Varicose veins, or varicose veins, in everyday life are often referred to as "the disease of tired feet". But in reality, the factors that cause it are much more complex. And the disease itself is by no means just a harmless cosmetic defect. Varicose veins of the lower extremities lead to the appearance of chronic venous insufficiency - a condition, the end result of which may 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 treated effectively and practically without recurrence. But first things first.
Why are varicose veins dangerous?
How common is varicose vein disease is hard to say: 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, the pathology has been recorded in more than 30 million people. At the same time, according to some studies, no more than 18% know about their disease and no more than 8% receive treatment.
Varicose veins of the lower extremities are a disease in which the structure of the vein wall changes. The vessels become longer, tangled, in the areas of thinning of the walls, the lumen widens, forming nodules.
Statistics
Varicose veins are a disease with an inherited predisposition. The probability of its occurrence in those in the family of whom no one has suffered from venous pathology does not exceed 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 the disease in both parents, the probability of varicose veins in the offspring is 90%.
With varicose veins, the ratio of the two main structural proteins of the venous walls is disturbed:collagenandelastin. . . If collagen forms stiffness, then elastin, as its name implies, is responsible for elasticity - the ability of the venous wall to return to its original state. In patients with varicose veins, the amount of this protein in the venous wall decreases. Collagen itself also changes: instead of the predominant type III collagen, which is responsible for elasticity, the type I collagen content increases - rigid, retaining the residual deformation. In addition, the number of smooth muscle cells that regulate the vascular lumen also changes and the ability to interact with each other decreases. These pathological changes are hereditary. Then the game comes into playExternal factors:
- long-term static loads - the need for stationary standing or sitting posture.
- 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 function of the leg muscle pump as predisposing factors.
Individually or in combination, these factors increase the pressure on the venous system of the lower extremities. The damaged venous wall ceases to "hold" pressure, the lumen of the vein expands. As a result of the dilation of the venous lumen, the valves, which provide blood flow in only one direction, stop working. Resultinglow tide- reverse outflow. The pressure inside the affected vein increases even more and the vicious circle closes.
Increased venous pressure, combined with changes in the structure of the wall over time, activateinflammatory response- at first only on the surface of the valves and on the inner wall of the vessels. Gradually, inflammatory proteins and blood cells begin to "leak" through the damaged venous wall into the surrounding tissue. There they are destroyed, releasing active substances -inflammatory mediators. . . They damage the surrounding cells and attractlymphocyteswhose function is to remove damaged tissue. As a result, swelling, induction (induction) of the skin of the feet and hyperpigmentation develop. These procedures can cause venous food 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 vein. Resultingthrombophlebitis- another dangerous complication of varicose veins.
The manifestations of varicose veins are divided into objective and subjective.Subjective symptoms- these are the patient's complaints about:
- gravity on the legs.
- rapid fatigue;
- hallucinations - unpleasant sensations of "goose bumps", changes in sensitivity.
- burning sensation in the muscles.
- pain in the legs, the characteristic of which is that the tension decreases after a walk.
- swelling at night.
- Restless Legs Syndrome - A condition in which discomfort in your legs prevents you from sleeping.
- night cramps in the lower extremities.
The combination of these symptoms and their severity are individual and are 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 is the basis of the modern classification of varicose veins and chronic venous insufficiency:
- C0- there are complaints, but there are no changes in appearance, venous lesions can be detected only by special examination and tests.
- C1- "spiders" (scientific name - telangiectasias) appear or a network of intradermal dilated veins (reticular veins) becomes visible.
- C2- the diameter of the dilated clear veins exceeds 3 mm, varicose veins appear.
- C3- the affected leg is constantly swollen.
- C4- changes occur in the surrounding tissues: the skin darkens (hyperpigmentation), eczema develops, subcutaneous tissue induction.
- C5- the stage of the treated ulcer.
- C6- the stage of an open ulcer.
Starting with the fourth stage, the described nutritional changes of the skin can no longer be completely eliminated. Even treated varicose veins at this stage will not lead to complete absorption of hyperpigmentation or induction. In addition, it is necessary to remember about a rather dangerous complication -thromboembolism. . .
