Help feet with varicose veins

healthy feet and varicose veins in the foot

Varicose veins of the lower extremities are rightly considered the most common pathology of peripheral blood vessels and one of the so-called ten diseases of civilization. According to epidemiological studies, venous insufficiency occurs in 80% of able-bodied people. In most cases, varicose veins of the legs do not cause serious pain, and sometimes they do not notice and do not require any treatment. However, there are cases when it is necessary to consult a specialist and undergo appropriate treatment without delay. What is the treatment of varicose veins of the lower extremities? What are their advantages and disadvantages?

Ways to get rid of the disease

Every year, thousands of people ask themselves: how to get rid of "ugly knots" or "white veins" on their feet? Media portals are full of advertisements for public and private clinics that treat varicose veins of the lower extremities. They offer "unique", "guaranteed", "painless" or "completely safe" ways to get rid of this disease. Sometimes it is difficult to understand this ad, to answer the question of which treatment option is most suitable. If you decide to deal with enlarged vessels and are not sure about the safety and effectiveness of this or that treatment, the best option for him is to visit several clinics and get qualified advice from at least two specialists. .

There are various reasons that make a patient with varicose veins see a doctor:

  • cosmetic considerations;
  • signs of anxiety;
  • complications of the disease (eg, ulcers, bleeding or thrombophlebitis);
  • fear for your health (how the disease will behave in the future if left untreated).

Sometimes it is difficult for a doctor to know what a patient wants. Therefore, it is important to find a mutual understanding with the doctor during the consultation, to correctly convey the main reason for contacting him. Often, patients need to make sure that their dilated arteries do not hurt them in any way and will not hurt them in the future.

If therapy is needed, the doctor often recommends self-treatment at home for 6 months:

  • use of compression stockings;
  • to train regularly;
  • Avoid "long breaks" - avoid sitting or standing for long periods of time;
  • while resting (in a horizontal position), lift the "broken" joint above the level of the heart.

If the patient is not satisfied with the result after the second consultation, the doctor may recommend conservative or surgical treatment of varicose veins of the lower extremities.

Treatment options for pathology of the lower extremities

Conservative treatment (compression and pharmacological therapy, lifestyle changes), surgical interventions, external and internal laser exposure, radiofrequency ablation, injection sclerotherapy are used to combat varicose veins of the legs. The choice of this or that option depends on the patient's preferences. It is also affected by the patient's financial resources, the qualifications of doctors and the equipment of the medical institution. However, the treatment of varicose veins of the lower extremities in each specific case depends largely on the disease itself: what are the symptoms, the degree of venous insufficiency and other features of vascular lesions.

Conservative treatment methods

Conservative treatment, as a rule, is complex and consists of several components.

Lifestyle changes that involve comprehensive measures to prevent blood clots in the arteries. As you know, prolonged standing or sitting position increases the activity of the venous-muscular pump (gastrocnemius muscle), which causes stagnation. Therefore, patients are advised to walk regularly, periodically raising their legs above the level of the heart in a prone position. You should also pay attention to different diets - salt-free, low-calorie. They will allow you to regulate body weight and eliminate seasonal vitamin deficiencies. It is necessary to consume foods high in bioflavonoids (substances that help strengthen the vascular wall).

People with varicose veins should avoid overheating their feet, visit baths and saunas, and if possible use warm floors.

Compression stockings improve venous hemodynamics, which leads to the disappearance of many manifestations of the disease. Disadvantages of this method:

  • limited use in time (not always able to wear compression stockings and socks);
  • The appearance of discomfort with constant compression, this is especially often observed in the spring, when most of the symptoms of varicose veins "manifest themselves".

The pharmacy, as a rule, offers compression stockings only from one manufacturer. However, there are many different brands, each of which can meet the needs of the patient to varying degrees.

Drug treatment can eliminate or reduce the symptoms of the disease, aimed at preventing and combating complications, and increase the effectiveness of compression therapy. Helps to cope with side effects after pharmacology, sclerotherapy or phlebectomy.

