Varicose veins of the lower extremities are considered to be the most common pathology of the peripheral vessels, it is one of the so-called top ten diseases of civilization. According to epidemiological studies, venous insufficiency occurs in 80% of people of working age. In most cases, varicose veins don't cause severe pain, and sometimes it goes unnoticed, requiring no treatment. However, there are situations where it is worthwhile to consult a specialist, for proper treatment. What is the treatment for varicose veins of the lower extremities? What are their advantages and disadvantages?
How to get rid of the disease
Thousands of people every year ask themselves the question: how to get rid of those "ugly knots" or "vascular nets" on their feet? Media portals are flooded with advertisements 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's hard to understand the hype, to answer the question of which treatment option is most appropriate. If a person has decided to treat his dilated blood vessels and he is unsure of the safety or effectiveness of this or that treatment, the best option for him is to involveContact several clinics, to get qualified advice from at least two professionals.
There are many reasons that compel patients with varicose veins to consult a doctor:
- cosmetic notes;
- unpleasant symptoms;
- complications of the disease (eg, ulcers, bleeding, or thrombophlebitis);
- fear for your health (how the disease will progress in the future if it is not treated).
Sometimes it is difficult for doctors to know what the patient wants. Therefore, during the consultation, it is important to find a mutual understanding with the doctor, in order to correctly communicate the main reason for contacting him. Usually, patients just need to be reassured that their varicose veins won't harm them in any way and are unlikely to do so in the future.
If treatment is needed, doctors usually recommend self-treatment at home for 6 months, including:
- the use of compression knitwear;
- exercise regularly;
- avoid "long downtime" - exclude long periods of stay in a sitting or standing position;
- while at rest (in a horizontal position), raise the "injured" limb above the level of the heart.
If after the second consultation, the patient is not satisfied with the results, the doctor may recommend conservative treatment or surgery for varicose veins of the lower extremities.
Treatment options for lower extremity disease
To combat varicose veins of the legs, conservative treatment is used (compression therapy and pharmacology, lifestyle changes), surgical interventions, external and internal laser irradiation, frequency ablationradio, injectable therapy. The choice of one option or the other depends on the preferences of the patient. It is also affected by the financial ability of the patient, the qualifications of the doctor and the equipment of the medical facility. However, the application of treatment for varicose veins of the lower extremities in each specific case depends largely on the disease itself: what are the symptoms, the degree of venous insufficiency, and the characteristics of the vascular damage. is different.
Conservative therapy
Treat with caution, as a rule, is complex and includes several components.
Lifestyle changes, including many measures to prevent blood stagnation in the veins. As you know, standing or sitting for a long time increases the activity of the venous (stomach) pump, which contributes to stagnation. Therefore, the patient is recommended to walk regularly, periodically raising the legs above the heart in the prone position. You should also pay attention to different diets - no salt, low calories. They will allow you to regulate your body weight, make up for seasonal vitamin deficiencies. It is necessary to consume foods high in bioflavonoids (substances that help strengthen blood vessels).
People with varicose veins should avoid overheating their feet, not going to baths and saunas, and if possible, not using heated floors.
Compression knitting improves venous hemodynamics, which leads to the disappearance of many manifestations of the disease. Disadvantages of this method:
- limited use of it during (inability to wear compression stockings and all the time);
- the appearance of discomfort with constant compression, which is especially common in the summer, when the symptoms of varicose veins "manifest" the most.
As a rule, the pharmacy offers only compression knitwear from one manufacturer. However, there are many different brands, each of which can meet a patient's needs to varying degrees.
Drug therapy can eliminate the symptoms of the disease or reduce their manifestations, aimed at preventing and combating its complications, and can enhance the effectiveness of compression therapy. Pharmacology helps to deal with the side effects that occur after sclerotherapy or phlebotomy.
