Varicose veins of the lower extremities are rightly considered the most common pathology of peripheral vessels, it is one of the first ten so-called diseases of civilization. According to epidemiological studies, venous insufficiency occurs in 80% of people of working age. In most cases, varicose veins of the legs do not cause serious suffering, and sometimes go unnoticed at all, do not require any treatment. However, 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 extremities? What are their advantages and disadvantages?
Ways to get rid of the disease
Thousands of people ask themselves every year: how to get rid of the "ugly knots" or "vascular network" on your feet? Media portals are full of ads for public and private clinics that treat varicose veins of the lower extremities. They offer "unique", "guaranteed", "painless" or "completely safe" ways to get rid of this disease. Sometimes it is difficult to understand this advertising, to answer the question of which treatment option is most appropriate. If a person who has decided to deal with his dilated vessels and is not sure about the safety or effectiveness of this or that method of treatment, the best option for him is to contact several clinics to get qualified advice from at leasttwo specialists.
There are various reasons for a patient with varicose veins to consult a doctor:
- cosmetic considerations;
- symptoms of discomfort;
- complications of the disease (eg ulcers, bleeding or thrombophlebitis);
- fear for your health (how the disease will behave in the future if left untreated).
Sometimes it is difficult for the doctor to understand what the patient wants. That is why during the consultation it is important to find mutual understanding with the doctor, to correctly convey the main reason for contact with him. Quite often patients just need reassurance that their varicose veins will not harm them in any way and are unlikely to do so in the future.
If therapy is needed, the doctor often recommends that you undergo self-medication at home within 6 months, which includes:
- the use of compression knitwear;
- regular exercise;
- avoid "long stay" - exclude 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 conservative or surgical treatment of varicose veins of the lower extremities.
Possibilities for treatment of pathology of the lower extremities
Conservative treatment (compression and pharmacological therapy, lifestyle changes), surgical interventions, external and internal laser exposure, radiofrequency ablation, injection sclerotherapy are used to combat varicose veins of the legs. The choice of this or that option depends on the patient's preferences. It also affects the financial capabilities of the patient, the qualifications of the doctors and the equipment of the medical institution. Regardless of which method of treating varicose veins of the lower extremities will be used in each case, depends largely on the disease itself: what symptoms are present, the degree of venous insufficiency and other characteristics of vascular lesions.
Conservative methods of treatment
Conservative treatment, as a rule, is complex and includes several components.
Lifestyle change, which involves a set of measures aimed at preventing blood stasis in the veins. As you know, prolonged standing or sitting position levels the activity of the venous-muscular pump (gastrocnemius muscle), which contributes to stagnation. Therefore, patients are recommended to walk regularly, periodically raising their legs above the level of the heart in a supine position. You should also pay attention to different diets - salt-free, low-calorie. They will allow you to regulate body weight, to compensate for the seasonal deficiency of vitamins. It is necessary to consume foods high in bioflavonoids (substances that help strengthen the vessel wall).
People with varicose veins should avoid overheating their feet, refrain from visiting baths and saunas and, if possible, do not use heated floors.
Compression stockings improve venous hemodynamics, which leads to the disappearance of many manifestations of the disease. Disadvantages of this method:
- limited use over time (no possibility to wear compression stockings and socks at all times);
- the appearance of discomfort with constant compression, this is observed especially often in the summer, when the symptoms of varicose veins "manifest themselves most".
As a rule, the pharmacy offers compression knitwear from only one manufacturer. However, there are many different brands, each of which can meet the needs of the patient to a different degree.
Drug treatment can eliminate the symptoms of the disease or reduce their manifestation, is aimed at preventing and combating its complications and can increase the effectiveness of compression therapy. Pharmacology helps to deal 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, strengthen the venous wall. They are considered essential pharmacotherapeutic agents. They include:
- Chestnut extract and thiamine (vitamin B1) are some of the drugs used to treat pain and heaviness in the legs, edema observed in chronic venous insufficiency. The drugs have shown their effectiveness 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).
- The butcher's broom (butcher's broom) is used as a food supplement. Helps relieve congestion in the veins. It is believed to be effective against spider veins. However, no clinical data have been available to support its safety and efficacy.
- Deproteinized hemoderivative in the blood of young calves is part of the popular drugs, which are excellent phleboprotectors, have a good therapeutic effect in varicose veins of the lower extremities.
As a rule, venotonics are prescribed in courses. The duration of the course depends on the dynamics of improvement of symptoms, the duration of the achieved remission. Therefore, your doctor may vary your medication 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 realized through two mechanisms: distracting and in fact therapeutic. In the first, evaporation of the alcohol base or essential oils contained in the gel occurs, which leads to a decrease in skin temperature, respectively, and improves the symptoms of the disease. As a result of the second drug, penetrating through the skin directly into the vein, begins to show its therapeutic effect.
Ointments and gels used for varicose veins of the legs are classified according to the main active ingredient they contain. These include such medicinal substances:
- Phleboprotectors (usually rutin, as well as herbal substances that strengthen the vessel wall).
