Laser treatment of varicose veins with laser coagulation. There are truths in my feet

Varicose veins, or varicose veins, in everyday life are often called "tired leg disease". But in fact, the factors that cause it are much more complicated. And the disease itself is by no means just a harmless cosmetic flaw. Varicose veins of the lower extremities lead to the appearance of chronic venous insufficiency - a condition, the end result of which may be the appearance of a trophic venous ulcer.

Of course, in the vast majority of cases we are dealing with varicose veins of moderate severity, which is now treated effectively and practically without recurrence. But first things first.

Why are varicose veins dangerous?

How common is varicose vein disease is hard 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 is registered in more than 30 million people. At the same time, according to some studies, no more than 18% know about their disease and no more than 8% receive treatment.

Varicose veins of the lower extremities are a disease in which the structure of the vein wall changes. The vessels become longer, intricate, in areas of wall thinning, the lumen expands, forming nodules.

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 is not more than 20%. If one of the parents is ill, the risk increases: for men - up to 25%, for women - up to 62%. In the presence of disease in both parents, the chance of varicose veins in 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 predominant type III collagen, which is responsible for elasticity, the type I collagen content of the solid increases, while retaining the remaining deformation. Moreover, the number of smooth muscle cells that regulate the lumen of the vessel also varies, and the ability to interact between them is impaired. These pathological changes are hereditary in nature. Then the game comes into playexternal factors:

• long-term static loads - the need for stationary standing or landing;
• overweight;
• pregnancy and childbirth.

Some experts point to chronic constipation, tight clothing that increases the pressure inside the abdomen, and high heels that interfere with the normal functioning of the leg muscle pump 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 dilates. As a result of the dilation of the venous lumen, the valves, which ensure blood flow in only one direction, stop working. Gets upreflux- reverse output. The pressure inside the affected vein increases even more and the vicious circle closes.

Increased venous pressure, combined with changes in wall structure over time, causeinflammatory response- initially only on the surface of the valves and the inner wall of the vessels. Gradually, inflammatory proteins and blood cells begin to "penetrate" through the damaged venous wall into the surrounding tissues. There they are destroyed, releasing active substances -inflammatory mediators. . . They damage the surrounding cells and pulllymphocyteswhose function is to remove damaged tissue. As a result, edema, induction (induction) of the skin of the feet, 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. Gets upthrombophlebitis- another dangerous complication of varicose veins.

The manifestations of varicose veins are divided into objective and subjective. Subjective symptoms- these are the patient complaints about:

• aggravation in the legs;
• rapid fatigue;
• paresthesia - unpleasant sensation of "goose bumps", changes in sensitivity;
• burning sensation in 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 restlessness on your feet prevents you from falling asleep;
• night cramps in the lower extremities.

The combination of these symptoms and their severity are individual and 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 no changes in appearance, venous lesions can be detected only with a special examination and tests;
• C1- "spiders" (scientific name - telangiectasias) appear or a network of intradermal dilated veins (veins with reticular varicose veins) becomes visible;
• C2- the diameter of the dilated saphenous veins exceeds 3 mm, varicose nodes appear;
• C3- the affected foot becomes constantly swollen;
• C4- changes appear in the surrounding tissues: skin darkens (hyperpigmentation), eczema develops, induction of subcutaneous tissue;
• C5- the stage of the ulcer healed;
• C6- the stage of an open ulcer.

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

On a note
From 30 to 60% of deaths due to the sudden onset of deep vein thrombosis and further thromboembolism occur against the background of varicose veins in combination with thrombophlebitis that is not detected and does not heal in time.

Therefore, you should not delay 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 certain 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 stockings, oils and venotonics (oral medications). Current clinical guidelines suggest that venotonics may be reducedsubjectivemanifestations (complaints) in the early stages of the disease and reduce edema, but in no way affect the condition of the venous wall itself. Different types of oils have the same effect. Compression stockings are considered a very effective treatment for varicose veins, as it reduces the manifestations of venous insufficiency, facilitates the patient's subjective complaints and prevents the progression of varicose veins. However, compression stockings are not able to cure varicose veins - varicose veins will not function properly.
• Traditional surgical removal.The large or small affected saphenous vein is connected to the site 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 - hematoma, postoperative paresthesia and neuralgia.
• Sclerotherapy.A special medicine is injected inside the varicose vein, which "sticks" to 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 large and small saphenous veins, as it is characterized by a higher degree of recurrence. In addition, such an unpleasant complication as hyperpigmentation within sclerosis is possible.
• Intravenous laser coagulation (EVLK)- minimally invasive, safe, modern and effective treatment for varicose veins. It has synonymous names: endovenous laser ablation, endovasal coagulation of the veins of the lower extremities, endovenous laser ablation (EVLO). But whatever the name, the laser coagulation technique remains the same. A radial fiber optic light guide is inserted through 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 thus protecting the surrounding tissues from overheating. For the procedure, modern vascular lasers are used, which create two waves: one of them is absorbed by the blood hemoglobin, the second - by the vascular wall. Vienna is "ripening". All phases (position of the light guide, solution infiltration around the vein, the "drinking" process itself) are monitored in real time by ultrasound equipment. The duration of the EVLK procedure on one limb is 30-60 minutes.