Modern treatment of varicose veins of the lower extremities is not complete without the use of venotonics (phleboprotectors), drugs that can improve symptoms and strengthen the vessel wall. They are considered the main pharmacotherapeutic agents. These include:

  • Horse chestnut fruit extract and thiamine (vitamin B1), part of the drugs used to treat pain and heaviness in the legs, are observed in chronic venous insufficiency. The tools have been shown to be effective in clinical trials. There are dosage forms: oral solution (10-15 drops 3 times a day) and tablet form (usually 1 tablet 3 times a day after meals).
  • Butcher's broom (butcher's broom) is used as a food supplement. Helps relieve vascular congestionIt is believed to be effective against spider veins. However, no clinical data have been obtained to confirm its safety and efficacy.
  • Depodoteinized hemoderivative of the blood of young calves is an excellent phleboprotector, part of a popular drug that has a good therapeutic effect on varicose veins of the lower extremities.

As a rule, it is prescribed in venotonic courses. The duration of the course depends on the dynamics of improvement of symptoms, the duration of remission. Therefore, your doctor may change your medication for 3 to 6 months or more.

Ointments and gels (topical medications) are also widely used. The treatment regimen for varicose veins of the lower extremities is selected by the doctor according to the condition and course of the disease. The therapeutic effect of these topical drugs is realized through two mechanisms: distracting and, in fact, therapeutic. First, the alcohol base or essential oils in the gel evaporate, which in turn reduces the temperature of the skin and improves the symptoms of the disease. As a result, the drug penetrates directly into the bloodstream through the skin and begins to have a therapeutic effect.

Ointments and gels used for varicose veins of the legs are classified according to their main active ingredient. These include:

  • Phleboprotectors (usually routine, plant substances that strengthen the vascular wall).
  • Non-steroidal anti-inflammatory drugs are commonly used to relieve pain.
  • Topical corticosteroids are used for allergic dermatitis, which can occur as a complication of venous insufficiency.
  • H1-histamine receptor blockers, on the other hand, are prescribed instead of corticosteroids.
  • Proteolytic enzymes can effectively clear trophic ulcers (complications of varicose veins of the legs).
  • Ionic silver is an effective antiseptic, perfectly cleanses and dries the wound, so it is an indispensable tool for the treatment of infected trophic ulcers.
  • Antibiotics are used topically for infection of varicose veins complications (thrombophlebitis, dermatitis).
  • Moisturizers and dermatoprotectors protect the skin from external influences, increase its elasticity. It is usually prescribed for atrophic skin changes (when compression stockings are used for a long time).
  • In addition to antithrombotic activity (prevents the formation of blood clots), heparin has an anti-inflammatory effect, can relieve pain.

Surgery

The main purpose of surgical treatment is to eliminate the pathological mechanism that causes the disease - the venous reflex, as well as its main manifestation - varicose veins. Surgical treatment is indicated: progressive pain in the legs and persistent fatigue, edema, chronic venous insufficiency, cosmetic problems, early hyperpigmentation (excessive pigment deposition in the skin), external bleeding, as well as trophic ulcers that cannot be treated conservatively in the presence of superficial thrombophlebitis.

There are currently three most popular types of surgery:

  • sapheno-femoral ligation (closure and removal of the superior saphenous vein);
  • peeling of the large saphenous vein:
    • In traditional or Bebkokk surgery, a special probe is inserted into the lumen of a large saphenous vein (two incisions are made in advance: one in the groin area, the other at the level of the upper third of the leg) and stretched along it. the entire length is then removed along with the varicose vein;
    • cryostripping is almost identical to the previous one, but differs in that the probe is cooled to -85 ° C, resulting in the vessel sticking to the probe, which allows it to be removed less traumatically;
  • Phlebectomy is a procedure to remove varicose veins with a few small incisions of 2-3 mm in the skin.

