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

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

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

Why are varicose veins dangerous?

How common is varicose vein disease, 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 of the United States and Europe suffers from it. In our country, the pathology has been 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 is a disease in which the structure of the vein wall changes. The vessels become longer, contoured, in the areas of thinning of the walls, the lumen expands and forms nodules.

Statistics
Varicose veins is a disease with a hereditary predisposition. The probability of it occurring in those in whose family no one has suffered from venous pathology is no 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 the disease in both parents, the probability of varicose veins in the offspring is 90%.

With varicose veins, the proportion of the two main structural proteins of the vein walls is altered:collagenYelastin. . . If collagen forms stiffness, then elastin, as the 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. The collagen itself also changes: instead of the predominant type III collagen, which is responsible for elasticity, the content of rigid type I collagen increases, which retains the residual deformation. 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 into playexternal factors:

• long-term static loads - the need to stand or sit without moving;
• over weight;
• pregnancy and childbirth.

Some experts point to chronic constipation, tight clothing that increases intra-abdominal pressure, and high heels that interfere with the normal functioning of the muscle pump in the legs as predisposing factors.

Individually or in combination, these factors increase the pressure within the venous system of the lower extremities. The altered venous wall stops "holding" pressure, the lumen of the vein expands. As a result of the expansion of the vein lumen, the valves, which provide blood flow in only one direction, stop working. ArisesReflux- reverse outlet flow. The pressure within the affected vein increases even more and the vicious cycle closes.

Increased venous pressure, combined with changes in wall structure over time, triggersinflammatory answer- at first only on the surface of the valves and the inner wall of the vessels. Gradually, inflammatory proteins and blood cells begin to "leak" through the damaged venous wall into the surrounding tissue. There they are destroyed, releasing active substances. inflammatory 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 lead to 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.

The 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 "goose bumps" sensations, changes in sensitivity;
• burning sensation in the muscles;
• pain in the legs, the characteristic feature of which is that the intensity decreases after a walk;
• swelling at night;
• restless leg syndrome - a condition in which discomfort in your legs prevents you from falling asleep;
• night cramps in the lower extremities.

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 are no changes 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 intradermal dilated veins becomes visible (reticular varicose veins);
• C2- the diameter of the dilated saphenous veins exceeds 3 mm, varicose nodes appear;
• C3- the affected leg constantly swells;
• 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. Also, it is necessary to remember a rather dangerous complication:thromboembolism. . .

On a note
From 30% to 60% of deaths due to sudden onset deep vein thrombosis and additional thromboembolism occur in the context of varicose veins in combination 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 a short rehabilitation period.

• Conservative therapy.Includes the use of compression stockings, ointments, and venotonics (oral medications). Current clinical guidelines suggest that venotonics can reducesubjectivemanifestations (complaints) in the early stages of the disease and reduce edema, but in no way affect the state 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 it reduces the manifestations of venous insufficiency, alleviates subjective complaints from the patient, and prevents the progression of varicose veins. However, compression stockings cannot cure varicose veins; enlarged veins do not work properly.
• Traditional surgical removal.The affected large or small saphenous vein is tied off 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: bruising, postoperative paresthesia and neuralgia.
• Sclerotherapy.A special medicine is injected into the varicose vein, which "sticks" its walls. The procedure is not very traumatic and is recommended for the treatment of small diameter veins. However, it is rarely used to remove the inoperative trunk of the greater and lesser saphenous vein, as it is characterized by a higher recurrence rate. In addition, such an unpleasant complication as hyperpigmentation is possible in the setting of sclerosis.
• Endovenous Laser Coagulation (EVLK)- Minimally invasive, safe, modern and effective type of treatment for varicose veins. It has synonymous names: endovenous laser ablation, endovascular coagulation of the veins of the lower extremities, endovenous laser obliteration (EVLO). But whatever the name, the laser coagulation technique remains the same. A radial fiberoptic 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 "brewing". All stages (position of the light guide, infiltration of the solution around the vein, the process of "making" itself) are monitored in real time by ultrasound devices. The duration of the EVLK procedure on one limb is 30 to 60 minutes.

It is important to know!
The only effective method to treat varicose veins is to remove the altered vein that cannot perform its functions.

The advantages of the 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 the operation;
• quick recovery;
• good cosmetic result: there are no marks or scars;
• high efficiency, low relapse rate.

Since endovenous laser coagulation is currently considered one of the most advanced, minimally traumatic, and minimally invasive types of treatment for 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 the options for its anatomical structure. It was possible to expand the range of EVLK indications due to the perfection of modern equipment: two-wave lasers, radial fibers.

Contraindications of 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;
• serious cardiovascular diseases: ischemic heart disease, in particular angina at rest, extensive myocardial infarction with decreased cardiac output, severe forms of cardiac arrhythmias, cerebrovascular accidents;
• severe blood clotting disorders, both descending and ascending;
• pregnancy and lactation;
• individual intolerance to the anesthetic used;
• impossibility of physical activity immediately after the procedure;
• inability to wear compression stockings.

Characteristically, the patient's age is not a contraindication.

How is laser coagulation of veins performed?

Shortly before the manipulation, you should buy compression stockings of the second degree of compression (25 to 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 endovenous laser obliteration are carried out under constant ultrasound control.

1. Before the start of the procedure, the vein is "marked": the doctor places marks on the skin, corresponding to the places where the blood flows backward, the tributaries flow into the vein.
2. At the beginning of the manipulation, local anesthesia is produced, the vein is perforated (perforated). The sensations are not different from the usual intravenous injection. A radial light guide is inserted into the vein using a special catheter.
3. A protective "sleeve" of the anesthetic drug is then 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 not only to relieve pain, but also to protect the surrounding tissue from excess heat from 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, providing 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 placed on the patient.

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

Possible complications

They are few, they are temporary, and the likelihood of complications is mainly associated with the use of outdated medical equipment and the low qualifications of a doctor.

• Deep vein thrombosis -it 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 general rule, they are used within 4-5 days after the intervention.
• Thrombophlebitis- most often associated with insufficient intensity of laser exposure.
• Pigmentation throughout the treated vein.resolves in 1. 5 to 2 months.
• Feeling of a "stretched" vein- passes within 1, 5 months.

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

Rehabilitation

On the first day, there may be pain and drawing pains along the vein. To eliminate them, conventional painkillers are enough. The temperature can rise in the first days. Just take traditional means to reduce it.

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

• Compression underwear -During the first 5 days, it is not eliminated even during a night's sleep. This is necessary so that the vein is completely "glued" and healed. Also, compression stockings are worn only during the day. It is enough to wear compression garments for 2, 5 to 3 months, but if there are risk factors (sedentary lifestyle, foot work, intake of female sex hormones), a greater preventive use 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, you should avoid hot baths, 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 characteristics of the operated vein;
• violations 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 regimen (usually - refusal of compression).

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

How much does EVLK cost?

The endovasal laser coagulation procedure requires high-tech equipment and expensive disposable consumables (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.

Therefore, endovenous laser coagulation is a modern and effective method of treating varicose veins. It gives excellent clinical results and, in fact, it does not leave a residue. The minimal trauma of the exposure 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 largely 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 I would therefore recommend choosing a clinic that specializes in this particular type of service, which has been operating for several years and has a proven reputation over time. "