Varicose veins or varicose veins in everyday life are often referred to as "the disease of tired legs. " But in fact, the factors that cause it are much more complicated. And the disease itself is by no means just a harmless cosmetic flaw. Varicose veins in the lower extremities lead to the occurrence of chronic venous insufficiency - a condition whose final result may be the occurrence of a venous trophic wound.
In the vast majority of cases, of course, we are dealing with varicose veins of moderate severity, which are now effectively and practically treated without relapse. But first things first.
Why are varicose veins dangerous?
How common is varicose veins disease, it is difficult to say: many patients consider it a cosmetic defect and do not go to the doctor. According to Western researchers, at least a quarter of the population in the United States and Europe suffers from it. In our country, the pathology is registered 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 in the lower extremities are a disease in which the structure of the vein walls changes. The vessels become longer, intricate, in the areas of thinning of the walls, the lumen expands and forms nodes.
Statistics
Varicose veins are a disease with an inherited predisposition. The probability of it occurring 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 the disease in both parents, the probability of varicose veins in the offspring is 90%.
Varicose veins disrupt the relationship between the two main structural proteins in the venous walls:collagenandelastin. . . If collagen forms stiffness, elastin, as the name suggests, is responsible for elasticity - the ability of the vein walls to return to its original state. In patients with varicose veins, the amount of this protein in the vein wall is reduced. Collagen itself also changes: instead of the predominant type III collagen, which is responsible for elasticity, the content of type I collagen increases - rigid, conservative residual deformation. In addition, the number of smooth muscle cells that regulate the vessel's lumen also changes and the ability to interact between them deteriorates. These pathological changes are hereditary in nature. Then the game plays into playexternal factors:
- long-term static loads - the need for immobile standing or sitting
- 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 muscle pump in the legs as predisposing factors.
Individually or in combination, these factors increase the pressure in the venous system of the lower extremities. The altered vein wall ceases to "hold" pressure, the lumen of the vein dilates. As a result of the dilation of the vein lumen, the valves, which only provide blood flow in one direction, stop the work. Occursrefluxreverse 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, triggersinflammatory reactioninitially only on the surface of the valves and the inner wall of the container. Eventually, inflammatory proteins and blood cells begin to "seep" through the damaged vein wall into the surrounding tissue. They are destroyed and release active substances -inflammatory mediators. . . They damage the surrounding cells and attractlymphocyteswhose function is to remove damaged tissue. As a result, edema, contamination (induration) of the bone skin and hyperpigmentation develop. These processes can cause venous trophic wounds. Prolonged inflammation of the vein wall also increases blood clots. In combination with venous congestion, this leads to the formation of blood clots in the varicose veins. Occursthrombophlebitis- 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:
- weight in the legs;
- rapid fatigue;
- paraesthesias - unpleasant sensations of "goosebumps", changes in sensitivity;
- burning sensation in the muscles;
- pain in the legs, whose characteristic feature is that the intensity decreases after a walk;
- swelling in the evening
- restless legs syndrome - a condition in which discomfort in your legs prevents you from falling asleep;
- night cramps in the lower extremities.
The combination of these symptoms and their severity is individual and does not always correlate with changes in venous wall and surrounding tissue.
The combination of subjective complaints and objective changes in the tissues of the lower extremities forms the basis for the modern classification of varicose veins and chronic venous insufficiency:
- C0- there are complaints, but there are no changes in appearance, lesions in the veins can be detected only with a special examination and test;
- C1"spiders" appear (scientific name - telangiectasias), or a network of intradermal dilated veins (reticular varicose veins) becomes visible;
- C2- the diameter of the dilated saphenous veins exceeds 3 mm, varicose veins appear;
- C3- the affected leg is constantly raised
- C4- changes occur in the surrounding tissue: the skin darkens (hyperpigmentation), eczema develops, contamination of the subcutaneous tissue;
- C5- the stage of the healed wound
- C6the scene of an open wound.
From the fourth step, the described trophic skin changes can no longer be completely eliminated. Even cured varicose veins at this stage will not lead to complete resorption of hyperpigmentation or curing. In addition, it is necessary to keep in mind a rather dangerous complication -thromboembolism. . .
On a note
From 30 to 60% of deaths due to sudden onset of deep vein thrombosis and further thromboembolism occur due to varicose veins in combination with thrombophlebitis that are not detected and are not cured in time.
Therefore, you should not postpone the treatment of varicose veins until later, especially in light of the results 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 relapse and complications, and a short rehabilitation period.
- Conservative therapy.Includes use of compression stockings, ointments and venotonics (oral medication). Current clinical guidelines suggest that venotonics may reducesubjectivemanifestations (complaints) in the early stages of the disease and reduces edema, but in no way affects the condition of the vein wall itself. Different kinds of ointments have the same effect. Compression stockings are considered a very effective treatment for varicose veins as it reduces manifestations of venous insufficiency, relieves the patient's subjective complaints and prevents the course of varicose veins. However, compression stockings are not able to heal varicose veins - dilated veins do not work properly.
- Traditional surgical removal.The affected large or small saphenous vein is bound at the site where it flows into the deep vein 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 paraesthesias and neuralgia.
- Sclerotherapy.A special drug is injected inside the varicose veins, which "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 inoperative strain of the large and small saphenous veins, as it is characterized by a higher recurrence rate. In addition, such an unpleasant complication as hyperpigmentation in sclerosis is possible.
