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

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

Of course, in the majority of cases we are dealing with varicose veins of moderate severity, which are now treated effectively and practically without recurrence. But first.

Why are varicose veins dangerous?

How common is varicose vein disease 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 this. In our country the pathology is 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 are a disease in which the structure of the venous wall changes. The vessels become longer, constricted, in the areas of thinning of the walls, the lumen expands, forming nodules.

Statistics
Varicose veins are a disease with a hereditary predisposition. The probability of its occurrence in those in whose family no one has suffered from venous pathology is not 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%.

In varicose veins, the ratio of the two main structural proteins of the venous walls is disturbed:collagenandelastin. . . If collagen forms stiffness, then elastin, as its 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. Collagen itself also changes: instead of the predominant type III collagen, which is responsible for elasticity, the content of type I collagen increases - hard, retaining residual deformation. In addition, the number of smooth muscle cells that regulate the vessel lumen also changes and the ability to interact between them is impaired. These pathological changes are hereditary. Then the game comes into playexternal factors:

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

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

Individually or in combination, these factors increase the pressure in the venous system of the lower extremities. The altered venous wall ceases to "hold" pressure, the lumen of the vein expands. As a result of the expansion of the lumen of the vein, the valves, which provide blood flow in only one direction, stop working. Occursreflux- backflow. The pressure inside the affected vein increases even more and the vicious circle closes.

Increased venous pressure, combined with changes in the structure of the wall over time, triggersinflammatory response- initially only on the surface of the valves and the inner wall of the vessels. Gradually, inflammatory proteins and blood cells begin to "penetrate" through the damaged venous wall into the surrounding tissue. There they are destroyed, releasing active substances -inflammatory mediators. . . They damage the surrounding cells and are attractedlymphocyteswhose function is to remove damaged tissue. As a result, swelling, thickening (thickening) of the skin of the feet 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 veins. Occursthrombophlebitis- 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 sensations of "goosebumps", 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 in the evening;
• restless legs syndrome - a condition in which discomfort in the legs prevents you from falling asleep;
• nocturnal spasms 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 is the basis of the modern classification of varicose veins and chronic venous insufficiency:

• C0- there are complaints, but no changes in appearance, venous lesions can be detected only with special examination and tests;
• C1- "spiders" appear (scientific name - telangiectasias) or a network of intradermal varicose veins (reticular varicose veins) becomes visible;
• C2- the diameter of the varicose veins exceeds 3 mm, varicose veins appear;
• C3- the affected leg is constantly swollen;
• C4- changes in the surrounding tissues appear: the skin darkens (hyperpigmentation), eczema develops, thickening of the subcutaneous tissue;
• C5- stage of the healed ulcer;
• C6- stage of open ulcer.

Starting from the fourth stage, the described trophic skin changes can no longer be completely eliminated. Even healed varicose veins at this stage will not lead to complete resorption of hyperpigmentation or induration. In addition, it is necessary to remember about a very dangerous complication -thromboembolism. . .

On a note
30 to 60% of deaths due to sudden deep vein thrombosis and further thromboembolism occur against the background of varicose veins in combination with thrombophlebitis, which is not detected and is not cured in time.

Therefore, you should not delay the treatment of varicose veins for 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 recurrence and complications and a short rehabilitation period.

• Conservative therapy.Includes the use of compression stockings, ointments and venotonics (oral medications). Current clinical guidelines indicate that venotonics may decreasesubjectivemanifestations (complaints) in the early stages of the disease and reduce edema, but in no way affect the condition of the venous wall itself. Different types of ointments have the same effect. Compression stockings are considered to be 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 - varicose veins will not work properly.
• Traditional surgical removal.The affected large or small subcutaneous vein is tied at the point where it flows into the deep venous system, and then 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 - hematomas, postoperative paresthesias and neuralgia.
• Sclerotherapy.A special drug is injected inside the varicose vein, which "sticks" to its walls. The procedure is low-traumatic and is recommended for the treatment of small diameter veins. However, it is rarely used to remove a malfunctioning trunk of the great and small subcutaneous vein, as it is characterized by a higher recurrence rate. In addition, such an unpleasant complication as hyperpigmentation within sclerosis is possible.
• Endovenous laser coagulation (EVLK)- minimally invasive, safe, modern and effective type of treatment for varicose veins. There are synonymous names: endovenous laser ablation, endovasal coagulation of the veins of the lower extremities, endovenous laser deletion (EVLO). But regardless of the name, the technique of laser coagulation remains the same. A radial optical fiber is inserted through a puncture into a vein. Then, with the help of a special pump around the vein, an anesthetic solution is pumped, which not only anesthetizes the procedure, but also compresses the vein, reducing its diameter and thus protects the surrounding tissues from overheating. Modern vascular lasers are used for the procedure, which generate two waves: one of them is absorbed by hemoglobin in the blood, the second - by the vascular wall. Vienna is "boiling". All stages (position of the light guide, infiltration of the solution around the vein, the process of "boiling") are observed in real time by ultrasound devices. The duration of the EVLK procedure on one limb is 30-60 minutes.

