Treatment of varicose veins by laser coagulation. There is truth in my legs

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

Of course, in the overwhelming majority of cases, we are dealing with varicose veins of moderate severity, which are now treated effectively and with virtually no relapse. But first.

Why are varicose veins dangerous?

How common is the disease of varicose veins, it is difficult 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 has been recorded in more than 30 million people. At the same time, according to some studies, no more than 18% are aware of their disease and no more than 8% receive treatment.

Varicose veins of the lower extremities are a disease in which the structure of the venous wall changes. The vessels become longer, convoluted, in areas of thinning of the walls, the lumen expands, forming knots.

Statistics
Varicose veins are a disease with a hereditary predisposition. The probability of its occurrence in those in the family from whom no one has suffered from venous pathology is not more than 20%. If one of the parents is sick, the risk increases: for men - up to 25%, for women - up to 62%. In the presence of the disease in both parents, the probability of varicose veins in the 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, elastin, as the name suggests, is responsible for elasticity - the ability of the venous wall to return to its original state. In patients with varicose veins, the amount of this protein in the venous wall is reduced. The collagen itself also changes: instead of the dominant type III collagen, which is responsible for elasticity, the content of type I - rigid collagen, retaining the residual deformation, increases. In addition, the number of smooth muscle cells that regulate the lumen of the vessel also changes, and the ability to interact with each other is impaired. These pathological changes are inherited in nature. Then the game comes inexternal factors:

• long-term static loads - the need to stand or sit still;
• Overweight;
• pregnancy and childbirth.

Some experts cite chronic constipation, tight clothing that increases intra-abdominal pressure, and high heels that interfere with normal leg muscle pump function as predisposing factors.

Individually or in combination, these factors increase the pressure in the venous system of the lower extremities. The altered venous wall stops "holding" the pressure, the lumen of the vein expands. Due to the expansion of the lumen of the vein, the valves, which ensure blood flow in one direction only, stop working. Arisesreflux- reverse output. The pressure inside the affected vein increases even more and the vicious circle is closed.

The increase in venous pressure, combined with changes in the structure of the wall over time, triggersinflammatory reaction- initially only on the surface of the valves and the inner wall of the vessels. Gradually, inflammatory proteins and blood cells begin to "seep" through the damaged vein wall into surrounding tissues. There they are destroyed, releasing active substances -inflammation mediators. . . They damage surrounding cells and attractlymphocyteswhose function is to remove damaged tissue. As a result, edema, induration (induration) of the skin of the legs, 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. Arisesthrombophlebitis- another dangerous complication of varicose veins.

Manifestations of varicose veins are divided into objective and subjective.Subjective symptoms- these are the patient's complaints about:

• heaviness in the legs;
• rapid fatigue;
• paresthesias - unpleasant "goosebumps" sensations, changes in sensitivity;
• burning sensation in the muscles;
• pain in the legs, the characteristic of which is that the intensity decreases after walking;
• swelling in the evening;
• restless leg syndrome - a condition in which discomfort in your legs prevents you from falling asleep;
• nocturnal cramps in the lower limbs.

The combination of these symptoms and their severity are individual and do not always correlate with 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 is no change in appearance, lesions of the veins can be detected only with special examination and tests;
• C1- "spiders" appear (scientific name - telangiectasias) or a network of dilated intradermal veins (reticular varices) becomes visible;
• C2- the diameter of the dilated saphenous veins exceeds 3 mm, varicose nodes appear;
• C3- the affected leg becomes constantly swollen;
• C4- changes appear in the surrounding tissues: the skin darkens (hyperpigmentation), eczema develops, induration of the subcutaneous tissue;
• C5- the stage of the healed ulcer;
• C6- the stage of an open ulcer.

From the fourth stage, the trophic skin changes described can no longer be completely eliminated. Even varicose veins healed at this stage will not lead to complete resorption of hyperpigmentation or induration. In addition, one must remember a rather dangerous complication -thromboembolism. . .

On a note
30-60% of deaths from sudden-onset deep vein thrombosis and additional thromboembolism occur against the background of varicose veins associated with undetected and not cured thrombophlebitis in time.

Therefore, you should not postpone 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 several criteria can be considered modern: minimal invasiveness (trauma), high efficiency, low probability of relapses and complications, and short period of rehabilitation.

• Conservative therapy.Includes use of compression stockings, ointments and venotonics (oral medications). Current clinical guidelines suggest that venotonics may reducesubjectivemanifestations (complaints) in the early stages of the disease and reduce edema, but in no case do not affect the condition of the venous wall itself. Different types of ointments have the same effect. Compression stockings are considered a very effective treatment for varicose veins, as they reduce the manifestations of venous insufficiency, alleviate the patient's subjective complaints, and prevent the progression of varicose veins. However, compression stockings are not able to cure varicose veins - dilated veins will not work properly.
• Traditional surgical removal.The affected large or small saphenous vein is tied where it empties 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 convalescence. There is a high probability of postoperative complications - hematomas, postoperative paresthesias and neuralgia.
• Sclerotherapy.A special medicine is injected inside the varicose vein, which "sticks" to its walls. The procedure is minimally traumatic and is recommended for the treatment of small diameter veins. However, it is rarely used to remove the inoperative trunk of the large and small saphenous veins, as it is characterized by a higher rate of recurrence. In addition, such an unpleasant complication as hyperpigmentation in the context of sclerosis is possible.
• Endovenous laser coagulation (EVLK)- type of minimally invasive, safe, modern and effective treatment for varicose veins. It has synonymous names: endovenous laser ablation, endovascular coagulation of the veins of the lower limbs, endovenous laser obliteration (EVLO). But whatever the name, the laser coagulation technique remains the same. A radial fiber optic light guide is inserted through the puncture into 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 generate two waves: one of them is absorbed by blood hemoglobin, the second - by the vascular wall. Vienna is "brewed". All the steps (position of the light guide, infiltration of the solution around the vein, even the "stirring" process) are monitored in real time by ultrasound devices. The duration of the EVLK procedure on a limb is 30-60 minutes.