- Non-steroidal anti-inflammatory drugs are commonly used to relieve pain.
- Topical corticosteroids are used for allergic dermatitis, which can occur as a complication of venous insufficiency.
- H1-histamine receptor blockers are prescribed instead of corticosteroids when the latter are contraindicated.
- Proteolytic enzymes are able to effectively clean a trophic ulcer (complications of widespread varicose veins of the legs).
- Ionized silver is an effective antiseptic, perfectly cleanses and dries the wound, making it an indispensable tool for the treatment of infected trophic ulcers.
- Antibiotics are used topically to infect complications of varicose veins (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 used for a long time).
- Heparin, in addition to antithrombotic activity (prevents the formation of blood clots), has an anti-inflammatory effect, 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: in patients with chest pain and constant leg fatigue, in the presence of edema, chronic venous insufficiency, cosmetic problems, early hyperpigmentation (excessive deposition of pigment in the skin), external bleeding, and in superficial thrombophlebitis progresses, in the presence of trophic ulcers that cannot be treated with conservative methods.
Currently, the most popular are three types of operations:
- sapheno-femoral ligature (ligation and removal of the upper part of the great saphenous vein);
- strips of the great saphenous vein:
- traditional or Babcock's operation, in which a special probe is inserted into the lumen of the great saphenous vein (two incisions are made in advance: one in the groin area, the second at the level of the upper third of the leg) and extends along its entire length, then removed along with the varicose vein;
- cryostripping, an operation that is almost similar to the previous one, but differs in that the probe is cooled to -85 ° C, as a result of which the vein adheres to the probe, which makes its removal less traumatic;
- Phlebectomy is a procedure to remove varicose veins through several small, 2-3 mm incisions in the skin.
The above surgical interventions help to improve the quality of life of the patient; their therapeutic and economic efficacy has been demonstrated in clinical trials. They are usually performed under general anesthesia, but most patients are discharged on the day of surgery. Full recovery, return to normal daily activity usually takes 2 to 3 weeks. Complications are possible, which are more common in patients with advanced varicose veins. During the operation, the nerves located in the subcutaneous tissue can be damaged, due to which, after surgical manipulation, temporary or even permanent tingling in some parts of the legs is sometimes observed, but this does not lead to serious damage.
New treatments
The main goal of using new treatments is to minimize the tissue trauma that is observed during surgery, 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 of the legs by "sealing" the large subcutaneous vein (or small) with high temperature, leading to regression of the dilated vessels (their walls stick together). Although these options do not include surgical procedures, additional phlebectomy and sclerotherapy are often resorted to. Both methods include:
- Insertion of a catheter into the great saphenous vein through a small incision in the upper third of the leg and progress to the saphenofemoral ligament under ultrasound guidance. No incision is made in the groin area.
- Performed 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 miniphlebectomies are to be performed simultaneously.
- The need to use bandages or socks after the procedure for two weeks.
- The dependence of their result on the anatomy of the subcutaneous veins in the patient is positive in the presence of straight lines, questionable when the vessels are distorted.
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 rapid recovery after the procedure, which is associated with a lower probability of wound infection and hematoma.
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 varicose veins, a substance that sticks to its walls, blood flow is moved to healthy vessels. Sclerotherapy is often combined with classic surgery, and in the case of telangiectasia and spider veins is used as the only method of therapy.
Contraindications:
- pregnancy,
- breastfeeding period,
- dermatitis,
- thrombophlebitis.
Sclerotherapy gives quite acceptable results that satisfy many patients.
Foam sclerotherapy
Unlike conventional sclerotherapy, with foam, sclerosant is injected into a vein after mixing with gas (usually air). The result is foam, which, spreading through the vein, displaces blood from it and causes vasospasm. The manipulation is usually performed under the guidance of a duplex ultrasound scan.
In addition to ordinary sclerotherapy with foam, after manipulation for 14 days it is necessary to wear compression knitwear.
Recovery after the procedure is faster than if a classic operation was performed. The medium-term results of treatment (the likelihood of recurrence of reflux) of foam sclerotherapy are slightly worse than those of surgery.
Treatment of "microvaricose": telangiectasia, spider veins
Spider veins are almost always treated for cosmetic reasons only, although they can sometimes cause a hot, throbbing sensation that indicates reflux. Two types of therapy are usually used:
- Microsclerotherapy - introduction of a sclerosing substance using a thin needle. Usually several spider veins are sclerosed at the same time. A compression bandage or sock is applied for 1 to 2 days. If the sclerosis goes out of the vessel during the injection, an ulcer may develop in this area, which heals slowly and then leaves a scar. 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 the treatment of telangiectasias (intradermal vascular growth that resembles 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 depends largely on the decision of the patient. Do not immediately "go under the knife", in the arsenal of doctors there are effective options for conservative therapy. According to doctors today it is impossible to completely cure this disease, but it is entirely within the power of modern medicine to save the patient from the disease and preventits further progression.