Impaired blood flow and stagnation of blood in the venous channel leads to pathological changes in the blood vessels - varicose veins. The reasons for the development of the disease can be different, including genetic predisposition (most often), overweight, hormonal imbalance, pregnancy, arterial hypertension, constipation, lifestyle and occupational activity (for example, work that requires prolonged standing). ).
In all these cases, the development of the disease follows the same scenario and is related to two factors: weakness of the vascular wall and functional failure of the venous valves.
Vascular valves prevent blood from flowing backwards. If they fail to cope with their task, the blood stagnates and accumulates (deposits) in the veins. As a result, the vessels not only dilate, but also lengthen, twist and intertwine into varicose veins.
Most often, this disease affects the superficial veins (large and small) of the lower limbs. They ensure the outflow of venous blood from the subcutaneous tissue and skin, which together make up no more than 1/10 of the entire circulatory system. The main work is done by the deep veins, connected to the superficial veins by perforating venous channels.
Treatment of varicose veins always means removal or resorption of the vein, i. e. its exclusion from the general venous circulatory system. But since such vessels play a secondary role in it, their removal does not have any negative consequences. Their function is easily taken over by the other veins.
Symptoms and stages of the disease
Varicose veins are one of the most common vascular diseases. According to statistics, 10-20% of men and 30-40% of women suffer from it.
The first signs of pathology are the appearance of a blue or red vascular pattern on the skin. This may be a capillary network or stars (telangiectasia). They most often appear on the legs and thighs, but can also be found on the face, labia (in women), legs and arms. Spider veins on the face are called rosacea.
Symptoms of varicose veins depend on the stage of the disease. Initially, it is only heaviness, increased leg fatigue, moderate swelling in the evening, which disappears after rest and sleep. Nocturnal leg cramps are possible.
A characteristic symptom of the disease is pain. Leg pain may occur or worsen with walking, prolonged standing, or be constant, accompanied by a feeling of fullness, burning, and warmth. Varicose veins become painful on pressure.
In international phlebology, the classification of the disease is from class 0 to class 6.
At zero stage there are no obvious symptoms, the only complaint may be heaviness in the legs.
In stage 1, a vascular pattern (telangiectasia) appears and muscle cramps occur at night.
Grade 2 disease is manifested by enlarged, thickened veins that protrude under the skin.
In stage 3, the swelling of the legs (ankles, feet, feet) no longer disappears after a night's sleep, prolonged rest, and becomes permanent.
In stage 4, the skin over the varicose veins becomes red or blue, areas of hyperpigmentation, itchy skin, dryness, scaling and inflammation appear.
In addition, at stages 5 and 6, the development of pre-ulcers and trophic skin ulcers follows.
Thus, varicose veins that begin as an aesthetic problem can lead to serious health problems over time.
Complications
Stagnation of venous blood and its accumulation (deposition) in the vessels of the lower extremities causes a decrease in blood pressure, hypotension and associated dizziness, fainting and headache.
The skin over the affected vessels thins, becomes inflamed, peels, itches, congestive dermatitis and varicose eczema develop, followed by the formation of trophic ulcers.
Blood clots appear in vessels filled with stagnant venous blood, which can break off at any time and, passing through the general circulatory system, block a vital artery and lead to death.
In the later stages of varicose veins, complications such as phlebitis and thrombophlebitis develop.
The later the treatment of the disease begins, the higher the risk of complications and the more radical methods will have to be used to prevent them. Therefore, when symptoms of varicose veins appear, you should not rely on self-medication, they can be useful for prevention. But only a doctor can provide real help.
Diagnosis and treatment
As usual, a visit to a doctor begins with a study of complaints, taking an anamnesis and an external examination. The main method for diagnosing varicose veins is Doppler ultrasound, duplex or triplex ultrasound scanning of blood vessels.
As a rule, this method gives a complete picture of the disease in order to determine the most appropriate treatment tactics.
If additional data are needed to clarify the diagnosis, the doctor may prescribe an X-ray with contrast (radiocontrast venography), MRI of the blood vessels (magnetic resonance venography) or multispiral computed angiography.
Before performing surgical interventions, both minimally invasive and extensive, a standard set of tests is prescribed - a general urine test, general clinical and biochemical blood tests, a coagulation test (coagulogram), tests for HIV, syphilis, viral hepatitis, fluorography, ECG.
In most cases, the treatment of varicose veins in a modern clinic is carried out on an outpatient basis or in a day hospital. It does not require a break from everyday life and after only 1-2 hours you can return to your normal activities. Minimally invasive procedures are performed under local anesthesia or without anesthesia.