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

The advantages of the laser removal method:

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

Since endovenous laser coagulation is currently considered one of the most advanced, least traumatic, and least invasive types of treatment for varicose veins, we will look at 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 has been possible to expand the range of indications of the EVLK thanks to the perfection of modern equipment - two-wave lasers, radial fibers.

Contraindications to the procedure

In most cases, they boil down to severe somatic conditions of the patient:

• deep vein thrombosis (obstruction, occlusion, blockage);
• decompensated type 1 diabetes mellitus;
• severe atherosclerosis of the arteries and ischemia of the lower extremities;
• severe cardiovascular diseases: ischemic heart disease, especially angina at rest, extensive myocardial infarction with decreased cardiac output, severe forms of cardiac arrhythmias, stroke;
• severe blood clotting disorders, both descending and ascending;
• pregnancy and breastfeeding;
• individual intolerance to the anesthetic used;
• inability to exercise immediately after the procedure;
• inability to use compression stockings.

It is characteristic that the patient's age is not a contraindication.

How is laser vein coagulation done?

Shortly before the manipulation, you should purchase compression stockings of the 2nd degree of compression (25-32 mm Hg). The doctor will tell you in detail what size is required. Laser endovasal coagulation itself does not require any special preparation.

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

1. Before the start of the operation, the vein is "marked": the doctor places marks on the skin, corresponding to the places where the blood flows back, the tributaries flow into the vein.
2. At the start of the manipulation, local anesthesia occurs, the vein is punctured (punctured). The sensations are no different from the usual intravenous injection. A radial light guide is inserted into the vein using a special catheter.
3. Next, a protective "sleeve" of the anesthetic drug is created around the vein. Under ultrasound control, using a special pump, the doctor injects local anesthetic into the space around the vessel. This not only relieves the pain, but also protects the surrounding tissue from the excessive heat of the laser.
4. The procedure itself is EVLO varicose veins. In modern optical fibers, laser radiation is delivered evenly around the entire circumference of 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. A compression garment is put on the patient.

Immediately after the end of the manipulation, the patient should go for a walk of at least 40 minutes.

Possible complications

They are few in number, they are temporary, and the probability of complications is mainly associated with the use of outdated medical equipment and the poor 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 drugs that reduce blood clotting. As a rule, they are used within 4 to 5 days after the procedure.
• Thrombophlebitis- most often associated with insufficient intensity of laser exposure.
• Pigmentation along the treated veinresolves in 1. 5 to 2 months.
• Feeling of a "stretched" vein- passes within 1. 5 months.

In order to avoid the development of complications as much as possible, you should adhere to a few simple rules, observance of which is necessary for successful rehabilitation.

Rehabilitation

On the first day, there may be a aching, pulling pain along the vein. To eliminate them, conventional pain relievers are sufficient. The temperature may rise for the first few days. It is enough to take traditional means to reduce it.

In general, for successful rehabilitation, 2 main conditions must be observed - wearing compression underwear and maintaining sufficient physical activity.

• Compression underwear -during the first 5 days, it is not removed even during a night's sleep. This is necessary so that the vein is completely "stuck" and healed. In addition, compression stockings are only worn during the day. It is sufficient to wear compression clothes for 2, 5 to 3 months, but if there are risk factors (sedentary lifestyle, standing work, taking female sex hormones), additional preventive wearing of compression stockings is desirable.
• Physical activity- It is recommended to walk at least one hour a day. But you will have to give up intensive sports for about a month.

During the month, avoid hot tubs, baths, and saunas.

Evaluation of the effectiveness of the method

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

• anatomical features of the operated vein;
• violations of the technical performance of the EVLK (insufficient laser power, insufficient compression of the vein with an anesthetic solution);
• non-compliance by the patient with the rules of the postoperative regimen (usually - refusal of compression).

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

How much does EVLK cost?

The laser endovascular coagulation procedure requires high-tech equipment and expensive disposable consumables (light guides), hence the cost. The total amount will depend on the volume and complexity of the procedure, the medical equipment used and the qualifications of the doctor.

Thus, endovenous laser coagulation is a modern and effective method of treating varicose veins. It gives excellent clinical results and, in fact, leaves no residue. The minimal trauma from exposure allows you to resume a normal life (with minor restrictions) from the day of surgery, without the need for a hospital regimen or special conditions for recovery.

How to choose a clinic

Said a vascular surgeon, phlebologist:

"The result of laser coagulation of the veins of the lower limbs 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 the doctors must be qualified. Therefore, I would recommend choosing a clinic that specializes in this particular type of service, which has been around for several years and has a proven reputation. "