Modern treatment of varicose veins of the lower extremities is incomplete without the use of phleboprotectors, drugs that can improve symptoms, strengthen the vein walls. They are considered the basic pharmacological agents. Including:
- Horse chestnut fruit extract and thiamine (vitamin B1) are part of a medication used to treat pain and heaviness in the legs and edema observed in chronic venous insufficiency. Funds have shown their effectiveness in clinical trials. There are dosage forms: oral solution (10-15 drops x 3 times a day) and tablet form (usually taken after meals 1 tablet x 3 times a day).
- Butcher's broom (butcher's broom) is used as a food additive. Helps relieve congestion in veins. It is said to be effective against spider veins. However, clinical data confirming its safety and effectiveness have not been performed.
- Antiseptics deposited in the blood of young calves are part of the common drugs, are excellent venoprotectors, have a good therapeutic effect on varicose veins of the lower extremities.
As a rule, venotonic is prescribed in courses. The duration of the course depends on the dynamics of improvement of symptoms, the time of remission achieved. As a result, your doctor may change the duration of your medication from 3 to 6 months or more.
Ointments and gels (topical) are also widely used. The treatment regimen for varicose veins of the lower extremities is selected by the doctor depending on the condition and progression of the disease. The therapeutic effect of these topical agents is achieved through two mechanisms: distraction and actual treatment. Initially, evaporation of the alcohol or essential oils contained in the gel occurs, which leads to a decrease in the temperature of the skin, and an improvement in the symptoms of the disease. As a result of the second time, the drug penetrates through the skin directly to the veins and begins to have a therapeutic effect.
Ointments and gels for varicose veins of the legs are classified according to the main active ingredient they contain. These include the following drugs:
- Phleboprotectors (usually rutin, as well as plant substances that strengthen the vascular wall).
- Nonsteroidal anti-inflammatory drugs are commonly used to relieve pain.
- Topical corticosteroids are used for atopic dermatitis, which can occur as a complication of venous insufficiency.
- H1-histamine receptor blockers are prescribed instead of corticosteroids when contraindicated.
- Proteolytic enzymes can effectively clear trophic ulcers (complications of varicose veins of the legs).
- Ionized silver is an effective antiseptic, it cleans and dries wounds perfectly, making it an indispensable remedy for treating infected sores.
- Antibiotics are used topically for infections caused by complications of varicose veins (thrombophlebitis, dermatitis).
- Rehydrating preparations and skin protectants protect the skin from external influences, improving its elasticity. They are often prescribed for cases of skin atrophy (when using compression stockings for a long time).
- Heparin in addition to antithrombotic activity (prevents blood clot formation) also has anti-inflammatory effects, has the ability to relieve pain.
Surgery
The main goal of surgical treatment is to eliminate the pathological mechanism that leads to the occurrence of the disease - venous reflex, as well as to eliminate its main manifestation - varicose veins. Surgical treatment is indicated: for patients with persistent leg pain and fatigue, accompanied by edema, chronic venous insufficiency, cosmetic problems, premature hyperpigmentation (excessive pigment deposition)in the skin), external bleeding, as well as in superficial thrombophlebitis. progressive, in the presence of trophic ulcers that cannot be treated with conservative methods.
Currently, the most common are three types of operations:
- sapheno-femoral ligation (ligating and removing the superior part of the great hemispheric vein);
- bands of great saphenous veins:
- traditional operation or Bebkokk, in which a special probe is inserted into the lumen of the great hemisphere vein (two incisions are made preliminary: one in the inguinal region, the second at the level of the upper third of theleg) and stretched along its entire length, after which it was excised along with the spermatic vein;
- cryotripping, an operation that is nearly identical to the previous one, but differs in that the probe is cooled to -85 °C, so the vein sticks to the transducer, making removal less traumatic;
- A varicocele is a procedure to remove veins through several small, 2-3 mm incisions in the skin.
