Varicose veins of the lower limbs are rightly considered the most common pathology of peripheral vessels, it is one of the ten main diseases of so-called civilization. According to epidemiological studies, venous insufficiency occurs in 80% of people of working age. In most cases, varicose veins in the legs do not cause serious pain, and sometimes they go unnoticed and do not require treatment. Nevertheless, there are situations when it is worth, without delay, to consult a specialist, to undergo appropriate therapy. What are the treatments for varicose veins of the lower limbs? What are their advantages and disadvantages?
Ways to get rid of the disease
Thousands of people each year ask themselves the question: how to get rid of "ugly knots" or "vascular mesh" on their legs? 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 "totally safe" ways to get rid of this disease. Sometimes it is difficult to understand this advertisement, to answer the question of which treatment option is the most appropriate. If a person who has decided to take care of their dilated vessels and is unsure of the safety or effectiveness of a particular method of treatment, the best option for them is to turn toat several clinics, to obtain qualified advice from at least two professionals.
There are different reasons that require a patient with varicose veins to see a doctor:
- cosmetic considerations;
- symptoms of discomfort;
- complications of the disease (for example, ulcers, bleeding, or thrombophlebitis);
- fear for your health (how the disease will behave in the future if it is not treated).
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 correctly convey the main reason for contacting him. Very often, patients just need to be reassured that their dilated veins will not hurt them and that they are unlikely to do so in the future.
If there is a need for therapy, the doctor often recommends self-treatment at home within 6 months, which includes:
- the use of compression stockings;
- exercise regularly;
- avoid "long downtimes" - exclude a long stay in a sitting or standing position;
- at rest (in a horizontal position), elevate the "compromised" limb above heart level.
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 combat 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 preferences of the patient. It is also influenced by the financial capacity of the patient, the qualifications of the doctors and the equipment of the medical institution. Nevertheless, which method of treating varicose veins of the lower extremities that will be used in each specific case depends largely on the disease itself: what symptoms are present, the degree of venous insufficiency and other features of vascular damage.
Conservative therapy methods
Conservative treatment, as a rule, is complex and consists of several components.
A change in lifestyle, which involves a set of measures aimed at preventing stagnation of blood in the veins. As you know, prolonged standing or sitting levels the activity of the venomuscular pump (gastrocnemius muscle), which contributes to stagnation. Therefore, patients are recommended to walk regularly, periodically raising their legs above heart level in a supine position. You should also pay attention to various diets - salt-free, low-calorie. They will allow you to adjust body weight, to compensate for seasonal vitamin deficiencies. It is necessary to consume foods rich in bioflavonoids (substances that help strengthen the wall of the vessels).
People with varicose veins should avoid overheating their feet, refrain from frequenting baths and saunas and, if possible, refrain from using heated floors.
Compression stockings improve venous hemodynamics, which leads to the disappearance of many manifestations of the disease. Disadvantages of this method:
- time-limited use (there is no possibility to wear compression stockings and socks all the time);
- the appearance of discomfort with constant compression, this is especially often observed in the summer, when the symptoms of varicose veins are most "manifested".
Usually, the pharmacy offers compression stockings from only one manufacturer. However, there are many different brands, each of which can meet the needs of the patient to varying degrees.
Drug therapy can eliminate the symptoms of the disease or reduce their manifestation, aims to prevent and combat its complications, and can improve the effectiveness of compression therapy. Pharmacology helps to cope with 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 pharmacotherapeutic agents. These include:
- Horse chestnut extract and thiamine (vitamin B1) are among the medicines used to treat pain and heaviness in the legs, edema seen in chronic venous insufficiency. The funds have shown their effectiveness in clinical trials. There are galenic forms: oral solution (10-15 drops 3 times a day) and tablet form (generally taken after meals 1 tablet 3 times a day).
- Butcher's broom (butcher's broom) is used as a food additive. Helps relieve congestion in the veins. It is believed to be effective against spider veins. However, no clinical data confirming its safety and efficacy has been obtained.
- Deproteinized hemodeplate from the blood of young calves is one of the popular drugs, which are excellent phleboprotectors, 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 symptom improvement, the duration of remission achieved. Therefore, the doctor may vary the intake of the drug 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 achieved through two mechanisms: distracting and truly therapeutic. At first, the evaporation of the alcohol base or essential oils contained in the gel occurs, which respectively leads to a decrease in the temperature of the skin 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.
Ointments and gels used for varicose veins on the legs are classified according to the main active ingredient they contain. They include such medicinal substances:
- Phleboprotectors (usually rutin, as well as plant substances that strengthen the wall of the vessels).
- Nonsteroidal anti-inflammatory drugs are generally used for pain relief.
- Topical corticosteroids are used for allergic dermatitis, which can occur as a complication of venous insufficiency.
- Histamine H1 receptor blockers are prescribed instead of corticosteroids when the latter are contraindicated.
- Proteolytic enzymes are able to effectively cleanse a trophic ulcer (complications of extensive varicose veins of the legs).
