Varicose veins, or varicose veins, are often referred to in everyday life as "tired leg disease. "But in fact, the factors that cause it are more complicated. And the disease itself is not a harmless cosmetic defect in any way. Varicose veins of the lower extremities lead to chronic venous insufficiency - a condition that can eventually lead to the formation of venous trophic ulcers.
Of course, in most cases, we suffer from moderate varicose veins, there is currently no cure for relapse. But first of all.
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 consult a doctor. According to Western scientists, at least a quarter of the population in the United States and Europe suffers from it. Pathology has been registered in more than 30 million people in our country. At the same time, according to some studies, more than 18% are unaware of their disease and more than 8% do not receive treatment.
Varicose veins of the lower extremities is a disease in which the structure of the vascular wall changes. The veins stretch and bend, the lumen expands in the thinning areas of the walls, and nodules form.
Statistics
Varicose veins are a hereditary disease. The probability of occurrence in those who do not suffer from any vascular pathology in the family 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%. If both parents have the disease, the probability of varicose veins in the children is 90%.
With varicose veins, the ratio of the two main structural proteins of the venous walls is disturbed:collagenandelastin. . . If collagen forms stiffness, elastin, as the name implies, is responsible for elasticity - the ability to return the vascular wall to its original state. In patients with varicose veins, the amount of this protein in the venous wall is reduced. Collagen itself also changes: instead of the predominant type III collagen, which is responsible for elasticity, the composition of type I collagen increases, while maintaining a rigid, residual deformation. In addition, the number of smooth muscle cells that regulate the lumen of the vessel changes, and the ability to interact with each other is impaired. These pathological changes are hereditary. Then the game enters the gameexternal factors:
- long-term static loads - the need to stand or sit still;
- overweight;
- pregnancy and childbirth.
Some experts view chronic constipation, tight clothing that increases intra-abdominal pressure, and high heels as factors that prevent the muscle pump in the legs from working properly.
Individually or in combination, these factors increase the pressure in the venous system of the lower extremities. Altered venous wall pressure stops "catching", the lumen of the vessel expands. As a result of the dilation of the vascular lumen, the valves that provide blood flow in only one direction stop working. It arisesreflux- reverse flow. The pressure inside the affected vessel rises even higher and closes the vicious circle.
Increases venous pressure with changes in wall structure over timeinflammatory response- initially only on the surface of the valves and on the inner wall of the vessels. Gradually, inflammatory proteins and blood cells begin to "leak" into the surrounding tissue through the damaged venous wall. They are destroyed by releasing active substances there -mediators of inflammation. . . Damages and attracts surrounding cellslymphocytesIts function is to remove damaged tissue. As a result, edema, induration (induration) and hyperpigmentation on the skin of the legs develop. These processes can lead to venous trophic ulcers. Prolonged inflammation of the venous wall also increases blood clotting. With venous obstruction, blood clots begin to form in the varicose veins. It arisesthrombophlebitis- Another dangerous complication of varicose veins.
Manifestations of varicose veins are divided into objective and subjective.Subjective symptoms- The patient's complaints are:
- weight on the legs;
- rapid fatigue;
- paresthesias - unpleasant sensations "gas bubbles", changes in sensitivity;
- burning sensation in muscles;
- leg pain, a characteristic feature of which is a decrease in intensity after walking;
- swelling in the evening;
- restless legs syndrome - a condition in which discomfort in your feet prevents you from falling asleep;
- nocturnal cramps in the lower extremities.
The combination of these symptoms and their severity is individual and is not always associated 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 change in appearance, vascular damage can be detected only by special examinations and tests;
- C1- "spiders" appear (scientific name - telangiectasia) or intradermal dilated vascular network (reticular varicose veins);
- C2- Dilated saphenous veins more than 3 mm in diameter, varicose nodules are visible;
- C3- the affected foot is constantly swollen;
- C4- changes occur in the surrounding tissues: the skin darkens (hyperpigmentation), eczema develops, subcutaneous tissue melts;
- C5- stage of healing ulcer;
- C6- open ulcer stage.
