Varicose veins of the lower extremities are legitimately considered the most common pathology of the peripheral vessels, it is one of the ten main diseases of 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 suffering, and sometimes it goes unnoticed at all, it does not require any treatment. However, there are situations in which it is worthwhile, without delay, to consult a specialist, to undergo adequate therapy. What are the treatments for varicose veins of the lower extremities? What are your advantages and disadvantages?
Ways to get rid of the disease
Thousands of people every year ask the question: how do you get rid of the "ugly knots" or "vascular meshes" in your legs? Media portals are full of advertisements for public and private clinics that treat lower extremity varicose veins. They offer "unique", "guaranteed", "painless" or "completely safe" ways to get rid of this ailment. Sometimes it is difficult to understand this announcement, to answer the question of which treatment option is the most appropriate. If a person who has decided to take care of his dilated vessels and is not sure of the safety or efficacy of this or that method of treatment, the best option for him is to contact several clinics, to obtain the qualified advice of at least two professionals. .
There are several reasons that compel a patient with varicose veins to consult a doctor:
- cosmetic considerations;
- symptoms of malaise;
- 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 a mutual understanding with the doctor, to correctly convey the main reason for contacting him. Very often, patients simply need reassurance that their enlarged veins will not harm them in any way and 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, including:
- the use of compression stockings;
- exercise regularly;
- avoid "prolonged downtime" - exclude a long stay in a sitting or standing position;
- While resting (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 a 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 (compression and pharmacological therapy, lifestyle modification), surgical interventions, external and internal laser exposure, radiofrequency ablation, injectable sclerotherapy are used. The choice of this or that option depends on the patient's preferences. It is also influenced by the financial capabilities of the patient, the qualifications of the doctors and the team of the medical institution. However, which method of treatment of 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.
Conservative therapy methods
Conservative treatment, as a rule, is complex and includes several components.
A lifestyle change, which involves a set of measures that aim to prevent stagnation of blood in the veins. As you know, prolonged standing or sitting position levels the activity of the venous muscle 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 a prone position. You should also pay attention to various diets: no salt, low in calories. They will allow you to adjust body weight and 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 visiting baths and saunas, and, if possible, not use 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 (no possibility of wearing compression stockings and socks all the time);
- the appearance of discomfort with constant compression, this is observed especially often in the summer, when the symptoms of varicose veins are more "manifested".
The pharmacy, as a rule, 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 treatment can eliminate the symptoms of the disease or reduce its manifestation, aims to prevent and combat its complications, and can improve 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 and strengthen the venous wall. They are considered basic pharmacotherapeutic agents. These include:
- Horse chestnut extract and thiamine (vitamin B1) are among the medications used to treat pain and heaviness in the legs, edema seen in chronic venous insufficiency. The funds have been proven effective 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'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 have been performed to confirm its safety and efficacy.
- Deproteinized blood product from the blood of young calves is part 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 the achieved remission. Therefore, the doctor can vary the intake of the drug from 3 to 6 months or more.
Ointments and gels (topical medications) are also widely used. The doctor chooses the treatment regimen for varicose veins of the lower extremities based on the condition and the course of the disease. The therapeutic effect of these topical drugs is achieved through two mechanisms: distraction and really therapeutic. At first, the evaporation of the alcoholic base or the essential oils contained in the gel occurs, which leads to a decrease in the temperature of the skin, respectively, and improves the symptoms of the disease. As a result of the second, the medicinal substance that penetrates through the skin directly into the vein begins to exert its therapeutic effect.
Ointments and gels used for varicose veins of the legs are classified according to the main active ingredient they contain. They include such medicinal substances:
- Phleboprotectors (generally routine, 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 can effectively clean a trophic ulcer (complications of powerful varicose veins in the legs).
- Ionized silver is an effective antiseptic, perfectly cleanses and dries the wound, making it an indispensable remedy for the treatment of an infected trophic ulcer.
- Antibiotics are used topically for infection of varicose vein complications (thrombophlebitis, dermatitis).
- Rehydrating preparations and dermatoprotectors protect the skin from external influences, improve its elasticity. They are usually prescribed for atrophic skin changes (when compression stockings are worn for a long time).
- Heparin, in addition to its antithrombotic activity (prevents the formation of blood clots), has an anti-inflammatory effect, it is able to relieve pain.
