Varicose veins of the lower extremities are rightly considered the most common pathology of peripheral blood vessels, it is one of the top ten so-called diseases of civilization. According to epidemiological studies, venous insufficiency occurs in 80% of people of working age. In most cases, varicose veins do not cause severe pain and sometimes go unnoticed at all, requiring no treatment. However, there are situations where it is worth, without delay, to consult a specialist, to undergo appropriate treatment. What are the treatments for varicose veins of the lower extremities? What are their advantages and disadvantages?
Ways to get rid of the disease
Thousands of people every year ask themselves the question: how to get rid of the "ugly knots" or the "vascular mesh" on their feet? The 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 the most appropriate. If a person who has decided to deal with dilated blood vessels and is not sure about the safety or effectiveness of this or that method of treatment, the best option for him is to contact several clinics, to receive specific advice from at least two professionals. The
There are several reasons why a patient with varicose veins should consult a doctor:
- cosmetic issues;
- symptoms of discomfort.
- complications of the disease (for example, ulcers, bleeding or thrombophlebitis).
- fear for your health (how the disease will behave in the future if left untreated).
Sometimes, it is difficult for the doctor to know what the patient wants. Therefore, during the consultation, it is important to find mutual understanding with the doctor, to properly convey the main reason for communication with him. Too often, patients just need reassurance that their dilated veins will not hurt them in any way and are unlikely to do so in the future.
If there is a need for treatment, the doctor often recommends that you do self-medication at home within 6 months, which includes:
- the use of compression stockings;
- do regular exercise;
- Avoid the "long shutdown" - exclude a long stay in a sitting or standing position.
- while resting (in a horizontal position), raise the "compromised" end above the level of the heart.
If, after a second consultation, the patient is not satisfied with the result, the doctor may recommend conservative or surgical treatment of varicose veins of the lower extremities.
Treatment options for lower limb pathology
To fight varicose veins, conservative treatment is used (compression and pharmacological treatment, lifestyle modification), surgeries, external and internal laser exposure, radiofrequency ablation, sclerotherapy with injection. The choice of this or that option depends on the preferences of the patient. It is also affected by the patient's financial capabilities, the qualifications of the doctors and the equipment of the medical institution. Nevertheless, which method of treatment of varicose veins of the lower extremities will be used in each case depends largely on the disease itself: what are the symptoms, the degree of venous insufficiency and other characteristics of vascular damage.
Conservative treatment methods
Conservative treatment, as a rule, is complex and includes many components.
A lifestyle change, which involves a set of measures aimed at preventing blood stasis in the veins. As you know, prolonged standing or sitting flattens the activity of the venous muscle pump (gastrocnemius muscle), which contributes to 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 various low-calorie, salt-free diets. They will allow you to adjust your body weight, to make up for the seasonal vitamin deficiency. It is essential to eat foods rich in bioflavonoids (substances that help strengthen the wall of blood vessels).
People with varicose veins should avoid overheating their feet, avoid visiting baths and saunas and, if possible, avoid using heated 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 (it is not possible to wear compression stockings and socks all the time).
- the appearance of discomfort with constant compression, this is especially common in the summer, when the symptoms of varicose veins "manifest" more.
The pharmacy, as a rule, offers compression tights only from one manufacturer. However, there are many different brands, each of which can meet the needs of the patient to a different degree.
Medication can eliminate the symptoms of the disease or reduce their manifestation, aims to prevent and fight its complications and can enhance the effectiveness of compression therapy. Pharmacology helps to treat the side effects that occur after sclerotherapy or phlebectomy.
The modern treatment of varicose veins of the lower extremities is not complete without the use of veniprotective drugs, drugs that can improve the symptoms, strengthen the venous wall. They are considered key agents of pharmacotherapy. These include:
- Chestnut fruit extract and thiamine (vitamin B1) are part of the medicines used to treat pain and weight in the legs, edema observed in chronic venous insufficiency. The funds have shown their effectiveness in clinical trials. There are dosage forms: oral solution (10-15 drops 3 times a day) and tablet form (usually taken after meals 1 tablet 3 times a day).
- The butcher broom (butcher broom) is used as a food additive. Helps relieve congestion in the veins. It is believed to be effective against spider veins. However, no clinical data have been performed to confirm its safety and efficacy.
- Deproteinizing the blood of young calves is part of the popular drugs, which are extremely venous protective, have a good therapeutic effect on varicose veins of the lower extremities.
As a rule, venotonic is prescribed in courses. The duration of the course depends on the dynamics of the improvement of the symptoms, the duration of the achieved recession. Therefore, the doctor may vary the intake of the drug from 3 to 6 months or more.
Ointments and gels (topical medicines) are also widely used. The treatment regimen for varicose veins of the lower extremities is chosen by the doctor depending on the condition and the course of the disease. The therapeutic effect of these topical drugs is realized through two mechanisms: distraction and treatment. In the beginning, the evaporation of the alcohol base or the essential oils contained in the gel occurs, which leads to a decrease in the skin temperature, respectively, and improves the symptoms of the disease. As a result of the latter, the drug that penetrates through the skin directly into the vein begins to exert its therapeutic effect.
Ointments and gels used for varicose veins are classified according to the main active ingredient they contain. They include such medicinal substances:
- Veniprotectants (usually routine, as well as herbal substances that strengthen the vessel 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 are prescribed instead of corticosteroids when the latter are contraindicated.
- Proteolytic enzymes are able to effectively clear a food ulcer (complications of extensive varicose veins of the legs).
- Ionized silver is an effective antiseptic, perfectly cleanses and dries the wound, so it is an essential medicine for the treatment of an infected food ulcer.
