Varicose veins, or varicose veins, in everyday life is often referred to as "the disease of tired legs. "But in fact, the factors causing it are much more complicated. And the disease itself is by no means just a harmless cosmetic defect. Varicose veins of the lower extremities leads to the occurrence of chronic venous insufficiency - a condition, the final result of which may be the occurrence of a venous trophic ulcer.
Of course, in the overwhelming majority of cases we are dealing with varicose veins of moderate severity, which is now effectively and practically without relapse treated. But first things first.
Why is 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 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 illness, and no more than 8% receive treatment.
Varicose veins of the lower extremities is a disease in which the structure of the vein wall changes. The vessels become longer, convoluted, in the areas of thinning of the walls, the lumen expands, forming nodes.
Varicose veins is a disease with a hereditary predisposition. The probability of its occurrence in those in whose family no one suffered from venous pathology is no more than 20%. If one of the parents is sick, 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 occurrence 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 vein wall to return to its original state. In patients with varicose veins, the amount of this protein in the venous wall is reduced. Collagen itself also changes: instead of the prevailing type III collagen, which is responsible for elasticity, the content of type I collagen - rigid, retaining residual deformation, increases. In addition, the number of smooth muscle cells that regulate the lumen of the vessel also changes, and the ability to interact between them is impaired. These pathological changes are hereditary in nature. Next, come into playexternal factors:
- long-term static loads - the need for motionless standing or sitting;
- pregnancy and childbirth.
Some experts point to chronic constipation, tight clothing that increases intra-abdominal pressure, and high heels that interfere with the normal functioning of the muscle pump in the legs as predisposing factors.
Individually or in combination, these factors increase the pressure within the venous system of the lower extremities. The altered venous wall ceases to "hold" pressure, the lumen of the vein expands. As a result of the expansion of the lumen of the vein, the valves, which provide blood flow in only one direction, stop working. Arisesreflux- reverse outflow. The pressure inside the affected vein rises even more, and the vicious circle is closed.
Increased venous pressure, combined with changes in wall structure over time, triggerinflammatory response- at first only on the surface of the valves and the inner wall of the vessels. Gradually, inflammatory proteins and blood cells begin to "seep" 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, edema, induration (induration) of the skin of the legs, and hyperpigmentation develop. These processes can cause venous trophic 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. Arisesthrombophlebitis- 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:
- heaviness in the legs;
- rapid fatigue;
- paresthesias - unpleasant sensations of "goose bumps", changes in sensitivity;
- burning sensation in the muscles;
- leg pain, the characteristic feature of which 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 are individual and do not always correlate with changes in the venous wall and surrounding tissues.
The combination of subjective complaints and objective changes in the tissues of the lower extremities forms the basis of the modern classification of varicose veins and chronic venous insufficiency:
- C0- there are complaints, but there are no changes in appearance, lesions of the veins can be detected only with a special examination and tests;
- 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 nodes appear;
- C3- the affected leg becomes permanently swollen;
- C4- changes appear in the surrounding tissues: the skin darkens (hyperpigmentation), eczema develops, induration of the subcutaneous tissue;
- C5- the stage of the healed ulcer;
- C6- the stage of an open ulcer.
Starting from the fourth stage, the described trophic skin changes can no longer be completely eliminated. Even a cured varicose veins at this stage will not lead to a complete resorption of hyperpigmentation or induration. In addition, it is necessary to remember about a rather dangerous complication -thromboembolism. . .
On a note
From 30 to 60% of deaths due to sudden onset deep vein thrombosis and further thromboembolism occur against the background of varicose veins in combination with thrombophlebitis not detected and not cured in time.
Therefore, you should not postpone the treatment of varicose veins until later, especially against the background of the achievements 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 likelihood of relapses and complications, and a short rehabilitation period.
- Conservative therapy.Includes the use of compression hosiery, ointments and venotonics (oral medications). Current clinical guidelines suggest that venotonics can reducesubjectivemanifestations (complaints) in the early stages of the disease and reduce edema, but in no way affect the state of the venous wall itself. Different kinds of ointments have the same effect. Compression hosiery is considered a very effective treatment for varicose veins, since it reduces the manifestations of venous insufficiency, alleviates the patient's subjective complaints, and prevents the progression of varicose veins. However, compression hosiery is not able to cure varicose veins - dilated veins will not work properly.
- Traditional surgical removal.The affected large or small saphenous vein is tied at the place where it flows into the deep venous system, after which it is removed with a special metal probe. This operation is effective, but quite traumatic and requires a long recovery. There is a high probability of postoperative complications - hematomas, postoperative paresthesias and neuralgia.