And only a radical surgical intervention (phlebectomy) may require short-term hospitalization in the inpatient department of the clinic.
Medication treatment
In the early stage of the disease or for its prevention, the doctor can prescribe drug therapy, including antibiotics and antiseptics (in the presence of inflammation), phleboprotectors, anticoagulants (to prevent thrombosis), phleboprotectors, heparin ointment and other heparin-containing drugs.
Hirudotherapy can be used as an alternative method of treatment.
Conservative therapy includes wearing compression stockings (tights, knee socks) and elastic bandages. It has a limited range.
Endovasal laser vascular coagulation (EVLC)
This method refers to minimally invasive methods for the treatment of varicose veins. The procedure is performed under local anesthesia on an outpatient basis. Under ultrasound control, a flexible optical fiber connected to a emitting device is inserted into the vascular bed.
Laser light of a certain wavelength is absorbed by blood cells and vein walls and turns into heat.
As a result, the vessel is sealed and becomes a thin bundle of connective tissue that dissolves on its own.
Laser coagulation is commonly used to treat varicose veins of small and medium-sized veins, especially on the face. But with its help, you can also remove large varicose veins, including the small and large saphenous veins of the legs.
Radiofrequency ablation
This method, like EVLC, is based on thermal coagulation, using only radiofrequency radiation and not a laser to seal the vessel. Otherwise, the procedure is similar. Under local anesthesia, an emitter of radio waves is introduced into the venous bed, which are absorbed by the blood and vessel walls, turn into heat and give a coagulation effect. The procedure is performed under ultrasound control.
Like laser coagulation, radiofrequency ablation can be used as the main, sole and sufficient method or as part of complex treatment as an additional method. For example, after surgical removal of the main trunk to eliminate smaller vascular tributaries.
Sclerotherapy
In this case, the varicose vein is sclerosed - stuck together from the inside using a sclerosant. This medicine is given into a vein by injection. It can be liquid or foamy.
The procedure is completely painless, during it a feeling of slight burning and tingling is possible. To eliminate these sensations, as well as to further compress the vessel, a stream of cold air can be used. This is called cryosclerotherapy.
The use of foaming sclerosants has a number of advantages. They have better contact with the vessel wall, which increases the effectiveness of the procedure. A significantly smaller amount of sclerosing agent is required to achieve the result because it does not dissolve in the blood.
In addition, it does not spread beyond the procedure area, making its volume easier to control.
Liquid sclerosants are usually used to remove small varicose veins, while foam preparations allow the sclerosing of even large veins.
Sclerosis of small veins and capillaries is usually performed under visual control, and the introduction of foam sclerosant in large vessels is performed under ultrasound control.
Miniphlebectomy
This is a minimally invasive surgical method for cutting out varicose veins. It does not require any incisions, anesthesia or epidural.
Treatment for this operation is carried out in a day hospital. The doctor performs an ultrasound scan of the vessel and marks it with a marker on the skin. Then he makes a puncture (incision no more than 1-2 mm), through which he pulls part of the vein with a special hook. This area is pinched and cut.
The doctor then moves on to the next area, makes a puncture, takes out part of the vein and cuts it off. In this way, it removes the entire affected vessel.
Skin breaks heal quickly and leave no traces, thus achieving an ideal cosmetic effect. The lack of incisions makes the rehabilitation period minimal. Excised vessels are not sutured, and punctures do not require stitches - they are simply sealed with a plaster.
Phlebectomy
This is a classic surgical operation, which is used less and less recently. It consists in radical removal of an enlarged vein along its entire length. To do this, an incision is made in the groin or below the knee, through which a probe is inserted into the vessel.
With the help of a probe, the vessel is separated from the surrounding tissue and pulled out. The operation is performed under general anesthesia or epidural anesthesia.
Rehabilitation
After treatment of varicose veins, it is necessary to wear compression stockings. For the first few days it must be worn around the clock, for the following weeks only during the day and can be removed at night. General restrictions for the rehabilitation period include the exclusion of hot baths, steam rooms and saunas.
After minimally invasive operations (laser coagulation, radiofrequency ablation, sclerotherapy, miniphlebectomy) it is recommended to get up and walk. In the future, walking is recommended as a mandatory part of the rehabilitation course (at least 1 hour per day), while all other physical activities should be limited.
The duration of the rehabilitation period depends on the volume of treatment and surgical intervention.