruction, occlusion, blockage);
- decompensated diabetes mellitus type 1;
- severe atherosclerosis of the arteries and ischemia of the lower extremities;
- severe cardiovascular diseases: ischemic heart disease, especially angina pectoris at rest, extensive myocardial infarction with a decrease in minute volume, severe forms of cardiac arrhythmias, stroke;
- severe blood clotting disorders, downward and upward;
- pregnancy and lactation;
- individual intolerance to the anesthetic used;
- inability to engage in physical activity immediately after the procedure;
- inability to use compression stockings.
Characteristically, the patient's age is not a contraindication.
How is laser vein coagulation performed?
Immediately before handling, you need to buy compression socks of the second degree of compression (25–32 mm Hg). The doctor will tell you in detail what size is needed. Endovasal laser coagulation alone does not require any special preparation.
All phases of endovenous laser obliteration are performed under constant ultrasound control.
- Before the procedure begins, the vein is "marked": the doctor puts marks on the skin, which corresponds to the places where the blood returns and the tributaries enter the vein.
- At the beginning of the manipulation, local anesthesia occurs, the vein is punctured (punctured). The sensations are no different from conventional intravenous injections. A radial light guide is inserted into a vein using a special catheter.
- A protective "sleeve" of anesthetic drug is then created around the vein. Under ultrasound control, using a special pump, the doctor injects a local anesthetic into the area around the vessel. This not only relieves pain, but also protects the surrounding tissue from excessive laser heat.
- The procedure itself is EVLO varicose veins. In modern optical fibers, the laser radiation is distributed evenly throughout the perimeter of the device, ensuring uniform heating of the vein from the inside. After removing the light guide, the patient undergoes ultrasound monitoring of the condition of the treated vessel, as well as the deep veins of the limbs.
- Compression garments are placed on the patient.
Immediately after the end of the manipulation, the patient should take a walk for at least 40 minutes.
Possible complications
There are few of them, they are temporary, and the likelihood of complications is mainly related to the use of outdated medical equipment and low qualifications of doctors.
- Deep vein thrombosis -may occur in patients with a tendency to increased thrombosis. Therefore, to prevent this complication, patients are prescribed medications that reduce blood clotting. They are usually used within 4-5 days after the intervention.
- Thrombophlebitis- most often associated with insufficient intensity of laser exposure.
- Pigmentation along the vein treatmentdisappears within 1, 5-2 months.
- Feeling of a "stretched" vein- passes within 1, 5 months.
To prevent the development of any complications as much as possible, you need to adhere to a few simple rules whose observance is necessary for successful rehabilitation.
Rehabilitation
On the first day, pain and withdrawal along the vein may occur. Conventional pain medications are sufficient to remove them. The temperature may rise in the first few days. It is enough to take traditional means to reduce it.
In general, for successful rehabilitation, 2 main conditions must be met - wearing compression underwear and maintaining sufficient physical activity.
- Compression underwear -during the first 5 days it is not removed even during a night's sleep. This is necessary for the vein to fully "stick" and heal. Furthermore, compression stockings are worn only during the day. It is enough to wear compression clothing 2, 5-3 months, but if there are risk factors (sitting, standing work, taking female sex hormones), it is desirable to further preventively wear compression stockings.
- Physical activity- It is recommended to walk for at least an hour a day. But you will have to give up intense sports for about a month.
Hot baths, baths and saunas should be avoided during the month.
Evaluating method efficiency
Analysis of foreign and domestic publications shows that the efficiency of laser coagulation of varicose veins ranges from 93 to 100%. Errors can be attributed to several groups of factors:
- anatomical features of the operated vein;
- violations of technical performance of EVLK (insufficient laser power, insufficient vein compression with anesthetic solution);
- non-compliance with the rules of the postoperative regime by the patient (usually - refusal of compression).
Immediate and long-term results of laser coagulation of lower extremity veins are better than the results of radiofrequency ablation and sclerotherapy and are comparable to traditional surgical techniques. At the same time, laser treatment of varicose veins is much better tolerated, rehabilitation time is shorter, and the number of complications is less than with classic surgeries.
How much does EVLK cost?
The endovasal laser coagulation procedure requires high-tech equipment and expensive disposable consumables (light guides), which explains their cost. The total amount will depend on the scope and complexity of the procedure, the medical equipment used and the qualifications of the doctor.
Thus, endovenous laser coagulation is a modern effective method of treating varicose veins. It gives excellent clinical results and actually leaves no traces. Minimal trauma exposure allows you to return to normal life (with minor restrictions) as early as the day of surgery, without the need for a hospital regimen and special recovery conditions.
How to choose a clinic
Says vascular surgeon, phlebologist:
"The result of laser coagulation of lower extremity veins largely depends on the professionalism of medical staff, as well as on the technical characteristics of the equipment used. This means that the equipment used must be modern and doctors must be qualified. Therefore, I would recommend choosing a clinic specializing in this type of service. , which has been operating for several years and has a proven reputation. "