The trophic skin changes described from the fourth stage can no longer be completely eliminated. Varicose veins treated at this stage will not cause such hyperpigmentation or complete resorption of induration. In addition, it is necessary to remember a very dangerous complication -thromboembolism. . .
Note
30-60% of deaths due to sudden onset deep vein thrombosis and subsequent thromboembolism occur in the background of varicose veins and are not detected and treated in time with thrombophlebitis.
Therefore, especially against the background of the achievements of modern phlebology, you should not delay the treatment of varicose veins until later.
Modern methods of treatment of varicose veins
Methods and techniques that meet several criteria can be considered modern: minimal invasiveness (trauma), high efficiency, low probability of relapses and complications, and a short rehabilitation period.
- Conservative therapy.Compressors include the use of socks, ointments and venotonics (oral medications). Existing clinical guidelines suggest that venotonics may reducesubjectiveReduces manifestations (complaints) and edema in the early stages of the disease, but in no way affects the condition of the venous wall. Different types of ointments have the same effect. Compression stockings are a very effective treatment for varicose veins because they reduce the manifestations of venous insufficiency, alleviate the patient's subjective complaints and prevent the progression of varicose veins. However, compression stockings cannot cure varicose veins - dilated veins will not work properly.
- Traditional surgical removal.The affected large or small saphenous vein is connected to the place where it flows into the deep venous system, and then removed with a special metal probe. This operation is effective, but quite traumatic and requires a long recovery. There is a high probability of postoperative complications - hematomas, postoperative paresthesias and neuralgia.
- Sclerotherapy.A special drug is injected into the varicose vein, "sticking" its walls. The procedure is less traumatic and is recommended for the treatment of small diameter vessels. However, it is rarely used to remove the dysfunctional trunk of large and small saphenous vessels, as it is characterized by a higher recurrence rate. In addition, an unpleasant complication such as hyperpigmentation within sclerosis is possible.
- Endovenous laser coagulation (EVLK)- Minimally invasive, safe, modern and effective type of treatment of varicose veins. There are synonymous names: endovenous laser ablation, endovasal coagulation of the vessels of the lower extremities, endovenous laser obliteration (EVLO). But whatever the name, the laser coagulation technique remains unchanged. A radial fiber optical light guide is inserted through the vein puncture. Then, with the help of a special pump, an anesthetic solution is injected around the vein, which, in addition to anesthetizing the procedure, compresses the vein, reduces its diameter and thus protects the surrounding tissues from overheating. The procedure uses modern vascular lasers that create two waves: one is absorbed by the blood hemoglobin, the other by the vascular wall. Vienna is "brewed". All stages (position of the light guide, leakage of solution around the vessel, the "infusion" process) are monitored in real time by ultrasonic devices. The duration of the EVLK procedure in one extremity is 30-60 minutes.
It is important to know!
The only effective way to treat varicose veins is to remove the altered vein that is no longer able to function.
Advantages of laser removal method:
- Minimal trauma, which allows the procedure to be performed in an outpatient setting and under local anesthesia;
- you can go home immediately after surgery;
- fast recovery;
- good cosmetic result: no scars and marks;
- high efficiency, low relapse rate.
As endovenous laser coagulation is currently considered one of the most advanced, minimally traumatic, and minimally invasive treatments for varicose veins, we will consider this technique in more detail.
Tips for laser coagulation
The main indication is varicose veins, regardless of the diameter of the venous body and the anatomical structure. Thanks to the perfection of modern equipment - two-wave lasers, radial fibers, it was possible to expand the range of EVLK indicators.
Contraindications to the procedure
In most cases, the patient has a severe somatic condition:
- deep vein thrombosis (obstruction, blockage, obstruction);
- decompensated type 1 diabetes;
- 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 decreased cardiac output, severe forms of cardiac arrhythmias, strokes;
- both lower and upper blood clotting disorders;
- pregnancy and breastfeeding;
- individual intolerance to the anesthesia used;
- impossibility of physical activity immediately after the procedure;
- not being able to use compression stockings.
It is characteristic that the patient's age is not contraindicated.
How is laser blood clotting performed?
Shortly before the manipulation, you should buy 2nd degree (25-32 mm Hg) compression stockings. The doctor will explain to you in detail what measurements are required. Endovasal laser coagulation itself does not require special training.