The above surgical interventions help improve the patient's quality of life; Their therapeutic and economic effectiveness 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, returning to normal daily activities usually takes 2 to 3 weeks. Complications can occur, usually in patients with advanced varicose veins. During surgery, nerves located in the tissue under the skin can be damaged, so after a surgical operation, temporary or even permanent numbness of some parts of the leg may sometimes be felt. , but this does not lead to serious disability.
New treatments
The main goal of using new treatments is to minimize the tissue trauma observed during surgical interventions, allowing patients to recover more quickly. They began to be widely used in the early 2000s.
Vein ablation (RF and laser)
Radiofrequency and laser ablation is a method of treating varicose veins of the legs by "sealing" the large (or small) hemispheric veins with high temperature leading to their degeneration into dilated vessels (vascular wall). Stick together). Although these options do not involve surgical procedures, it is quite common to require the addition of phlebotomy and therapy. Both methods involve:
- A catheter is inserted into the great mesenteric vein through a small incision in the upper third of the leg and guided it to the omental junction under ultrasound guidance. Do not make an incision in the groin area.
- Performed under local anesthesia (the anesthetic penetrates deep into the subcutaneous tissue of the thigh). Additional general anesthesia may be required if a large number of minor surgeries are performed at the same time.
- The need to use bandages or socks after the procedure for two weeks.
- The dependence of their results on the anatomy of the hemispheric veins in the patient is positive in the presence of straight lines, suspected when the vessels are tortuous.
The use of intravenous ablation, which has been widely used over the past ten years, has not shown a significant difference in effectiveness compared with surgery.
The main advantage of this technique is the rapid recovery from the procedure, which is associated with less chance of wound infection and hematoma.
However, complications are typical for this procedure: skin burns, transient paresthesia, deep vein thrombosis (occurring in less than 1% of patients).
Simple therapy
This treatment method is easy to perform and less traumatic, so it is now applied by many clinics. Its essence is that, when sclerosant is injected into a dilated vein, a substance that sticks to its walls, blood flow will move into healthy vessels. Sclerotherapy is often combined with classical operations, and in the case of varicocele and spider veins, it is used as a sole therapy.
Contraindications:
- pregnancy,
- lactation period,
- dermatitis,
- thrombophlebitis.
Sclerotherapy gives quite acceptable results, satisfying many patients.
Foam Therapy Mineral Spray
Unlike simple sclerotherapy, with foam, sclerotherapy is injected into a vein after mixing with gas (usually air). As a result, foam is obtained, which spreads through the veins, moving blood from there and causing vasoconstriction. Usually operations are performed under the guidance of a duplex ultrasound scan.
As with simple foam therapy, it is necessary to wear compression knits after the operation for 14 days.
The recovery process after the procedure is faster than when performing a classic surgery. However, the medium-term outcome (probability of reflux) of foam sclerotherapy is somewhat inferior to that of surgery.
Treatment of "microvaricose": varicocele, spider veins
Spider vein treatments are almost always done for cosmetic reasons only, although they can sometimes cause a burning, stinging sensation, indicating the presence of reflux. Usually two types of therapy are used:
- Microtherapy - the introduction of a sclerotherapy using a thin needle. Usually several spider veins become sclerotic at the same time. A compression bandage or bandage is applied for 1 to 2 days. If the scleroderma gets outside the blood vessel during the injection, an ulcer may develop in this area, which will slow to heal, which will then leave a scar. This is rare, provided "if the doctor's hand is not shaken during surgery. " There may also be injection site hyperpigmentation (tanning).
- Laser ablation. This method works well in treating vasodilatation (growth of blood vessels in the skin that looks like a birthmark).
There are many effective ways to treat varicose veins of the lower extremities that traditional medicine offers. The choice of treatment option depends largely on the patient's own decision. Do not immediately "go under the knife", in the doctor's arsenal there are effective options for conservative therapy. According to doctors, today it is not possible to completely cure the disease, 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 the disease from further progressing.