Surgery
The main goal of surgical treatment is to eliminate the pathological mechanism that led to the appearance of the disease, the venous reflex, as well as to eliminate its main manifestation, varicose veins. Surgical treatment is indicated: for patients with aching pain and constant fatigue in the legs, in the presence of edema, chronic venous insufficiency, cosmetic problems, early hyperpigmentation (excessive deposit of pigment in the skin), external bleeding, as well as when superficial thrombophlebitis . progresses, in the presence of trophic ulcers that cannot be treated conservatively.
At the moment, the most popular are three types of operations:
- saphenous-femoral ligation (ligation and removal of the upper section of the great saphenous vein);
- fringes 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 preliminarily: one in the groin area, the second at the level of the upper third of the leg) and extends along its entire length, after which it is removed along with the varicose vein;
- the cryostrip, an operation almost similar to the previous one, but which differs in that the probe is cooled to -85 ° C, so the vein adheres to the probe, allowing it to be removed in a less traumatic way;
- Phlebectomy is a procedure to remove varicose veins through several small 2-3mm incisions in the skin.
Previous surgical interventions help to improve the quality of life of the patient, their therapeutic and economic efficacy has been proven in clinical trials. They are usually performed under general anesthesia, but most patients are discharged the day of surgery. Full recovery, return to normal daily activity generally takes 2 to 3 weeks. Complications are possible and are 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.
New treatments
The main goal of using new treatment methods is to minimize tissue trauma seen during surgical interventions, allowing 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 (or small) saphenous vein with high temperature, which leads to regression of the dilated vessels (their walls stick together). Although these options do not involve surgical procedures, it is quite common to resort to additional phlebectomy and sclerotherapy. Both methods involve:
- Insert a catheter into the great saphenous vein through a small incision in the upper third of the leg and advance to the saphenous-femoral junction under ultrasound guidance. No incision is made in the groin area.
- Execution under local anesthesia (the anesthetic infiltrates extensively into the subcutaneous tissue of the thigh). Additional general anesthesia may be required if a large number of minibectomies are to be performed at the same time.
- The need to wear bandages or stockings after the procedure for two weeks.
- The dependence of its 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 for the last ten years, has not shown significant differences in its effectiveness compared to surgery.
The main advantage of this technique is the quick recovery after the procedure, which is associated with a lower probability of wound infection and bruising.
However, complications are typical of this procedure: skin burns, temporary paresthesias, deep vein thrombosis (occurs in less than 1% of patients).
Simple sclerotherapy
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 sclerosant is injected into the varicose vein, a substance that sticks its walls, the blood flow moves to healthy vessels. Sclerotherapy is often combined with classical operations and, in the case of telangiectasia and spider veins, it is used as the only method of therapy.
Contraindications:
- the pregnancy,
- lactation period,
- dermatitis,
- thrombophlebitis.
Sclerotherapy gives quite acceptable results that satisfy many patients.
Foam sclerotherapy
Unlike simple, foam sclerotherapy, the sclerosant is injected into a vein after mixing it with a gas (usually air). As a result, a foam is obtained which, spreading through the vein, displaces the blood and causes a spasm of the vessel. Manipulation is usually carried out under the guidance of a duplex ultrasound.
In addition to simple foam sclerotherapy, compression stockings are required after manipulation for 14 days.
Recovery after the procedure is faster than if a classic operation were performed. However, the medium-term treatment results (the likelihood of reflux recurrence) of foam sclerotherapy are somewhat worse than those of surgery.
Treatment of "microvaricosa": telangiectasia, spider veins
Treatment for spider veins is almost always done for cosmetic reasons only, although they can sometimes cause a sensation of heat and throbbing, indicating the presence of reflux. Generally, two types of therapy are used:
- Microsclerotherapy: the introduction of a sclerosing substance with a fine needle. Usually, several spider veins are sclerosed at the same time. A compression bandage or stocking is applied for 1 to 2 days. If the sclerosis comes out of the vessel during injection, ulcerations may develop in this area, slowly heal, after which a scar remains. This rarely happens, as long as "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 to treat telangiectasias (intradermal vascular growth that looks like a birthmark).
There are many effective ways to get rid of varicose veins of the lower extremities that traditional medicine offers. The choice of treatment option is highly dependent on the patient's own decision. Do not "go under the knife" immediately, in the arsenal of doctors there are effective options for conservative therapy. According to doctors, today it is impossible to completely cure this ailment, but it is within the power of modern medicine to save the patient from the manifestations of the disease as much as possible and prevent its further progression.