All stages of endovenous laser obliteration are performed under constant ultrasound control.
- Before the procedure, the vein is "marked": the doctor marks the skin according to where the blood flows back, the arms flow into the vein.
- At the beginning of the manipulation, local anesthesia is performed, the vessel is punctured (perforated). The sensations are no different from a normal intravenous injection. A radial light guide is inserted into the vein using a special catheter.
- Then, a protective "arm" of the anesthetic drug is created around the vein. Under the control of ultrasound, using a special pump, the doctor injects local anesthesia into the space around the vessel. This not only relieves pain, but also protects the surrounding tissues from excess laser heat.
- The procedure itself is EVLO varicose veins. In modern optical fibers, the laser radiation is transmitted evenly around the device, providing uniform heating of the vessel from the inside. After removing the light guide, the patient monitors the condition of the treated vessel, as well as the deep veins of the joint with ultrasound.
- The patient is dressed in compression garments.
Immediately after the end of the manipulation, the patient should go for a walk lasting at least 40 minutes.
Possible complications
Their number is small, temporary, and the likelihood of complications is mainly due to the use of outdated medical equipment and the low qualification of the doctor.
- Deep vein thrombosis -may appear in patients prone to increased thrombosis. Therefore, to prevent this complication, patients are prescribed drugs that reduce blood clotting. As a rule, it is used within 4-5 days after the intervention.
- Thrombophlebitis- is often associated with insufficient intensity of laser exposure.
- Pigmentation along the treated vein1. Resolved within 5-2 months.
- The feeling of "stretched" veins- Passes within 1, 5 months.
To prevent the development of any complication as much as possible, you should follow a few simple rules that need to be followed for successful rehabilitation.
Rehabilitation
On the first day, there may be pain and soreness along the vein. Traditional painkillers are enough to eliminate them. The temperature may rise in the first days. It is enough to use traditional means to reduce it.
In general, 2 basic conditions must be met for successful rehabilitation - wear compression underwear and maintain adequate physical activity.
- Compressor underwear -not removed during the first 5 days, even during a night's sleep. This is necessary for the vessel to completely "stick" and heal. In addition, compression stockings are worn only during the day. It is enough to wear compression garments for 2, 5-3 months, but if there are risk factors (sitting, working on the legs, taking female sex hormones), further prophylactic wear of compression stockings is desirable.
- Physical activity- It is recommended to walk at least one hour a day. But you will have to give up intense sports for about a month.
During the month you should stay away from hot baths, baths and saunas.
Evaluate the effectiveness of the method
Analysis of foreign and local publications shows that the effectiveness of laser coagulation of varicose veins varies from 93 to 100%. Failures can be attributed to several groups of factors:
- anatomical features of the operated vessel;
- Violation of the technical parameters of EVLK (insufficient laser, insufficient compression of the vessel with anesthetic solution);
- the patient's non-compliance with the rules of the postoperative regime (in general - the refusal to compress).
The immediate and long-term results of laser coagulation of the vessels of the lower extremities are better than radiofrequency ablation and sclerotherapy and are comparable to traditional surgical methods. At the same time, laser treatment of varicose veins is better tolerated, the rehabilitation period is shorter and the number of complications is less than with conventional surgery.
How much is EVLK?
The endovasal laser coagulation procedure requires high-tech equipment and expensive disposable consumables (light guides) that explain the cost. The total amount will depend on the size and complexity of the procedure, the medical equipment used and the doctor's qualifications.
Thus, endovenous laser coagulation is a modern effective method in the treatment of varicose veins. Gives excellent clinical results and leaves virtually no trace. Minimal exposure trauma allows you to return to normal life (with minor restrictions) on the day of surgery, to the hospital regimen and without requiring any special conditions for recovery.
How to choose a clinic
Vascular surgeon, phlebologist says:
"The results of laser coagulation of the vessels of the lower extremities depend mainly on the professionalism of medical staff and the technical characteristics of the equipment used. This means that the equipment used must be modern and doctors must be qualified. I advise you to choose a clinic that specializes in this particular type of service. "