Varicose veins in the lower extremities are rightly considered the most common pathology of peripheral vessels, it is one of the ten best so-called diseases of civilization. According to epidemiological studies, venous insufficiency occurs in 80% of people of working age. In most cases, varicose veins in the legs do not cause serious suffering and sometimes it goes unnoticed at all, requiring no treatment. Nevertheless, there are situations where it is worthwhile, without delay, to consult a specialist to undergo appropriate treatment. What are the treatments for varicose veins in the lower extremities? What are their pros and cons?
Ways to get rid of the disease
Thousands of people ask themselves the question every year: how to get rid of "ugly lumps" or "vascular mesh" on the legs? Media portals are full of advertisements for public and private clinics that treat varicose veins in the lower extremities. They offer "unique", "guaranteed", "painless" or "completely safe" ways to get rid of this disorder. Sometimes it is difficult to understand this ad, to answer the question of which treatment option is the most suitable. If a person has decided to treat his dilated vessels and he is not sure about the safety or effectiveness of this or that treatment method, the best option for him is to contact several clinics for qualified advice from at least two professionals.
There are various reasons to force a patient with varicose veins to consult a doctor:
- cosmetic considerations;
- symptoms of discomfort
- 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 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 contacting him. Quite often, patients simply need reassurance that their enlarged veins will not harm them in any way and are unlikely to do so in the future.
If therapy is needed, the doctor often recommends self-treatment at home within 6 months, which includes:
- use of compression stockings;
- regular exercise;
- avoid "long downtime" - exclude a longer stay in a sitting or standing position;
- while resting (in a horizontal position), lift the "compromised" limb above the level of the heart.
If after another consultation the patient is not satisfied with the result, the doctor may recommend conservative or surgical treatment of varicose veins in the lower extremities.
Treatment options for lower extremity
To combat varicose veins in the legs, conservative treatment (compression and pharmacological therapy, lifestyle change), surgical procedures, external and internal laser exposure, radiofrequency ablation, injection sclerotherapy are used. The choice of this or that option depends on the patient's preferences. It is also affected by the patient's financial abilities, the qualifications of the doctors and the equipment of the medical institution. Nevertheless, the method of treating varicose veins in the lower extremities in each case depends largely on the disease itself: what symptoms are present, the degree of venous insufficiency and other characteristics of vascular lesions.
Conservative therapy methods
Conservative treatment is usually complex and contains several components.
A change in lifestyle, which involves a complex of measures aimed at preventing stagnation of blood in the veins. As you know, prolonged standing or sitting position increases the activity of the venous-muscular pump (gastrocnemius muscle), which contributes to stagnation. Therefore, patients are advised to walk regularly and regularly raise their legs above the level of the heart in an inclined position. You should also pay attention to various diets — salt-free, low-calorie. They allow you to adjust body weight, compensate for seasonal vitamin deficiencies. It is necessary to consume foods high in bioflavonoids (substances that help strengthen the vessel wall).
People with varicose veins should avoid overheating their feet, refrain from visiting baths and saunas and if possible do not use underfloor heating.
Compression stockings improve venous hemodynamics, leading to the disappearance of many manifestations of the disease. Disadvantages of this method:
- limited use of it in time (there is no possibility to wear compression stockings and socks all the time);
- the appearance of discomfort with constant compression, this is especially often seen in summer, when the symptoms of varicose veins are most "manifesting".
The pharmacy usually offers compression stockings from only one manufacturer. However, there are many different brands, each of which can meet the patient's needs to varying degrees.
Drug treatment can eliminate the symptoms of the disease or reduce their manifestation, aims to prevent and combat its complications and can increase the effectiveness of compression therapy. Pharmacology helps to cope with side effects that occur after sclerotherapy or phlebectomy.
Modern treatment of varicose veins in the lower extremities is not complete without the use of venotonics (phleboprotectors), drugs that can improve the symptoms, strengthen the vein wall. They are considered as basic pharmacotherapy drugs. These include:
- Horse chestnut extract and thiamine (vitamin B1) are part of medicines used to treat pain and heaviness in the legs, edema observed in chronic venous insufficiency. The agents 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).
- Butcher's diet (butcher's diet) is used as a food additive. Helps relieve congestion in the veins. It is believed to be effective against spiders. However, no clinical data have been performed to confirm its safety and efficacy.
- Deproteinized hemoderivative of young calves' blood is part of popular drugs, which are excellent phleboprotectors, have a good therapeutic effect for varicose veins in the lower extremities.
As a rule, venotonically prescribed in courses. The duration of the course depends on the dynamics of improvement of symptoms, the duration of the remission obtained. Therefore, the doctor may vary the intake of the drug from 3 to 6 months or more.
Ointments and gels (topical drugs) are also widely used. The treatment regimen for varicose veins in the lower extremities is chosen by the doctor depending on the condition and course of the disease. The therapeutic effect of these topical drugs is realized through two mechanisms: distracting and indeed therapeutic. In the first place, the evaporation of the alcohol base or essential oils contained in the gel takes place, which leads to a decrease in the temperature of the skin, respectively, and improves the symptoms of the disease. As a result of the second, the medicinal substance that penetrated through the skin directly to the vein begins to exert its therapeutic effect.
Ointments and gels used for varicose veins in the legs are classified according to the main active ingredient they contain. They include such medicinal substances:
- Phlebo protectors (usually routine as well as plant substances that strengthen the vessel wall).
