Varicose veins of the lower extremities are rightly considered the most common pathology of peripheral vessels, it is one of the ten so-called diseases of civilization. According to epidemiological studies, venous insufficiency occurs in 80% of people of working age. In most cases, varicose veins of the legs do not cause serious suffering, and sometimes it goes unnoticed at all, does not require any treatment. However, there are situations when it is worth, without delay, to consult a specialist, to undergo proper therapy. What are the treatments for varicose veins of the lower extremities? What are their advantages and disadvantages?
Ways to get rid of the disease
Thousands of people every year ask themselves the question: how to get rid of the "ugly joints" or "vascular nets" on their feet? Media portals are full of ads for public and private clinics treating 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 of which treatment option is most appropriate. If a person who has decided to deal with his enlarged vessels and is not sure about the safety or effectiveness of this or that method of treatment, the best option for him is to contact several clinics, get qualified advice from himat least two professionals Me
There are various reasons that force a patient with varicose veins to consult a doctor:
- cosmetic considerations;
- symptoms of anxiety;
- complications of the disease (for example, 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 accurately convey the main reason for contacting him. Too often, patients simply need reassurance that their varicose veins will not harm them in any way and are unlikely to do so in the future.
If therapy is needed, the doctor often recommends self-medication at home within 6 months, which includes:
- use of compression stockings;
- doing regular exercise;
- avoid "long break time" - exclude a long stay in a sitting or standing position;
- during rest (in a horizontal position), raise the "compromised" limb above the level of the heart.
If, after a 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 limb pathology
To fight varicose veins of the legs, conservative treatment is used (compression and pharmacological therapy, lifestyle modification), surgical interventions, external and internal laser exposure, radiofrequency ablation, injection sclerotherapy. The choice of this or that option depends on the patient's preferences. It is also influenced by the patient's financial capabilities, physicians' qualifications, and medical institution equipment. However, which method of treating varicose veins of the lower extremities will be used in each specific case depends largely on the disease itself: what symptoms are present, the degree of venous insufficiency, and other characteristics of the vascular lesions.
Methods of conservative therapy
Conservative treatment, as a rule, is complex and includes several components.
A change in lifestyle, which implies a complex of measures aimed at preventing blood stagnation in the veins. As you know, prolonged standing or sitting levels the activity of the venous-muscular pump (gastrocnemius muscle), which contributes to stagnation. Therefore, patients are advised to walk regularly, periodically raising their legs above the level of the heart in an inclined position. You should also pay attention to different low-calorie, salt-free diets. They will allow you to regulate body weight, compensate for seasonal vitamin deficiency. It is necessary to consume foods high in bioflavonoids (substances that help strengthen the vessel wall).
People with varicose veins should avoid overheating the legs, refrain from visiting baths and saunas, and, if possible, avoid using heated floors.
Compression stockings improve venous hemodynamics, which leads to the disappearance of many manifestations of the disease. Disadvantages of this method:
- its limited use in time (it is not possible to wear compression stockings and socks all the time);
- the appearance of discomfort with constant compression, this is observed especially often in summer, when the symptoms of varicose veins are more "visible".
The pharmacy, as a rule, offers compression socks from only one manufacturer. However, there are many different brands, each of which can meet the needs of the patient to varying degrees.
Medication treatment can eliminate the symptoms of the disease or reduce their manifestation, aims to prevent and fight its complications and can increase the effectiveness of compression therapy. Pharmacology helps to cope 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 (phleboprotectors), drugs that can improve symptoms, strengthen the venous wall. They are considered basic agents of pharmacotherapy. This includes:
- Horse chestnut fruit extract and thiamine (vitamin B1) are part of medicines used to treat pain and aggravation in the leg, edema 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 meals 1 tablet 3 times a day).
- Butcher broom (butcher broom) is used as a food additive. Helps relieve congestion in the veins. It is believed to be effective against spider veins. However, clinical data confirming its safety and efficacy have not been performed.
- Deproteinized hemodialysis blood of small calves is part of the well-known drugs, which are excellent phleboprotectants, have a good therapeutic effect for varicose veins of the lower extremities.
As a rule, venotonic is prescribed in courses. The duration of the course depends on the dynamics of improvement of symptoms, the duration of remission achieved. Therefore, the doctor may change the medication intake from 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 depending on the condition and course of the disease. The therapeutic effect of these topical drugs is realized through two mechanisms: distracting and in fact therapeutic. Initially, evaporation of the base of alcohol or essential oils contained in the gel occurs, which leads to a decrease in skin temperature, respectively, and improves the symptoms of the disease. As a result of the second, the medicinal substance penetrated through the skin directly into the vein begins to exert its therapeutic effect.
Oils and gels used for varicose veins of the legs are classified according to the main active ingredient they contain. They include such medicinal substances:
- Phleboprotectants (usually routine as well as herbal substances that strengthen the vessel wall).
- Non-steroidal anti-inflammatory drugs 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 are contraindicated.
- Proteolytic enzymes are able to effectively clear a trophic ulcer (complication of varicose veins of the legs).
- Ionized silver is an effective antiseptic, it cleans and dries the wound perfectly, therefore it is an indispensable medicine for the treatment of an infected trophic ulcer.
