Varicose veins of the lower extremities are rightly considered the most common pathology of peripheral vessels, it is the e. წ. According to epidemiological studies, venous insufficiency is manifested in 80% of people of working age. In most cases, the varicose veins of the legs do not cause serious suffering and sometimes it goes unnoticed, not requiring any treatment. Nevertheless, there are situations when it is worthwhile, without delay, to consult a specialist, to undergo appropriate therapy. What is the treatment for varicose veins of the lower extremities? What are their pros and cons?
Ways to get rid of the disease
Every year thousands of people ask themselves the question: how to get rid of "ugly knots" or "vascular nets" on their feet? Media portals are full of advertisements for public and private clinics that treat varicose veins of the lower extremities. They offer "unique", "guaranteed", "painless" or "completely safe" ways to get rid of this disease. Sometimes it is difficult to understand this ad, to answer the question, which treatment option is most suitable. If a person who has decided to deal with his own dilated vessels and is unsure of the safety and effectiveness of this or that method of treatment, the best option for him is to contact several clinics, seek qualified advice from at least two professionals. What
There are many reasons why a patient with varicose veins should consult a doctor:
- Cosmetic considerations;
- Symptoms of discomfort;
- Complications of the disease (e. g. , 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 convey correctly the main reason for contacting him. Often, patients just need to be reassured that varicose veins are not causing them any harm and are unlikely to do so in the future.
If therapy is needed, your doctor will often recommend that you have treatment at home for 6 months, which includes:
- Use of compression stockings;
- Regular exercise;
- Avoid "prolonged disconnection" - exclude prolonged sitting or standing;
- At rest (in a horizontal position) raise the "compromised" limb above the level of the heart.
If after the second consultation the patient is not satisfied with the result, the doctor may recommend conservative or surgical treatment of varicose veins of the lower extremities.
Treatment options for lower extremity pathology
Conservative treatment (compression and pharmacological therapy, lifestyle changes), surgical interventions, external and internal laser exposure, radiofrequency ablation, injection sclerotherapy are used to fight varicose veins of the leg. The choice of this or that option depends on the patient's preferences. It also affects the patient’s financial capabilities, physicians ’qualifications, and medical facility equipment. Nevertheless, which method of treating varicose veins of the lower extremities will be used in each case depends largely on the disease itself: what the symptoms are, the degree of venous insufficiency, and other characteristics of the vascular damage.
Conservative therapy methods
Conservative treatment is usually difficult and involves several components.
Lifestyle change, which involves a set of measures aimed at preventing blood stagnation in the veins. As you know, prolonged standing or sitting position regulates the activity of the venous-muscular pump (gastrocnemius muscle), which promotes stagnation. Therefore, patients are advised to walk regularly, periodically raising their legs in a position inclined above the level of the heart. You should also pay attention to different diets - without salt, low in calories. They allow you to change body weight, fill the seasonal vitamin deficiency. It is necessary to consume foods rich 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 hot floors.
The compression garment improves venous hemodynamics, leading to the disappearance of many manifestations of the disease. Disadvantages of this method:
- Its limited timely use (there is no possibility of wearing compression socks and socks constantly);
- The appearance of discomfort with constant compression, it is especially often observed in the summer, when the symptoms of varicose veins are most "manifested".
The pharmacy usually offers compression garments from only one manufacturer. However, there are many different brands, each of which can meet the needs of the patient to varying degrees.
Medication 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 deal with the side effects that occur after sclerotherapy or phlebectomy.
Modern treatment of varicose veins of the lower extremities is not complete without the use of venotonics (phleboprotectants), medications that can improve symptoms, strengthen the venous wall. They are considered basic pharmacotherapy agents. ენიYour include:
- Horse chestnut fruit extract and thiamine (vitamin B1) are part of medications used to treat pain and heaviness, with swelling observed in chronic venous insufficiency. The funds 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 a meal 1 tablet 3 times a day).
- Butcher broom (butcher broom) is used as a food additive. Helps to remove swelling in the veins. It is believed to be effective against spider veins. However, no clinical data confirming its safety and efficacy have been performed.
- Deproteinized blood hemoderivative of young calves is part of the popular drugs that are excellent phleboprotectants, have a good therapeutic effect for varicose veins of the lower extremities.
Typically, venotonic is prescribed in courses. The duration of the course depends on the dynamics of symptom improvement, the duration of remission achieved. Therefore, your doctor may change your medication for 3 to 6 months or more.
Ointments and gels (topical medications) are also widely used. The treatment regimen for varicose veins of the lower extremities is chosen by the doctor according to the condition and course of the disease. The therapeutic effect of these topical medications is realized through two mechanisms: focusing and actually therapeutic. First, there is an evaporation of the essential oils contained in the alcohol base or gel, which leads to a decrease in skin temperature, respectively, and improves the symptoms of the disease. As a result of the second, the healing substance, which penetrates the skin directly into the vein, begins to show its therapeutic effect.
Ointments and gels used to treat varicose veins of the legs are classified according to their main active ingredient. These include medicinal substances:
- Phleboprotectants (usually routine, as well as herbal substances that strengthen the vessel wall).
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly 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 can effectively clear trophic ulcers (complications of varicose veins of the legs).
- Ionized silver is an effective antiseptic, it thoroughly cleanses and dries the wound, so it is an indispensable tool for treating infected trophic ulcers.
- Antibiotics are used topically for infections of complications of varicose veins (thrombophlebitis, dermatitis).