- Endogenous laser coagulation (EVLK)minimally invasive, safe, modern and effective treatment of varicose veins. It has synonymous names: endovenous laser ablation, endovasal coagulation of the veins of the lower extremities, endovenous laser eradication (EVLO). But regardless of the name, the technique of laser coagulation remains the same. A radial fiber optic light guide is inserted through the puncture in the vein. Then, by means of a special pump, an anesthetic solution is pumped around the vein, which not only numbs the procedure, but also compresses the vein, reducing its diameter and thereby protecting the surrounding tissue from overheating. For the procedure, modern vascular lasers are used, which generate two waves: one of them is absorbed by blood hemoglobin, the other - by the vascular wall. Vienna "brews". All stages (position of the light guide, infiltration of the solution around the vein, "brewing" itself) are monitored in real time by ultrasound devices. The duration of the EVLK procedure on a limb is 30-60 minutes.
It is important to know!
The only effective method of treating varicose veins is to remove the altered vein that is unable to perform its functions.
The 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 the operation;
- rapid recovery;
- good cosmetic result: no marks and scars left;
- high efficiency, low relapse rate.
As endovenous laser coagulation is currently considered to be one of the most advanced, low-traumatic and minimally invasive types of varicose vein treatment, we will consider this technique in more detail.
Indications for laser coagulation
The main indication is varicose veins, regardless of the diameter of the venous trunk and possibilities for its anatomical structure. It was possible to extend the range of indications for EVLK due to the perfection of modern equipment - two-wave lasers, radial fibers.
Contraindications to the procedure
In most cases, they boil down to severe somatic conditions in the patient:
- deep vein thrombosis (obstruction, occlusion, blockage);
- decompensated type 1 diabetes mellitus;
- 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 cardiac output, severe forms of cardiac arrhythmias, stroke;
- severe blood clots, both downward and upward;
- pregnancy and lactation;
- individual intolerance to the anesthetic used;
- impossibility of physical activity immediately after the procedure
- inability to use compression stockings.
It is characteristic that the age of the patient is not a contraindication.
How does laser coagulation of veins take place?
Shortly before manipulation, you should buy compression stockings of 2nd compression degree (25–32 mm Hg). Your doctor will tell you in detail what size is required. Endovasal laser coagulation by itself does not require any special preparation.
All stages of endovenous laser erasure are performed under constant ultrasound control.
- Before starting the procedure, the vein is "marked": the doctor puts marks on the skin, corresponding to the places where the blood flows back, the inflows flow into the vein.
- At the beginning of the manipulation local anesthesia occurs, the vein is punctured (punctured). The sensations are not 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 is created around the vein. During ultrasound check, using a special pump, the doctor injects local anesthetic into the space around the tub. This allows not only to relieve pain, but also to protect the surrounding tissue from excess laser heat.
- The procedure itself is EVLO varicose veins. In modern optical fibers, laser radiation is delivered evenly around the entire circumference of the unit, which provides uniform heating of the vein from the inside. After removal of the light guide, the patient undergoes ultrasound monitoring of the condition of the treated vessel as well as the deep veins in the limb.
- A compression garment is put on the patient.
Immediately after the end of the manipulation, the patient should take a walk lasting at least 40 minutes.
Possible complications
There are few of them, they are temporary and the likelihood of complications is mainly associated with the use of outdated medical equipment and low qualifications of a doctor.
- Deep vein thrombosis -may occur in patients with a tendency to increased thrombosis. To prevent this complication, patients are therefore prescribed drugs that reduce blood clots. They are usually used within 4-5 days after the intervention.
- Thrombophlebitis- most often associated with insufficient intensity of laser exposure.
- Pigmentation along the treated veinresolves within 1, 5–2 months.
- Feeling of a "stretched" vein- goes within 1, 5 months.
To prevent the development of any complications as much as possible, you should adhere to a few simple rules, compliance with which is necessary for a successful rehabilitation.
Rehabilitation
On the first day, there may be pain and pulling pain along the vein. To remove them, conventional painkillers are sufficient. The temperature can rise in the first few days. It is enough to take traditional remedies to reduce it.
In general, in order to succeed in rehabilitation, 2 main conditions must be met - wearing compression underwear and maintaining adequate physical activity.
- Compression underwear -during the first 5 days it is not removed even during a night's sleep. This is necessary so that the vein is completely "glued" and healed. In addition, compression stockings are worn only during the day. It is enough to wear compression clothing for 2, 5–3 months, but if there are risk factors (sedentary, standing work, intake of female sex hormones), it is desirable with additional preventive wear of compression stockings.
- Physical activity- It is recommended to walk at least one hour a day. But you will have to give up intensive sports for about a month.
During the month you should avoid hot baths, baths and saunas.
Evaluation of the effectiveness of the method
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 the technical performance of EVLK (insufficient laser power, insufficient compression of the vein with an anesthetic solution);
- the patient's non-compliance with the rules of the postoperative regimen (usually - refusal of compression).
The immediate and long-term results of laser coagulation of the veins of the lower extremities are better than radiofrequency ablation and sclerotherapy and can be compared to traditional surgical techniques. At the same time, treatment of varicose veins with a laser is much better tolerated, the rehabilitation time is shorter and the number of complications is less than with classic operations.
How much does EVLK cost?
The endovasal laser coagulation procedure requires high-tech equipment and expensive disposable items (light guides), which explains the cost. The total amount depends on the volume and complexity of the procedure, the medical equipment used and the qualifications of the doctor.
So endogenous laser coagulation is a modern effective method of treating varicose veins. It gives excellent clinical results and in fact leaves no residue. The minimal exposure trauma allows you to return to normal life (with minor restrictions) already on the day of surgery without requiring a hospital regimen and special conditions for recovery.
How to choose a clinic
Says a vascular surgeon, phlebologist:
"The result of laser coagulation of the veins in the lower extremities depends to a large extent on the professional staff 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 qualified. recommend choosing a clinic that specializes in this type of service, which has been in operation for several years and has a time-tested reputation. "