- Non-steroidal anti-inflammatory drugs are usually 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 is contraindicated.
- Proteolytic enzymes are able to effectively cleanse a trophic wound (complications of extensive varicose veins in the legs).
- Ionized silver is an effective antiseptic, it cleanses and dries the wound perfectly, therefore it is an indispensable remedy for treating an infected trophic wound.
- Antibiotics are used topically for infection of complications of varicose veins (thrombophlebitis, dermatitis).
- Rehydration of preparations and dermatoprotectors protects the skin from external influences, improves its elasticity. They are 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 and 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 sore pain and constant fatigue in the legs, in the presence of edema, chronic venous insufficiency, cosmetic problems, early hyperpigmentation (excessive pigment deposition in the skin), external bleeding and in superficial thrombophlebitis progress in the presence of trophic ulcers, which cannot be treated with conservative methods.
Currently, the most popular are three types of surgeries:
- sapheno-femoral ligation (ligation and removal of the upper section of the great saphenous vein);
- streaks of the great saphenous vein:
- traditional or Bebokk's operation, in which a special probe is inserted into the lumen of the great saphenous vein (two incisions are made provisionally: one in the groin area, the other at the level of the upper third of the leg) and extends along its entire length, after which it is removed togetherwith varicose veins;
- cryostripping, an operation that is almost similar to the previous one, but differs in that the probe is cooled to -85 ° C, whereby the vein adheres to the probe, making it possible to remove it less traumatic;
- Phlebectomy is a procedure to remove varicose veins through several small 2-3 mm incisions in the skin.
The above surgical procedures help to improve the patient's quality of life; their therapeutic and economic efficacy have 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. Complications are possible, which are more common in patients with advanced varicose veins. During the operation, the nerves in the subcutaneous tissue can be damaged, therefore, after surgical manipulation, temporary or even permanent numbness can sometimes be observed in some parts of the legs, but this does not lead to severe disability.
New treatments
The main goal of using new treatment methods is to minimize tissue traumas observed during surgery, allowing the patient to recover more quickly. They began to become widespread in the early 2000s.
Intravenous ablation (RF and laser)
Radiofrequency and laser ablation are methods of treating varicose veins in the legs by "sealing" the large saphenous vein (or the small one) at high temperature, leading to regression 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 involve:
- Insertion of a catheter into the large saphenous vein through a small incision in the upper third of the leg and guided to the saphenofemoral junction under ultrasound guidance. No incisions are made in the groin area.
- Execution under local anesthesia (the anesthesia infiltrates extensively into the subcutaneous tissue of the thigh). Additional general anesthesia may be required if a large number of miniflebectomies are to be performed at the same time.
- The need to wear bandages or stockings after the procedure for two weeks.
- The dependence of their result on the anatomy of the saphenous veins of the patient is positive in the presence of straight lines, doubtful when the vessels are twisted.
The use of intravenous ablation, which has been widespread over the last ten years, has not shown significant differences in efficacy compared to surgery.
The main advantage of this technique is rapid recovery after the procedure, which is associated with a lesser likelihood of wound infection and hematoma.
Nevertheless, complications are typical of this procedure: skin burns, temporary paresthesias, deep vein thrombosis (occurring in less than 1% of patients).
Simple sclerotherapy
This treatment method, due to its easy implementation and low trauma, is currently used by many clinics. Its essence lies in the fact that sclerosant is injected into varicose veins, a substance that adheres to its walls, blood flow moves into healthy vessels. Sclerotherapy is often combined with classic surgeries, and in the case of telangiectasia and spiders, it is used as the only treatment method.
Contraindications:
- pregnancy,
- breastfeeding period,
- dermatitis,
- thrombophlebitis.
Sclerotherapy gives quite acceptable results that satisfy many patients.
Foam sclerotherapy
Unlike simple sclerotherapy, with foam, the sclerosant is injected into a vein after mixing with a gas (normal air). As a result, foam is obtained, which spreads through the vein, displaces blood from it and causes a spasm in the vessel. The manipulation is usually performed under the guidance of duplex ultrasound scanning.
In addition to simple foam sclerotherapy, it is required to wear compression stockings after manipulation for 14 days.
Recovery after the procedure is faster than if a classic operation was performed. However, the medium-term results of treatment (the likelihood of relapse of reflux) of foam sclerotherapy are somewhat worse than the results of surgery.
Treatment of "microvaricosis": telangiectasia, spiders
Treatment of spiders is almost always solely for cosmetic reasons, although they can sometimes cause a hot, throbbing sensation, indicating the presence of reflux. Usually two types of therapy are used:
- Microsclerotherapy - introduction of a sclerosing substance using a thin needle. Usually scleros several spiders at the same time. A compression bandage or sock is applied for 1 to 2 days. If sclerosis occurs outside the vessel during the injection, ulceration may develop in this area, which heals slowly, after which a scar remains. This rarely happens, provided that "if the doctor's hands do not shake during the operation. " Hyperpigmentation at the injection site (darkening of the skin) is also possible.
- Laser ablation. The method works well for treating telangiectasia (intradermal vascular growth resembling a birthmark).
There are many effective ways to get rid of varicose veins in the lower extremities that traditional medicine offers. The choice of treatment option depends to a large extent on the patient's own decision. Do not immediately go "under the knife", in the arsenal of doctors there are effective options for conservative therapy. According to doctors, today it is impossible to cure this disorder completely, but it is quite within modern medicine to save the patient as much as possible from the manifestations of the disease and prevent its further development.