- Rehydrating preparations and dermatoprotectors protect the skin from external influences, improve its elasticity. They are usually prescribed for atrophic changes in the skin (when compression stockings are used for a long time).
- Heparin, in addition to antithrombotic activity (prevents the formation of blood clots), has an anti-inflammatory effect, can relieve pain.
Surgery
The main goal of surgical treatment is to eliminate the pathological mechanism that led to the appearance of the disease - venous reflex, as well as its main manifestation - the removal of varicose veins. Surgical treatment is indicated: for patients who have pain and constant fatigue in the legs, edema, chronic venous insufficiency, cosmetic problems, early hyperpigmentation (excessive accumulation of skin pigments), external bleeding, as well as superficial thrombophlebitis. Progresses in the presence of trophic ulcers, which cannot be treated by conservative methods.
Three types of surgery are the most popular at the moment:
- Saphenous femur (ligation and removal of the upper vein of the saphenous vein);
- Large diaper vein removal:
- Traditional or bebok surgery, in which a special probe is inserted into a large diaphragmatic vein lumen (two incisions are made in advance: 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 with a varicose vein;
- Cryostriping, an operation that is almost similar to the previous one but differs in that the probe is cooled to -85 ° C, causing the vein to occupy the probe, making it possible to remove it less traumatically;
- Phlebectomy is a procedure to remove varicose veins through several small, 2-3 mm incisions in the skin.
The above surgical interventions help to improve the patient's quality of life; Their therapeutic and economic efficacy has been proven in clinical trials. They are usually administered under general anesthesia, but most patients are discharged on the day of surgery. It takes you 2 to 3 weeks to fully recover, return to normal daily activities. Complications are possible that are more common in patients with advanced varicose veins. During surgery, nerves in the subcutaneous tissue can be damaged, so after surgical manipulation, temporary or even permanent numbness of some parts of the legs is sometimes observed, but this does not lead to serious disability.
New treatment
The main goal of using new methods of treatment is to reduce the tissue trauma observed during surgery, allowing the patient to recover more quickly. They began to be widely used in the early 2000s.
Intravenous ablation (RF and laser)
Radiofrequency ablation and laser ablation are methods of treating varicose veins of the legs by "sealing" a large vein (or small) high temperature vein, causing regression of dilated vessels (their walls fitting together). Although these options do not include surgical procedures, the use of additional phlebectomy and sclerotherapy is quite common. Both methods include:
- Insert the catheter through a small incision in the upper third of the leg into a large saphenous vein and deliver it to the saphenous femoral node under ultrasound guidance. No incisions are made in the groin area.
- Perform under local anesthesia (anesthetic-intensive infiltration of the subcutaneous tissue of the thigh). Additional general anesthesia may be needed if a large number of miniphlebectomies are required at the same time.
- The need to use a bandage or socks for two weeks after the procedure.
- The dependence of their result on the anatomy of the saphenous veins in the patient is positive in the presence of straight lines, it is doubtful when the vessels are round.
The use of intravenous ablation, which has been widely used in the last ten years, has not shown significant differences in its effectiveness compared to surgery.
The main advantage of this technique is the rapid recovery after the procedure, which is associated with a lower likelihood of wound infection and hematoma formation.
Nevertheless, complications are typical for this procedure: skin burns, temporary paresthesia, deep vein thrombosis (found in less than 1% of patients).
Simple sclerotherapy
This method of treatment is currently used by many clinics due to its ease of implementation and low trauma. Its essence lies in the fact that sclerosant is injected into a varicose vein, a substance that sticks to its walls, blood flow is transferred to healthy vessels. Sclerotherapy is often combined with classical surgeries and in the case of telangiectasia and spider veins it is used as the only method of therapy.
Contraindications:
- Pregnancy,
- Breastfeeding period,
- Dermatitis,
- Thrombophlebitis.
Sclerotherapy gives quite acceptable results that satisfy many patients.
Foam sclerotherapy
Unlike simple sclerotherapy with foam, sclerosant is injected into a vein after mixing with gas (usually air). As a result, foam is obtained, which is applied to the vein, changes the blood from it and causes vascular spasm. Manipulation is usually performed under the guidance of a duplex ultrasound scan.
Like foam sclerotherapy, it is necessary to wear a compression garment for 14 days after manipulation.
Recovery after the procedure is faster than in the case of classic surgery. However, the median outcomes of foam sclerotherapy treatment (likelihood of recurrence of reflux) are somewhat worse than surgical.
Treatment of "microvaricose": telangiectasia, spider veins
Treatment for spider veins is almost always done for cosmetic reasons only, although sometimes they can cause a hot, flickering sensation, indicating the presence of reflux. Two types of therapy are commonly used:
- Microsclerotherapy - the introduction of a sclerosing substance using a thin needle. Usually, several spider veins are sclerosed simultaneously. Used with compression bandage or supplies for 1 to 2 days. If sclerosis passes outside the vessel during injection, an ulcer may develop on this side that slowly heals, after which the scar remains. This rarely happens, provided that "unless the doctor's hands are tense during surgery. "Hyperpigmentation (darkening of the skin) at the injection site is also possible.
- Laser ablation. The method works well for the treatment of telangiectasias (internal growth of blood vessels that looks like 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 largely depends on the decision of the patient himself. Not immediately "under the knife", there are effective options for conservative therapy in the arsenal of doctors. According to doctors, today it is impossible to completely cure this disease, but modern medicine has the power to save the patient from the manifestations of the disease as much as possible and prevent its further progression.