The above surgical interventions help to improve the patient's quality of life; their therapeutic and economic effectiveness has been proven in clinical trials. It is usually performed under general anesthesia, but most patients are discharged home on the day of surgery. Full recovery, return to normal daily activities usually takes 2-3 weeks. Complications are more common in patients with advanced varicose veins. Nerves in the subcutaneous tissue can be damaged during the operation, so after surgical manipulation, temporary or even permanent numbness is sometimes observed in some parts of the legs, but this does not cause serious disability.

New treatments

The main goal of using new treatment methods is to minimize tissue trauma observed during surgery, which allows the patient to recover faster. It became widely used in the early 2000s.

Intravenous ablation (RF and laser)

Radiofrequency and laser ablation are methods of treating varicose veins of the legs by "sealing" a large saphenous vein (or small vein) with high temperature, which causes the dilated veins (the walls stick together) to shrink. Although these options do not cover surgical procedures, additional phlebectomy and sclerotherapy are very common. Both methods include:

  • Insert a catheter into a large saphenous vein with a small incision in the upper third of the foot and proceed to the saphenofemoral junction under ultrasound guidance. It is not cut in the groin area.
  • Performed under local anesthesia (anesthesia penetrates extensively into the subcutaneous tissue of the thigh). At the same time, additional general anesthesia may be required if multiple miniphlebectomy is performed.
  • The need to use a bandage or socks for two weeks after the procedure.
  • The dependence of the results on the anatomy of the saphenous vessels in the patient is positive in the presence of straight vessels, it is doubtful if the vessels are curved.

The use of intravenous ablation, which has been widely used in the last decade, has not shown significant differences in its effectiveness compared to surgery.

The main advantage of this technique is the rapid recovery after surgery, which is associated with a lower likelihood of wound infection and hematoma.

However, complications are typical for this procedure: skin burns, temporary paresthesias, deep vein thrombosis (occurs in less than 1% of patients).

Simple sclerotherapy

This method of treatment is currently used in many clinics due to its ease of application and low trauma. Its essence is the injection of sclerosis into the varicose veins, a substance that adheres to the walls, and the transfer of blood flow to healthy blood vessels. Sclerotherapy is often combined with classical surgery and is used as the only treatment for telangiectasia and spider veins.

Contraindications:

  • pregnancy,
  • breastfeeding period,
  • dermatitis,
  • thrombophlebitis.

Sclerotherapy gives very acceptable results that satisfy many patients.

Foam sclerotherapy

Unlike simple sclerotherapy, foam is injected into a vein after being mixed with a sclerosing gas (usually air). As a result, foam is formed that spreads from the vein, drawing blood from it and causing the vein to spasm. The manipulation is usually performed under the guidance of a duplex ultrasound examination.

In addition to simple foam sclerotherapy, compression stockings are required after 14 days of manipulation.

Recovery after the procedure is faster than with a classic operation. However, the results of medium-term treatment of foam sclerotherapy (probability of recurrence of reflux) are worse than surgery.

Foam sclerotherapy for varicose veins

Treatment of "microvaricosis": telangiectasia, spider veins

Treatment of spider veins is almost always performed for cosmetic reasons only, although it can sometimes cause a hot, throbbing sensation that indicates reflux. Two types of therapy are commonly used:

  • Microsclerotherapy - the application of a sclerosing substance using a thin needle. Usually, several spider veins are sclerosed at the same time. Apply a compression bandage or socks for 1-2 days. If the sclerosis enters the outside of the vein during the injection, a slowly healing ulcer may develop in this area, and then a scar remains. This is rare, provided that "the doctor's hands do not tremble during the operation. "Hyperpigmentation (darkening of the skin) at the injection site is also possible.
  • Laser ablation. The method is effective in the treatment of telangiectasia (intradermal vascular enlargement, similar to the birthmark).

There are many effective ways to get rid of varicose veins of the lower extremities offered by traditional medicine. The choice of treatment depends mainly on the patient's own decision. Do not immediately "get under the knife", in the arsenal of doctors there are effective options for conservative therapy. Doctors say that today it is impossible to completely cure this disease, but it is within the power of modern medicine to save the patient from the manifestations of the disease as much as possible and prevent its further progression.