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Treatment of varicose veins with laser coagulation. There is truth in my feet

Varicose veins, or varicose veins, are often referred to in everyday life as "tired leg disease. "In fact, its causative factors are much more complex. And the disease itself is by no means just a harmless cosmetic flaw. Varicose veins of the lower extremities lead to chronic venous insufficiency - a condition that can ultimately lead to the development of venous trophic ulcers.

Of course, in most cases we are dealing with moderate-severity varicose veins, which are now treated effectively and practically without recurrence. But above all.

Why are varicose veins dangerous?

How common varicose vein disease is is hard to say: many patients consider it a cosmetic defect and do not go to the doctor. According to Western science, at least a quarter of the population in the United States and Europe suffers from it. Pathology is observed in more than 30 million people in our country. At the same time, according to some studies, no more than 18% are aware of their illness and no more than 8% are cured.

Varicose veins of the lower extremities is a disease in which the structure of the venous wall changes. The vessel becomes longer, tangled, in areas of wall thickening, the lumen expands, nodules form.

Statistics
Varicose veins are a disease with a hereditary predisposition. The probability of its occurrence in those in whose family no one has suffered from venous pathology does not exceed 20%. If either parent is ill, the risk increases: up to 25% for men and up to 62% for women. In the presence of disease in both parents, the probability of varicose veins in the offspring is 90%.

With varicose veins, the ratio of the two major structural proteins of the venous walls is disrupted:CollagenAndElastin. . . If collagen creates firmness, then elastin, as its name implies, is responsible for elasticity - the ability of the venous wall to return to its original state. The amount of this protein in the venous wall decreases in patients with varicose veins. Collagen itself changes: Instead of type III collagen, which is responsible for elasticity, the content of type I collagen increases - while maintaining a rigid, residual deformation. In addition, the number of smooth muscle cells that regulate the vessel lumen changes and the ability to interact between them is impaired. These pathological changes are hereditary. Then the game will be activatedExternal factors:

  • Long-term static loads - the need to stand still or sit;
  • Excess weight;
  • 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 in the venous system of the lower extremities. The altered venous wall ceases to "maintain" pressure, the venous lumen expands. As a result of the dilation of the venous lumen, the valves that provide blood flow in only one direction stop working. AppearsReflux- Reverse drain. The pressure inside the vein increases even more and the vicious circle closes.

An increase in venous pressure, along with changes in wall structure over time, causesInflammatory response- Initially only on the surface of the valves and on the inner wall of the vessels. Gradually, inflammatory proteins and blood cells begin to "penetrate" the damaged venous wall into the surrounding tissue. There they are destroyed, releasing active substances -Inflammatory mediators. . . They damage nearby cells and attract themLymphocytesWhose function is to remove damaged tissue. As a result, swelling, induction (induction) and hyperpigmentation of the skin of the foot develop. These processes can lead to venous trophic ulcers. Prolonged inflammation of the venous wall also increases blood clotting. With venous edema, this leads to the fact that blood clotting begins in the varicose vein. AppearsThrombophlebitis- Another dangerous complication of varicose veins.

Manifestations of varicose veins are divided into objective and subjective.Subjective symptoms- These are the patient complaints:

  • Heaviness in the legs;
  • Rapid fatigue;
  • Paresthesias - unpleasant sensations of "goose bumps", changes in sensitivity;
  • Burning sensation in muscles;
  • Leg pain, the characteristic feature of which is that the intensity decreases after walking;
  • Swelling in the evening;
  • Restless Legs Syndrome - a condition in which discomfort in the legs prevents you from sleeping;
  • Night cramps in the lower extremities.