- Antibiotics are used topically for the infection of varicose vein complications (thrombophlebitis, dermatitis).
- Moisturizing preparations and dermatoprotectors protect the skin from external influences, improve its elasticity. They are usually prescribed for atrophic skin changes (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, is able to relieve pain.
Surgery
The main purpose of surgical treatment is to eliminate the pathological mechanism that led to the appearance of the disease - the venous reflex, as well as the removal of its main manifestation - varicose veins. Surgical treatment is indicated: for patients with persistent pain and fatigue in the legs, in the presence of edema, chronic venous insufficiency, cosmetic problems, early hyperpigmentation (excessive deposition of pigment in the skin), external bleeding, and when superficial thrombophlebitis, in the presence of trophic ulcers that can not be treated with conservative methods.
Currently, the best known are three types of operations:
- safeno-femoral ligament (ligation and removal of the upper part of the great saphenous vein);
- removal of the great saphenous vein:
- traditional surgery or Bebkokk, in which a special probe is inserted into the lumen of the great saphenous vein (two incisions are made in advance: one in the groin area, the second at the level of the upper third of the leg) and extends along it allthe length after which it is removed along with the varicose vein;
- cryostripping, an operation that is almost similar to the previous one, but differs in that the probe cools to -85 ° C, as a result of which the vein adheres to the probe, which makes its removal less traumatic;
- Phlebectomy is a procedure to remove varicose veins through several small incisions, 2-3 mm 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 performed under general anesthesia, but most patients are released on the day of surgery. Complete recovery, return to normal daily activity usually takes 2 to 3 weeks. Complications are possible, which are more common in patients with advanced varicose veins. During surgery, nerves located in the subcutaneous tissue can be damaged, therefore, 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 treatments
The main purpose of using new treatment methods is to minimize the tissue trauma observed during surgical interventions, which allows the patient to recover faster. They began to be widely used in the early 2000s.
Intravenous ablation (RF and laser)
Radiofrequency and laser ablation are methods of treating varicose veins of the legs by "sealing" the large saphenous vein (or small one) with high temperature, which leads to regression of dilated vessels (their walls stick together). ). Although these options do not involve surgical procedures, it is quite common to use additional phlebectomy and sclerotherapy. Both methods include:
- Insertion of a catheter into the large saphenous vein through a small incision in the upper third of the leg and its progression to the saphenofemoral junction under ultrasound guidance. No incisions are made in the hip area.
- Execution under local anesthesia (anesthetic is widely infiltrated into the subcutaneous tissue of the thigh). Additional general anesthesia may be required if a large number of miniflebectomies are to be performed at the same time.
- Need to use bandage or socks after the procedure for two weeks.
- The dependence of their result on the anatomy of the saphenous veins in the patient is positive in the presence of straight lines, suspicious when the vessels are twisted.
The use of intravenous ablation, which has been widely used over the last ten years, has not shown significant differences in its effectiveness compared to surgery.
The main advantage of this technique is the rapid healing after the procedure, which is associated with a lower chance of wound infection and the appearance of hematoma.
However, complications are typical for this procedure: skin burns, temporary paresthesia, deep vein thrombosis (occurs in less than 1% of patients).
Simple sclerotherapy
This method of treatment, due to its ease of application and low trauma, is currently used by many clinics. Its essence lies in the fact that sclerosant is injected into the vein with varicose veins, a substance that sticks to its walls, blood flow moves to healthy vessels. Sclerotherapy is often combined with classical surgeries, and in the case of telangiectasia and spider veins, it is used as the sole method of therapy.
Contraindications:
- pregnancy,
- breastfeeding period,
- dermatitis,
- thrombophlebitis.
Sclerotherapy gives quite acceptable results that satisfy many patients.
Foam sclerotherapy
Unlike simple, foam sclerotherapy, sclerosant is injected into a vein after mixing with gas (usually air). As a result, foam is obtained, which, spreading into the vein, displaces blood from it and causes a vessel spasm. The manipulation is usually performed under the direction of duplex ultrasound scanning.
As well as simple foam sclerotherapy, you are required to wear compression stockings after manipulation for 14 days.
Recovery after the procedure is faster than if a classic operation was performed. However, the medium-term results of treatment (possibility of recurrence of reflux) of foam sclerotherapy are somewhat worse than those of surgery.
Treatment of "microvaricose veins": telangiectasia, spider veins
Treatment of spider veins is almost always done only for cosmetic reasons, although sometimes they can cause a hot, throbbing 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 at the same time. A compression bandage or sock is applied for 1 to 2 days. If sclerosis comes out of the vessel during the injection, the ulcer may develop in this area, which heals slowly, leaving a scar. This rarely happens, provided "unless the doctor's hands shake during surgery". Hyperpigmentation at the injection site (darkening of the skin) is also possible.
- Laser ablation. The method works well for treating telangiectasias (growth of intradermal vessels that looks like a birthmark).
There are many effective ways to get rid of varicose veins of the lower extremities offered by traditional medicine. The choice of treatment option depends mainly on the decision of the patient himself. Do not "go under the knife" right away, in the arsenal of doctors there are effective options for conservative therapy. According to doctors, today it is impossible to completely cure this disease, but it is entirely within the power of modern medicine to save the patient from the manifestations of the disease as much as possible and to prevent his further progression.