On a note
Between 30 and 60% of deaths due to sudden onset of deep vein thrombosis and further thromboembolism occur in the background of varicose veins in combination with thrombophlebitis that is not detected and treated in time.
Therefore, you should not postpone the treatment of varicose veins until later, especially in the context of the achievements of modern phlebology.
Modern methods of treating varicose veins
Methods and techniques that meet various criteria can be considered modern: minimal invasiveness (trauma), high efficiency, low probability of recurrence and complications and a short recovery period.
- Conservative therapy.Includes the use of compression tights, ointments and phlebotonics (oral medications). Current clinical guidelines suggest that phlebotonics may be reducedsubjectivemanifestations (complaints) in the early stages of the disease and reduce swelling, but in no way affect the condition of the venous wall itself. Different types of ointments have the same effect. Compression stockings are considered a very effective treatment for varicose veins, as they reduce the manifestations of venous insufficiency, relieve the patient's subjective complaints and prevent the development of varicose veins. However, compression stockings are not able to cure varicose veins - dilated veins will not work properly.
- Traditional surgical removal.The affected large or small clear vein is tied at the point where it flows into the deep venous system, after which it is removed with a special metal catheter. This operation is effective, but quite traumatic and requires a long recovery. There is a high probability of postoperative complications - hematomas, postoperative hallucinations and neuralgia.
- Sclerotherapy.A special drug is injected into the varicose vein, which "sticks" to its walls. The procedure is low wound and is recommended for the treatment of small diameter veins. However, it is rarely used to remove the non-functional trunk of large and small clear veins, as it is characterized by a higher recurrence rate. In addition, such an unpleasant complication as hyperpigmentation in the context of sclerosis is possible.
- Intravenous laser coagulation (EVLK)- minimally invasive, safe, modern and effective treatment for varicose veins. It has synonymous names: intravenous laser removal, intravascular coagulation of the veins of the lower extremities, intravenous laser removal (EVLO). Whatever the name, the laser coagulation technique remains the same. A radial fiber optic guide is inserted through the perforation into the vein. Then, with the help of a special pump, an anesthetic solution is pumped around the vein, which not only anesthetizes the process, but also compresses the vein, reducing its diameter and thus protecting the surrounding tissues from overheating. For the procedure, modern vascular lasers are used, which create two waves: one is absorbed by blood hemoglobin, the second - by the vascular wall. Vienna is "fermenting". All stages (position of the light guide, filtration of the solution around the vein, the very process of "preparation") are monitored in real time by ultrasound devices. The duration of the EVLK procedure at one end is 30-60 minutes.
It is important to know!
The only effective method of treating varicose veins is to remove the damaged vein that is unable to perform its functions.
The advantages of the laser removal method:
- Minimal trauma, which allows the procedure to be performed in outpatients and under local anesthesia.
- you can go home immediately after surgery.
- quick recovery;
- good cosmetic result: no marks and scars remain.
- high efficiency, low recurrence rate.
Since laser intravenous coagulation is currently considered one of the most advanced, low-trauma and minimally invasive types of treatment for varicose veins, we will look at this technique in more detail.
Indications for laser coagulation
The main indication is the varicose veins, regardless of the diameter of the venous trunk and the choices for its anatomical structure. It was possible to extend the range of EVLK indications due to the perfection of modern equipment - two-wave laser, radial fibers.
Contraindications to the procedure
In most cases, the following are reduced in the patient's severe physical condition:
- deep vein thrombosis (obstruction, obstruction, obstruction).
- uncompensated type 1 diabetes mellitus;
- severe atherosclerosis of the arteries and ischemia of the lower extremities.
- Severe cardiovascular disease: ischemic heart disease, especially angina at rest, extensive myocardial infarction with decreased cardiac output, severe forms of cardiac arrhythmias, strokes.
- severe blood clotting disorders, both down and up.