The combination of these symptoms and their severity is individual and is not always related to 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, damage to the veins can be detected only by special examination and tests;
  • C1- "Spiders" (scientific name - telangiectasia) appear or a network of intradermal varicose veins (reticular varicose veins) becomes visible;
  • C2- The diameter of the varicose veins is more than 3 mm in diameter, varicose nodes are revealed;
  • C3- The affected leg is constantly swollen;
  • C4- Changes occur in the surrounding tissues: the skin darkens (hyperpigmentation), develops eczema, induction of subcutaneous tissue;
  • C5- stage of cured ulcer;
  • C6- Open ulcer stage.
Stages of development of varicose veins of the legs

Starting from the fourth stage, the described trophic skin changes can no longer be completely eliminated. Even healed varicose veins at this stage will not result in complete resorption of hyperpigmentation or induction. In addition, it is necessary to remember about a rather dangerous complication -Thromboembolism. . .

On the note
With a sudden onset of 30 to 60% of deaths, deep vein thrombosis and subsequent thromboembolism occur in the setting of varicose veins, along with thrombophlebitis, detected and cured in a timely manner.

Therefore, you should not delay treatment of varicose veins later, especially in the light of advances in modern phlebology.

Modern methods of treatment of varicose veins

Methods and techniques that meet several criteria can be considered modern: minimal invasiveness (trauma), high efficiency, low probability of recurrence and complications, and short rehabilitation period.

  • Conservative therapy.Includes the use of compression garments, ointments and venotonics (oral medications). Current clinical indications suggest that venotonics may reduce thisSubjectiveManifestations (complaints) in the early stages of the disease and reduce swelling, but in no way affect the condition of the venous wall itself. Different types of ointments have the same effect. A compression garment is considered a very effective treatment for varicose veins as it reduces the manifestations of venous insufficiency, alleviates the patient's subjective complaints and prevents the progression of varicose veins. However, a compression garment cannot cure varicose veins - varicose veins will not work properly.
  • Traditional surgical removal.The affected large or small diaper vein is tied to the place where it flows into the deep venous 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 paresthesias and neuralgia.
  • Sclerotherapy.A special drug is inserted into 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 non-operative trunk of large and small diaphragm veins, as it is characterized by a higher rate of recurrence. In addition, an unpleasant complication such as hyperpigmentation within sclerosis is possible.
  • Endovenous Laser Coagulation (EVLK)- Minimally invasive, safe for varicose veins, Modern and effective type of treatment. It has synonymous names: endovenous laser ablation, endovascular coagulation of the veins of the lower extremities, endovenous laser obliteration (EVLO). Whatever the name, the technique of laser coagulation remains unchanged. A guide of radial optical-fiber light is inserted through a puncture into a vein. Then, with the help of a special pump, the anesthetic solution is pumped around the vein, which not only anesthetizes the procedure but also compresses the vein, reducing its diameter and thus protecting the surrounding tissues from overheating. Modern vascular lasers are used for the procedure, which generate two waves: one of them is absorbed by the blood hemoglobin, the other - by the vascular wall. The vein is "brewing". All stages (position of the light guide, infiltration of the solution around the vein, the process of "boiling" itself) are monitored in real time by ultrasonic devices. The duration of the EVLK procedure on one limb is 30-60 minutes.

It is important to know!
The only effective method of treating varicose veins is to remove a modified vein that is unable to perform its functions.

Advantages of laser removal method:

  • Minimal trauma that makes it possible to perform the procedure on an outpatient basis and under local anesthesia;
  • You can go home as soon as the operation is completed;
  • Fast recovery;
  • Good cosmetic result: no traces and scars remain;
  • High efficiency, low recurrence rate.

Since endovenous laser coagulation is currently considered one of the most advanced, low-trauma, and minimally invasive types of varicose vein treatment, we will discuss this technique in more detail.

Indications for laser coagulation

The main indication is varicose veins, regardless of the venous trunk diameter and variants of its anatomical structure. It became possible to expand the range of EVLK markings due to the perfection of modern equipment - two-wave laser, radial fibers.