Importers is important to know!
The only effective method for treating varicose veins is to remove the altered vein that is unable to perform its functions.

Advantages of laser removal method:

• Minimal trauma, which allows the procedure to be performed on an outpatient basis and under local anesthesia;
• you can go home immediately after surgery;
• rapid recovery;
• good cosmetic result: no marks and scars remain;
• high efficiency, low rate of recovery.

Since laser endovenous coagulation is currently considered one of the most advanced types of treatment for low and minimally invasive trauma to 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 scope of indications of EVLK due to the perfection of modern equipment - two-wave laser, radial fiber.

Contraindications to the procedure

In most cases, they descend into severe patient somatic conditions:

• deep vein thrombosis (obstruction, closure, blockage);
• decompensated type 1 diabetes mellitus;
• severe atherosclerosis of the arteries and ischemia of the lower extremities;
• severe cardiovascular disease: ischemic heart disease, in particular resting angina pectoris, extensive myocardial infarction with decreased cardiac output, severe forms of cardiac arrhythmias, stroke;
• severe blood clotting disorders, both up and down;
• pregnancy and breastfeeding;
• individual intolerance to anesthesia used;
• impossibility of physical activity immediately after the procedure;
• inability to use compression stockings.

It is characteristic that the age of the patient is not a contraindication.

How is laser coagulation of veins done?

Shortly before manipulation, you should buy second-degree compression stockings (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 laser endovenous disappearance are performed under continuous ultrasound control.

1. Before starting the procedure, the vein is "marked": the doctor places marks on the skin, corresponding to the places where the blood flows again, the branches pour into the vein.
2. At the beginning of the manipulation, local anesthesia occurs, the vein is pierced. The sensations do not differ from the usual intravenous injection. A guide of radial light is inserted into the vein using a special catheter.
3. Next, a protective "sleeve" of 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 you to not only relieve pain, but also protect the surrounding tissues from excessive laser heat.
4. The procedure itself is EVLO varicose veins. In modern optical fibers, laser radiation is supplied evenly throughout the perimeter of the device, ensuring uniform heating of the vein from the inside. After removal of the light guide, the patient undergoes ultrasound monitoring of the condition of the treated vessel as well as the deep veins of the limbs.
5. A compression garment is put on the patient.

Immediately after the completion of the manipulation, the patient should take a walk, lasting at least 40 minutes.

Possible complications

There are few of them, they are temporary, and the possibility of complications is mainly associated with the use of outdated medical equipment and the low qualifications of a 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. As a rule, they are used within 4-5 days after the intervention.
• Thrombophlebitis- most often accompanied by insufficient intensity of laser exposure.
• Pigmentation along the treated veinresolved within 1. 5-2 months.
• Feeling of a "lying" vein- passes within 1. 5 months.

To prevent the development of any complication as much as possible, you should adhere to some simple rules, the observance of which is necessary for a successful rehabilitation.

reHabiLitatiON

On the first day, there may be aching and tingling pain along the vein. Conventional pain relievers are sufficient to eliminate them. The temperature may rise in the first few days. Just take traditional remedies to reduce it.

In general, for successful rehabilitation, 2 main conditions must be met - wearing tight underwear and maintaining adequate physical activity.

• Compression underwear -during the first 5 days, it is not removed even during a night's sleep. This is necessary in order for the vein to "stick" completely and heal. Moreover, compression stockings are worn only during the day. It is enough to wear tight-fitting clothes for 2. 5-3 months, but if there are risk factors (sitting, walking, taking female sex hormones), further preventive wearing of tight-fitting socks is desirable.
• Physical 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.

During the month, you should avoid hot baths, baths and saunas.

Evaluate the effectiveness of the method

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

• anatomical features of the operated vein;
• violation 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).

Immediate and long-term results of laser coagulation of the lower extremity veins are better than those of radiofrequency ablation and sclerotherapy, and are comparable to traditional surgical techniques. At the same time, treatment of varicose veins with a laser is much better tolerated, rehabilitation time is shorter and the number of complications is less than with classical surgeries.

How much does EVLK cost?

The endovasal laser coagulation procedure requires high-tech equipment and expensive disposable expenses (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 laser intravenous coagulation is a modern effective method for treating varicose veins. It gives excellent clinical results and, in fact, leaves no residue. Minimal exposure trauma 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 depends mainly 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. "