Disruption of blood flow and stagnation of blood in the venous bed leads to pathological changes in the veins - varicose veins. The causes of the development of the disease can be various, including genetic predisposition (mostly), excess weight, hormonal imbalance, pregnancy, arterial hypertension, constipation, lifestyle and professional activity (for example, work that requires standing for a long time). ).
In all these cases, the development of the disease follows the same scenario and is associated with two factors: weakness of the vascular wall and functional failure of the venous valves.
Vein valves prevent blood from flowing back. If they cannot cope with their work, the blood stagnates and collects (deposits) in the veins. As a result, the veins not only expand, but also stretch, become curved and merge into varicose veins.
Often, this disease affects the superficial veins (large and small) of the lower extremities. Together, they provide the outflow of venous blood from the subcutaneous tissue and skin, which makes up more than 1/10 of the total circulatory system. The main work is done by the deep veins, which are connected to the superficial veins through the perforating venous channels.
Treatment of varicose veins always means removal or resorption of the vein, i. e. removing it from the general venous circulation system. However, since such ships play a minor role, their elimination has no negative consequences. Their function is easily accepted by the rest of the vessels.
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 vein pattern on the skin. It can be a capillary network or star (telangiectasia). Most often they appear on the legs and thighs, but they can also be found on the face, labia (women), feet and hands. Spider veins on the face are called rosacea.
Symptoms of varicose veins depend on the stage of the disease. At first, it is only heaviness, increased fatigue of the legs, moderate swelling in the evening, which disappears after rest and sleep. Leg cramps at night are possible.
A characteristic symptom of the disease is pain. Pain in the legs can occur or worsen when walking, standing for a long time, or it can be constant, accompanied by a feeling of fullness, burning and warmth. Dilated veins are painful when pressed.
In international phlebology, the classification of the disease is from 0 to 6 classes.
In the 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.
Class 2 disease is characterized by enlarged, thickened veins that bulge under the skin.
In the 3rd stage, the swelling of the legs (ankles, feet, legs) does not go away after a night's sleep or long rest and becomes persistent.
In the 4th stage, the skin over the dilated veins becomes red or blue, areas of hyperpigmentation appear, itching, dryness, peeling and inflammation appear on the skin.
In addition, the development of pre-ulcers and trophic skin ulcers is observed in the 5th and 6th stages.
So, varicose veins that start as an aesthetic problem can cause serious health problems over time.
Complications
Stagnation of venous blood and its accumulation (clumping) in the veins of the lower extremities leads to a decrease in blood pressure, hypotension and related dizziness, fainting and headaches.
The skin over the affected vessels thins, becomes inflamed, crusts, scabs, congestive dermatitis and varicose eczema develop, followed by the formation of trophic ulcers.
Blood clots appear in vessels filled with stagnant venous blood, and can break off at any time and travel through the general circulatory system, blocking a vital artery and causing death.
Complications such as phlebitis and thrombophlebitis develop in the later stages of varicose veins.
The later the treatment of the disease is started, the higher the risk of its complications, and the more radical methods will be needed to prevent them. Therefore, when symptoms of varicose veins appear, you should not rely on self-medication, they can be good for prevention. But only a doctor can really help.
Diagnosis and treatment
As always, a visit to the doctor begins with the examination of complaints, collection of anamnesis and external examination. The main method of diagnosing varicose veins is Doppler ultrasound, duplex or triplex ultrasound examination of blood vessels.
As a rule, this method provides a comprehensive picture of the disease in order to determine the most suitable treatment tactics.
If additional information is needed, to clarify the diagnosis, the doctor can prescribe contrast radiography (radiocontrast venography), MRI of blood vessels (magnetic resonance venography) or multispiral computer angiography.
Before performing both minimally invasive and extensive surgical interventions, a standard set of examinations is prescribed - general urine test, general clinical and biochemical blood tests, coagulation test (coagulogram), 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 daily life and you can return to your normal activities after only 1-2 hours. Minimally invasive procedures are performed under local anesthesia or without any anesthesia.
And only radical surgical intervention (phlebectomy) may require short-term hospitalization in the inpatient department of the clinic.
Drug treatment
In the early stages of disease development or prevention, the doctor can prescribe drug treatment, including antibiotics and antiseptics (in case of inflammation), phleboprotectors, anticoagulants (to prevent thrombosis), phleboprotectors, heparin ointment and other heparins. - containing medicines.
Hirudotherapy can be used as an alternative treatment method.
Conservative treatment includes compression stockings (tights, knee socks) and elastic bandages. It has a limited scope.
Endovasal laser vascular coagulation (EVLC)
This method refers to minimally invasive methods of treating varicose veins. The procedure is performed on an outpatient basis under local anesthesia. Under ultrasound guidance, a flexible fiber-optic light guide connected to an emission device is inserted into the vascular bed.
Laser light of a certain wavelength is absorbed by blood cells and vessel walls and turns into heat.
As a result, the vessel is sealed and turns into a thin bundle of connective tissue that dissolves on its own.
Laser coagulation is commonly used to treat small and medium-sized veins, especially facial varicose veins. But with its help, you can eliminate 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 rather than a laser to seal the vessel. Otherwise the procedure is similar. Under local anesthesia, a radio wave emitter is inserted into the venous bed, it is absorbed by the blood and vessel walls, turns into heat and has 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 branches.
Sclerotherapy
In this case, the varicose vein is sclerosed - it is glued from the inside with the help of a sclerosant. This medicine is given by injection into a vein. It can be liquid or foamy.
The procedure is completely painless, during this period a slight burning and tingling sensation is possible. A stream of cold air can be used to relieve these sensations, as well as to tighten the vessel further. This is called cryosclerotherapy.
The use of foam sclerosants has several advantages. They are in better contact with the vessel wall, which increases the effectiveness of the procedure. Significantly less amount of sclerosing agent is required to achieve results as it is not dissolved in the blood.
In addition, it does not extend beyond the procedure area, making it easier to control its volume.
Liquid sclerosants are usually used to eliminate small varicose veins, while foam preparations make it possible to sclerose even large veins.
Sclerosis of small vessels and capillaries is usually performed under visual control, and introduction of foam sclerosant into large vessels is performed under ultrasound control.
Miniphlebectomy
This is a minimally invasive surgical method for cutting varicose veins. It requires no incision, anesthesia or epidural.
The treatment of this operation is carried out in the hospital during the day. The doctor conducts an ultrasound examination of the vessel and marks it with a marker on the skin. After that, he makes a puncture (an incision of no more than 1-2 mm), through which a part of the vein is removed with a special hook. This area is compressed and cut.
Then the doctor moves to the next area, makes a puncture, removes part of the vein and cuts it. In this way, he removes the entire affected vein.
Skin punctures heal quickly and leave no scars, thus achieving an ideal cosmetic effect. The absence of incisions minimizes the rehabilitation period. Cut veins are not sutured, and punctures do not require stitches - they are simply closed with an adhesive plaster.
Phlebectomy
This is a classic surgical procedure that is used less and less recently. It consists of radical removal of the varicose vein along its entire length. To do this, an incision is made in the groin or under the knee, through which a probe is inserted into the vein.
With the help of a probe, the vessel is separated from the surrounding tissues and removed. The operation is performed under general anesthesia or epidural anesthesia.
Rehabilitation
Compression stockings should be worn after treatment of varicose veins. It should be worn day and night for the first few days, and during the following weeks it should be worn only during the day and can be removed at night. General restrictions for the rehabilitation period include the exclusion of hot baths, steam baths 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), all other physical activities should be limited.
The duration of the rehabilitation period depends on the volume of treatment and surgical intervention.