- Sclerotherapy.A special preparation is injected inside the varicose vein, 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 trunk of the great and small saphenous veins, since it is characterized by a higher recurrence rate. In addition, such an unpleasant complication as hyperpigmentation in the framework of sclerosis is possible.
- Endovenous laser coagulation (EVLK)- minimally invasive, safe, modern and effective type of treatment for varicose veins. It has synonymous names: endovenous laser ablation, endovasal coagulation of the veins of the lower extremities, endovenous laser obliteration (EVLO). But whatever the name, the technique of laser coagulation remains the same. A radial fiber-optic light guide is inserted through the puncture into the vein. Then, with the help of a special pump, an anesthetic solution is pumped around the vein, which not only anesthetizes the procedure, but also compresses the vein, reducing its diameter and thereby protecting the surrounding tissues from overheating. For the procedure, modern vascular lasers are used, which generate two waves: one of them is absorbed by blood hemoglobin, the second - by the vascular wall. Vienna is "brewing". All stages (position of the light guide, infiltration of the solution around the vein, the very process of "brewing") are monitored in real time by ultrasound devices. The duration of the EVLK procedure on one limb is 30-60 minutes.
It's important to know!
The only effective treatment for varicose veins is to remove the altered vein that is unable to perform its functions.
Advantages of the laser removal method:
- Minimal trauma, which allows the procedure to be carried out on an outpatient basis and under local anesthesia;
- you can go home immediately after the operation;
- fast recovery;
- good cosmetic result: no marks and scars remain;
- high efficiency, low relapse rate.
Since endovenous laser coagulation is currently considered one of the most advanced, low-traumatic and minimally invasive types of treatment for varicose veins, 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 options for its anatomical structure. It was possible to expand the range of indications of 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 of 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, in particular angina pectoris at rest, extensive myocardial infarction with a decrease in cardiac output, severe forms of cardiac arrhythmias, strokes;
- severe blood clotting disorders, both downward and upward;
- pregnancy and breastfeeding;
- individual intolerance to the anesthetic used;
- impossibility of physical activity immediately after the procedure;
- inability to use compression hosiery.
It is characteristic that the patient's age is not a contraindication.
How is laser coagulation of veins done?
Shortly before manipulation, you should purchase compression stockings of the 2nd degree of compression (25–32 mm Hg). The doctor will tell you in detail what size is required. Endovasal laser coagulation itself does not require any special preparation.
All stages of endovenous laser obliteration are carried out under constant ultrasound control.
- Before the start of the procedure, the vein is "marked": the doctor puts marks on the skin, corresponding to the places where the blood flows back, the tributaries flow into the vein.
- At the beginning of the manipulation, local anesthesia occurs, the vein is punctured (punctured). The sensations 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 space around the vessel. 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 supplied evenly around the entire circumference of the device, providing uniform heating of the vein from the inside. After removing 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 put on the patient.
Immediately after the end of the manipulation, the patient should take a walk, lasting at least 40 minutes.
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 appear 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 intensity of laser exposure.
- Pigmentation along the treated veinresolves within 1. 5–2 months.
- Feeling of a "stretched" vein- passes within 1. 5 months.
In order to prevent the development of any complications as much as possible, you should adhere to a few simple rules, the observance of which is necessary for successful rehabilitation.
On the first day, there may be aching and pulling pains along the vein. To eliminate them, conventional pain relievers are sufficient. The temperature may rise in the first few days. It is enough to take traditional means to reduce it.
In general, for successful rehabilitation, 2 main conditions must be observed - wearing compression underwear and maintaining sufficient 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. Further, compression hosiery is worn only in the daytime. It is enough to wear compression garments for 2. 5–3 months, but if there are risk factors (sedentary, standing work, taking female sex hormones), further preventive wear of compression hosiery is desirable.
- Physical activity- It is recommended to walk for at least an hour daily. 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%. 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 an anesthetic solution);
- non-compliance by the patient with the rules of the postoperative regime (usually - refusal of compression).
The immediate and long-term results of laser coagulation of the veins of the lower extremities are better than those of radiofrequency ablation and sclerotherapy, and are comparable to traditional surgical techniques. At the same time, the 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 classical operations.
How much does EVLK cost?
The endovasal 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.
So, endovenous laser coagulation is a modern effective method of treating varicose veins. It gives excellent clinical results and, in fact, leaves no residue. The minimal trauma of exposure allows you to return to normal life (with minor restrictions) already on the day of surgery, without requiring a hospital regimen and any special conditions for recovery.
How to choose a clinic
Says a vascular surgeon, phlebologist:
"The result of laser coagulation of the veins of the lower extremities largely depends 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 qualified. Therefore, I would recommend choosing a clinic that specializes in this particular type of service, which has been operating for several years and has a time-tested reputation. "