It is important to know!
The only effective method of treating varicose veins is to remove the altered vein, which is unable to 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;
• fast recovery;
• good cosmetic result: no traces and scars remain;
• high efficiency, low recurrence rate.

Because endovenous laser coagulation is currently considered one of the most advanced, low-trauma, and minimally invasive treatments 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 the possibilities for its anatomical structure. It is possible to expand the range of EVLK readings due to the perfection of modern equipment - two-wave lasers, radial fibers.

Contraindications to the procedure

In most cases, they are reduced to severe somatic conditions of the patient:

• deep vein thrombosis (obstruction, obstruction, obstruction);
• decompensated type 1 diabetes mellitus;
• severe atherosclerosis of the arteries and ischemia of the lower extremities;
• severe cardiovascular diseases: ischemic heart disease, in particular angina pectoris at rest, extensive myocardial infarction with decreased cardiac output, severe forms of cardiac arrhythmias, strokes;
• severe coagulation disorders, both down and up;
• pregnancy and lactation;
• individual intolerance to the anesthetic used;
• inability to engage in physical activity immediately after the procedure;
• impossibility to use compression knitwear.

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

How is laser coagulation of veins performed?

Shortly before the procedure, you should buy compression socks of the 2nd degree of compression (25-32 mm Hg). The doctor will tell you in detail what size is needed. Endovasal laser coagulation does not require special training.

All stages of endovenous laser removal are performed under constant ultrasonic control.

1. Before the procedure, the vein is "marked": the doctor puts scars on the skin, corresponding to the places where the blood flows back, the tributaries flow into the vein.
2. At the beginning of the manipulation, local anesthesia occurs, the vein is punctured (punctured). The sensations do not differ from the usual intravenous injection. A radial light guide is inserted into the vein using a special catheter.
3. A protective "sleeve" of the narcotic 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 laser heat.
4. The procedure itself is EVLO varicose veins. In modern optical fibers, the laser radiation is applied evenly around the entire circumference of the device, ensuring even heating of the vein from the inside. After removal of 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 should take a walk lasting at least 40 minutes.

Possible complications

They are few, they are temporary and the likelihood of complications is mainly related to the use of outdated medical equipment and low qualification of the doctor.

• Deep venous thrombosis -may occur in patients with a tendency to increased thrombosis. Therefore, to prevent this complication, patients are prescribed drugs that reduce blood clotting. As a rule, they are used within 4-5 days after the intervention.
• Thrombophlebitis- most often associated with insufficient intensity of laser exposure.
• Pigmentation in the treated veindisappears within 1, 5–2 months.
• Feeling of a "stretched" vein- passes within 1, 5 months.

To prevent the maximum development of complications, you need to adhere to a few simple rules, compliance with which is necessary for successful rehabilitation.

Rehabilitation

On the first day there may be pain and pulling pain in the vein. Conventional painkillers are enough to remove them. The temperature may rise during the first few days. It is enough to take traditional means to reduce it.

In general, for successful rehabilitation, two 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 "glued" and healed. In addition, compression knitwear is worn only during the day. It is enough to wear compression garments for 2, 5–3 months, but if there are risk factors (sedentary, standing work, intake of female sex hormones), further preventive wearing of compression knitwear is desirable.
• Physical activity- It is recommended to walk at least one hour a day. But you will have to give up intense sports for about a month.

During the month you should avoid hot baths, baths and saunas.

Evaluation of the effectiveness of the method

The analysis of foreign and local publications shows that the efficiency of laser coagulation of varicose veins varies from 93 to 100%. Failures can be due to several groups of factors:

• anatomical features of the operated vein;
• violations of the technical characteristics of EVLK (insufficient laser power, insufficient compression of the vein with anesthetic solution);
• non-observance by the patient of the rules of the postoperative regime (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, the treatment of varicose veins with laser is much better tolerated, the rehabilitation time is shorter, and the number of complications is smaller than in classical surgeries.

How much is EVLK?

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 qualification of the doctor.

Thus, endovenous laser coagulation is a modern effective method for the treatment of varicose veins. It gives excellent clinical results and in fact leaves no traces. The minimal trauma from exposure allows you to return to normal life (with small restrictions) on the day of surgery, without requiring a hospital regime and no special conditions for recovery.

How to choose a clinic

Says vascular surgeon, phlebologist:

"The result of laser coagulation of the veins of the lower extremities largely depends on the professionalism of the medical staff, as well as on 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 operating for several years and has a reputation that has stood the test of time. "