- Antibiotics are used topically to infect the complications of varicose veins (thrombophlebitis, dermatitis).
- Moisturizers and skin protectors protect the skin from external influences, improve its elasticity. They are usually prescribed for atrophic changes in the skin (when compression stockings are used for a long time).
- Heparin, in addition to its anticoagulant action (prevents the formation of blood clots), has anti-inflammatory action, is able to relieve pain.
Surgery
The main goal of surgical treatment is to eliminate the pathological mechanism that led to the appearance of the disease - the venous reflex, as well as to remove its main manifestation - varicose veins. Surgical treatment is indicated: for patients with pain and constant fatigue in the legs, presence of edema, chronic venous insufficiency, cosmetic problems, early hyperpigmentation (excessive pigmentation of the skin), external bleeding, and when superficial thrombophlebitis that does not develop, can be treated with conservative methods.
Currently, the most popular are three types of functions:
- saphenous femoral ligation (ligation and removal of the upper part of the great saphenous vein).
- stripping of the great saphenous vein:
- traditional or Bebkokk operation, in which a special catheter is inserted into the lumen of the great saphenous vein (two preliminaries are made: one in the groin area, the second at the level of the upper third of the foot) and extends along its entire length, after which it is removed along with the varicose vein.
- Cryoprotection, a function that is almost similar to the previous one, but differs in that the detector is cooled to -85 ° C, with the result that the vein adheres to the catheter, which makes its removal less traumatic.
- Phlebectomy is a procedure to remove varicose veins through several small 2-3 mm incisions in the skin.
The above surgeries help to improve the patient's quality of life; their therapeutic and financial effectiveness has been proven in clinical trials. They are usually performed under general anesthesia, but most patients are discharged on the day of surgery. Full recovery, return to normal daily activity usually takes 2 to 3 weeks. Possible complications, which are more common in patients with advanced varicose veins. During the operation, the nerves in the subcutaneous tissue can be damaged, therefore, after surgery, there is sometimes temporary or permanent numbness of some parts of the legs, but this does not lead to severe disability.
New treatments
The main purpose of using new methods of treatment is to minimize the tissue trauma observed during surgery, which allows the patient to recover faster. They began to be widely used in the early 2000s.
Intravenous removal (RF and laser)
Radiofrequency and laser removal are methods of treating varicose veins of the legs by "sealing" the large clear vein (or small vein) at a high temperature, which leads to the retraction of the dilated vessels (their walls stick together). Although these options do not involve surgery, it is quite common to resort to additional phlebectomy and sclerotherapy. Both methods include:
- Insertion of a catheter into the large clear vein through a microscopic incision in the upper third of the leg and forward it to the saphenous ligament under ultrasound guidance. No incision is made in the groin.
- Performed under local anesthesia (the anesthetic penetrates extensively into the subcutaneous tissue of the thigh). Additional general anesthesia may be required if a large number of mini-phlebectomies are to be performed at the same time.
- The need to use bandages or socks after the procedure for two weeks.
- The dependence of their effect on the anatomy of the clear veins in the patient is a positive presence of straight lines, doubtful when the vessels are distorted.
The use of intravenous removal, which has been widely used for the last ten years, has not shown significant differences in its effectiveness compared to surgery.
The main advantage of this technique is the rapid recovery after the procedure, which is associated with a lower chance of wound infection and hematoma.
Nevertheless, complications are typical for this procedure: skin burns, temporary hallucinations, deep vein thrombosis (occurs in less than 1% of patients).
Simple sclerotherapy
This method of treatment, due to its ease of application and low trauma, is currently used by many clinics. Its essence lies in the fact that the hardener is injected into the varicose vein, a substance that sticks to its walls, the blood flow moves to healthy vessels. Sclerotherapy is often combined with conventional surgery and in the case of teleangiectasia and spider veins, it is used as the only method of treatment.
Contraindications:
- pregnancy,
- breastfeeding period,
- dermatitis,
- thrombophlebitis.
Sclerotherapy gives quite acceptable results that satisfy many patients.
Foam sclerotherapy
Unlike simple sclerotherapy with foam, the hardener is injected into a vein after mixing it with gas (usually air). As a result, foam is obtained, which, by spreading the vein, displaces the blood from it and causes spasm of the vessel. The operation is usually performed under the guidance of a double-sided ultrasound scan.
In addition to simple foam sclerotherapy, you are required to wear compression stockings after handling for 14 days.
Recovery after the procedure is faster than if a classic operation had been performed. However, the mid-term results of treatment (the possibility of recurrence) of foam sclerotherapy are somewhat worse than those of surgery.
Treatment of "microbaricosis": telangiectasia, spider veins
The treatment of spider veins is almost always done only for aesthetic reasons, although sometimes they can cause a hot, throbbing sensation, indicating the presence of reflux. Two types of treatment are commonly used:
- Microsclerotherapy - the introduction of a hardener using a fine needle. Usually several cobwebs harden at the same time. Apply a compression bandage or sock for 1 to 2 days. If the sclerosis reaches outside the vessel during the injection, an ulcer may develop in this area, which heals slowly, after which a scar remains. This rarely happens, provided "unless the doctor's hands are clenched during surgery". Hyperpigmentation at the injection site (darkening of the skin) is also possible.
- Laser removal. The method works well for the treatment of telangiectasias (intradermal vascular growth that looks like a birthmark).
There are many effective ways to get rid of varicose veins offered by traditional medicine. The choice of treatment largely depends on the decision of the patient himself. Do not "get under the knife" immediately, in the arsenal of doctors there are effective options for conservative treatment. According to doctors, today it is impossible to completely cure this disease, but it is quite within the power of modern medicine to save the patient from the manifestations of the disease as much as possible and to prevent its further development.