- pregnancy and lactation;
- individual intolerance to the anesthetic used;
- inability to engage in physical activity immediately after the procedure;
- inability to use compression tights.
It is characteristic that the age of the patient is not a contraindication.
How are veins coagulated by laser?
Just before handling, you should buy 2nd degree compression stockings (25–32 mm Hg). The doctor will tell you in detail what size is required. Laser intravascular coagulation alone does not require special preparation.
All stages of intravenous laser removal are performed under continuous ultrasound control.
- Before the procedure begins, the vein is "noted": the doctor puts marks on the skin, corresponding to the points where the blood flows back, the tributaries flow into the vein.
- At the beginning of the operation, local anesthesia appears, the vein is pierced (punctured). The senses are no different from the usual intravenous injection. A radial light guide is inserted into the vein using a special catheter.
- Next, a protective "sleeve" of the anesthetic drug is 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 delivered evenly throughout the periphery of the device, providing uniform heating of the vein from within. After removal of the light guide, the patient undergoes ultrasound monitoring of the condition of the treated vessel as well as the deep veins of the limb.
- A compression garment is placed on the patient.
Immediately after the end of the operation, the patient should take a walk of at least 40 minutes.
Possible complications
There are a few of them, they are temporary and the possibility of complications is mainly related to the use of outdated medical equipment and the low qualifications of a doctor.
- Deep vein thrombosis -may occur in patients with a tendency to increased thrombosis. Therefore, to prevent this complication, patients are prescribed drugs that reduce blood clotting. As a rule, they are used within 4-5 days after the intervention.
- Thrombophlebitis- most often associated with insufficient laser exposure intensity.
- Coloring along the treated veinsubsides within 1, 5-2 months.
- Feeling of "stretched" vein- passes within 1, 5 months.
To prevent the development of any complications as much as possible, you should follow a few simple rules, the observance of which is essential for successful recovery.
Reform
On the first day, there may be pain and pulling along the vein. Conventional analgesics are sufficient to eliminate them. The temperature may rise in the first days. It is enough to use traditional means to reduce it.
In general, for successful recovery, 2 basic conditions must be met - wear compression underwear and maintain adequate 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 "stick" completely and heal. In addition, compression stockings are only worn during the day. It is enough to wear compression garments for 2, 5-3 months, but if there are risk factors (sedentary life, standing work, taking female sex hormones), further preventive use of compression tights is desirable.
- Physical activity- It is recommended to walk for at least one hour daily. But you should give up intense sports for about a month.
During the month, you should avoid hot tubs, baths and saunas.
Evaluation of the effectiveness of the method
Analysis of foreign and domestic publications shows that the effectiveness of laser coagulation of varicose veins ranges from 93 to 100%. Failures can be attributed to several groups of factors:
- anatomical features of the operated vein.
- Violations of the technical performance of EVLK (insufficient laser power, insufficient compression of the vein with anesthetic solution).
- non-compliance by the patient with the rules of the postoperative regime (usually - refusal of compression).
The immediate and long-term effects of laser coagulation of the lower extremity veins are better than those 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, recovery time is shorter and the number of complications is less than with conventional surgeries.
How much does EVLK cost?
The intravascular laser coagulation procedure requires high-tech equipment and expensive disposable consumables (light guides), which explains its cost. The total amount will depend on the volume and complexity of the procedure, the medical equipment used and the qualifications of the doctor.
Thus, laser intravenous coagulation is a modern effective method of treating varicose veins. It gives excellent clinical results and, in fact, leaves no residue. Minimal exposure trauma allows you to return to normal life (with minor restrictions) already on the day of surgery, without the need for hospitalization and any special conditions for recovery.
How to choose a clinic
Says a vascular surgeon, venologist:
"The result of laser coagulation of the veins of the lower extremities depends to a large extent on the professionalism of the medical staff, as well as on the technical characteristics of the equipment used. This means that the equipment used must be modern and the doctors must be trained. Therefore, I would recommend that you choose a clinic that specializes in this particular type of service, which has been operating for several years and has a reputation that has been tested over time.