- Ionized silver is an effective antiseptic, it cleans and dries the wound perfectly, so it is an essential remedy for the treatment of an infected trophic ulcer.
- Antibiotics are used locally for infection of complications of varicose veins (thrombophlebitis, dermatitis).
- Rehydrating and dermatoprotective preparations 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 its antithrombotic activity (prevents the formation of blood clots), has an anti-inflammatory effect, is able to relieve pain.
The main goal of surgical treatment is to eliminate the pathological mechanism that led to the onset of the disease - the venous reflex, as well as to eliminate its main manifestation - varicose veins. Surgical treatment is indicated: in patients with aching pain and constant fatigue in the legs, in the presence of edema, chronic venous insufficiency, cosmetic problems, early hyperpigmentation (excessive pigment deposition in the skin), dExternal bleeding, as well as when superficial thrombophlebitis progresses, in the presence of trophic ulcers which cannot be treated by conservative methods.
Currently, the most popular are three types of operations:
- saphenofemoral ligation (ligation and removal of the upper part of the great saphenous vein);
- Striping of the great saphenous vein:
- traditional or Bebkokk operation, in which a special probe is inserted into the lumen of the great saphenous vein (two incisions are made beforehand: one in the groin area, the second in the upper third of the leg) and s'stretches along its entire length, after which it is removed together with the varicose vein;
- cryostriping, an operation almost similar to the previous one, but which differs in that the probe is cooled to -85 ° C, which causes the vein to adhere to the probe, allowing it to be removed in a less traumatic manner;
- Phlebectomy is a procedure to remove varicose veins through several small 2-3mm incisions in the skin.
The above surgical procedures help to improve the patient's quality of life; their therapeutic and economic efficacy has been proven in clinical trials. They are usually done under general anesthesia, but most patients are discharged the day of the surgery. Full recovery, it usually takes 2-3 weeks to return to normal daily activity. Complications are possible, more common in patients with advanced varicose veins. During the operation, the 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.
The main goal of using new treatment methods is to minimize tissue trauma seen during surgical procedures, 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 in the legs by "sealing" the large saphenous vein (or the small one) at high temperature, which causes the dilated vessels to regress (their walls stick together). While these options do not involve surgery, it is quite common to have additional phlebectomy and sclerotherapy. Both methods involve:
- Insertion of a catheter into the great saphenous vein through a small incision in the upper third of the leg and advance to the saphenofemoral junction under ultrasound guidance. No incision is made in the groin area.
- Performed under local anesthesia (the anesthetic seeps widely into the subcutaneous tissue of the thigh). Additional general anesthesia may be necessary if a large number of miniflebectomies are to be performed at the same time.
- The need to use bandages or stockings 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, doubtful when the vessels are tortuous.
The use of intravenous ablation, which has been widely used over the past 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 probability of wound infection and the appearance of hematomas.
Nevertheless, complications are typical of this intervention: skin burns, transient paresthesias, deep vein thrombosis (occurring in less than 1% of patients).
This method of treatment, due to its ease of implementation and low trauma, is currently used by many clinics. Its essence lies in the fact that the sclerosant is injected into the varicose vein, a substance that sticks to its walls, the blood flow moves through healthy vessels. Sclerotherapy is often combined with conventional operations and, in the case of telangiectasias and spider veins, it is used as the only method of therapy.
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Sclerotherapy gives completely acceptable results which satisfy many patients.
Unlike simple sclerotherapy, with foam, the sclerosant is injected into a vein after mixing it with a gas (usually air). As a result, foam is obtained, which, spreading through the vein, displaces the blood from it and causes the vessel to spasm. Usually, manipulation is performed under the guidance of a duplex ultrasound.
In addition to simple foam sclerotherapy, it is mandatory to wear compression stockings after handling for 14 days.
Recovery after the operation is faster than if a conventional operation were performed. However, the medium-term treatment results (likelihood of reflux recurrence) of foam sclerotherapy are somewhat poorer than those of surgery.
Treatment of "microvarices": telangiectasias, spider veins
Treatment for spider veins is almost always done purely for cosmetic reasons, although sometimes they can cause a throbbing sensation of heat, indicating the presence of reflux. Usually two types of therapy are used:
- Microsclerotherapy - introduction of a sclerosing substance using a fine needle. Usually, several spider veins are sclerotic at the same time. A bandage or a compression stocking is applied for 1 to 2 days. If the sclerosis comes out of the vessel during the injection, an ulceration may develop in this area, which heals slowly, after which a scar remains. This rarely happens, provided "if the doctor's hands do not shake during the operation". Hyperpigmentation at the injection site (darkening of the skin) is also possible.
- Laser ablation. The method works well for treating telangiectasias (intradermal vascular growth that looks like a birthmark).
There are many effective ways to get rid of varicose veins in the lower extremities offered by traditional medicine. The choice of treatment option depends largely on the decision of the patient himself. Do not immediately "go under the knife", in the arsenal of doctors there are effective options for conservative treatment. According to doctors, today it is impossible to completely cure this disease, but it is quite within the reach of modern medicine to save the patient as much as possible from the manifestations of the disease and prevent its progression.