Contraindications to the procedure

In most cases, they get sick before the patient has a severe somatic condition:

  • Deep vein thrombosis (obstruction, occlusion, blockage);
  • Decompensated type 1 diabetes;
  • 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 decreased cardiac output, severe forms of cardiac arrhythmia, stroke;
  • Severe disorders of blood clotting, both down and up;
  • Pregnancy and breastfeeding;
  • Individual intolerance to the anesthetic used;
  • Inability to engage in physical activity after the procedure;
  • Inability to use compression socks.

Characteristically, the patient's age is not a contraindication.

How is laser coagulation of veins done?

Shortly before manipulation, you should purchase 2nd degree compression stockings (25-32 mm Hg). The doctor will tell you in detail what size is needed. Endovascular laser coagulation itself does not require any special training.

All stages of endovenous laser obliteration are performed under constant ultrasound control.

  1. Before the procedure, the vein is "marked": the doctor puts marks on the skin, corresponds to the places where the blood flows back, the tributaries flow into the vein.
  2. At the beginning of the manipulation local anesthesia is performed, the vein is dug (dig). The sensations are no different from a conventional intravenous injection. The radial light guide is inserted into a vein using a special catheter.
  3. Next, a protective "sleeve" of anesthetic is formed around the vein. Under ultrasound control, using a special pump, the doctor places a local anesthetic around the vessel. This allows you to not only relieve pain, but also protect the surrounding tissue from excess laser heat.
  4. The procedure itself is EVLO varicose veins. In modern optical fibers, laser radiation is evenly distributed throughout the device, ensuring 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.
  5. The patient wore a compression garment.

Upon completion of the manipulation, the patient should take a walk for at least 40 minutes.

Possible complications

In some of them, they are temporary and the likelihood of complications is mainly related to the use of outdated medical equipment and the low qualification of the doctor.

  • Deep vein thrombosis -May appear in patients with a tendency to increase thrombosis. Therefore, to prevent this complication, patients are prescribed medications that reduce blood clotting. 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 veinTerminated 1. within 5-2 months.
  • Feeling of a "stretched" vein- runs for 1. 5 months.

To avoid the development of any complications, you should follow a few simple rules that must be followed for successful rehabilitation.

Rehabilitation

On the first day, there may be pain along the vein. Ordinary painkillers are enough to eliminate them. The temperature may rise in the first days. It is enough to use traditional means to reduce it.

In general, for a successful rehabilitation, two basic conditions must be met - wearing compression underwear and maintaining sufficient physical activity.

  • Compression Underwear -For the first 5 days, it will not be removed even during nighttime sleep. This is necessary so that the vein is completely "glued" and healed. In addition, the compression garment is worn only during the day. It is enough to wear compression garments for 2. 5-3 months, but if there are risk factors (sitting, standing work, taking female sex hormones), Further prophylactic wearing of compression garments is desirable.
  • ზიPhysical activity- It is recommended to walk at least one hour a day. But you will have to give up intense sports for about a month.

You should avoid hot baths, spas and saunas for months.

Evaluate the effectiveness of the method

Analysis of foreign and domestic publications shows that the efficiency of laser coagulation of varicose veins is from 93 to 100%. Failure can be attributed to several groups of factors:

  • Anatomical features of the operative vein;
  • Violation of the technical characteristics of EVLK (insufficient laser power, insufficient compression of the vein with anesthetic solution);
  • Non-compliance with the rules of the postoperative regimen by the patient (usually - refusal to compress).

The immediate and long-term results of laser coagulation of the veins of the lower extremities are better than the results of radiofrequency ablation and sclerotherapy and are comparable to traditional surgical techniques. At the same time, the treatment of varicose veins with laser is much better, the rehabilitation time is shorter and the number of complications is less than with conventional surgeries.

How much does EVLK cost?

The endovascular 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. Minimal exposure to trauma allows you to return to normal life (with minor restrictions) already on the day of surgery, without requiring special hospital conditions and recovery conditions.

How to choose a clinic

Says the 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 the technical characteristics of the equipment used. This means that the equipment used must be modern and doctors must be qualified. Therefore, I recommend choosing a clinicIt has a year and has an experienced reputation over time. "