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

Varicose veins or varicose veins are often referred to as the "disease of tired legs" in everyday life. In fact, the causes are much more complicated. And the disease itself is by no means just a harmless blemish. Varicose veins of the lower extremities lead to the appearance of chronic venous insufficiency - a condition, the end result of which may be the appearance of a venous trophic ulcer.

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

Why are varicose veins dangerous?

It is difficult to say how common varicose vein disease is: Many patients consider it a cosmetic defect and do not see a doctor. According to Western scientists, at least a quarter of the population in 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% are treated.

Varicose veins of the lower extremities are a condition in which the structure of the vein wall changes. The vessels in the areas of wall thinning become longer, tortuous, the lumen expands and forms knots.

statistics
Varicose veins are a hereditary condition. The probability of its occurrence in those in whose family no one has suffered from venous pathology is no more than 20%. If one parent falls ill, the risk increases: for men - up to 25%, for women - up to 62%. If both parents have the disease, the probability of varicose veins in the offspring is 90%.

In varicose veins, the relationship between the two main structural proteins of the vein walls is disturbed:Collagenandelastin. . . When collagen becomes stiff, elastin, as the name suggests, 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 vein wall is reduced. The collagen itself also changes: Instead of the predominant type III collagen, which is responsible for elasticity, the content of type I collagen increases - rigid, remaining residual deformations are retained. In addition, the number of smooth muscle cells that regulate the lumen of the vessel 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 motionless;
• Obesity;
• Pregnancy and childbirth.

Some experts point to chronic constipation, tight clothing that increases intra-abdominal pressure, and high heels that disrupt 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 changed vein wall no longer "holds" the pressure and the lumen of the vein expands. By widening the lumen of the veins, the valves stop allowing blood to flow in only one direction. ArisesReflux- reflux. The pressure in the affected vein increases even further and the vicious circle closes.

Increased venous pressure, combined with changes in wall structure 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 "seep" through the damaged vein wall into the surrounding tissue. There they are destroyed and release active substances -Inflammation mediators. . . They damage the surrounding cells and attract each otherLymphocyteswhose function is to remove damaged tissue. As a result, edema, hardening (hardening) of the skin of the legs and hyperpigmentation develop. These processes can cause venous trophic ulcers. Prolonged inflammation of the vein wall also increases blood clotting. Combined with venous congestion, this causes blood clots to 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 sensations of "goose bumps", changes in sensitivity;
• burning sensation in the muscles;
• Leg pain, the characteristic feature of which is that the intensity decreases after a walk;
• Swelling in the evening;
• Restless Legs Syndrome - a condition in which leg discomfort 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 tissue.

The combination of subjective complaints and objective tissue changes in the lower extremities forms the basis of the modern classification of varicose veins and chronic venous insufficiency:

• C0- there are discomfort, but no changes in appearance, lesions of the veins can only be detected with a special examination and tests;
• C1- "Spiders" appear (scientific name - telangiectasia) or a network of intradermal dilated veins (reticular varicose veins) becomes visible;
• C2- the diameter of the dilated saphenous veins exceeds 3 mm, varicose veins appear;
• C3- the affected leg is constantly swelling;
• C4- Changes in the surrounding tissues: the skin darkens (hyperpigmentation), eczema develops, hardening 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 healed varicose veins at this stage do not lead to complete absorption of the hyperpigmentation or induration. In addition, it is necessary to remember a rather dangerous complication -Thromboembolism. . .

On a note
30 to 60% of deaths from sudden onset of deep vein thrombosis and further thromboembolism occur against the background of varicose veins in combination with thrombophlebitis that was not recognized and not cured 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 are considered modern: minimal invasiveness (trauma), high efficiency, low likelihood of relapse 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 are thesubjectiveManifestations (discomfort) in the early stages of the disease and reduce edema, but in no way affect the condition of the vein wall itself. Different 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, relieve the patient's subjective discomfort and prevent the progression of varicose veins. However, compression stockings cannot heal varicose veins - dilated veins do not work properly.
• Traditional surgical removal.The affected large or small saphenous vein is tied off at the point where it joins the deep venous system and then removed with a special metal probe. This surgery is effective but quite traumatic and requires a long recovery. There is a high likelihood of postoperative complications - hematoma, postoperative paresthesia and neuralgia.
• Sclerotherapy.A special drug is injected into the varicose vein that "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 great saphenous vein and small, as it is characterized by a higher rate of recurrence. In addition, such an unpleasant complication as hyperpigmentation in the context of sclerosis is possible.
• Endovenous laser coagulation (EVLK)- minimally invasive, safe, modern and effective way of treating 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 technique of laser coagulation remains the same. A radial fiber optic light guide is inserted into the vein through the puncture. 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 tissue from overheating. For the procedure, modern vascular lasers are used, which generate two waves: one of them is absorbed by the blood hemoglobin, the second - by the vascular wall. Vienna "brews". All phases (position of the light guide, infiltration of the solution around the vein, the actual "brewing" process) are monitored 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 way to treat varicose veins is to remove the altered vein that is unable to perform its function.

The advantages of the laser ablation process:

• Minimal trauma, which makes it possible to perform the procedure on an outpatient basis and under local anesthesia;
• You can go home immediately after the operation;
• quick recovery;
• good cosmetic result: no marks or scars remain;
• high efficiency, low relapse rate.

Since endovenous laser coagulation is currently considered to be one of the most advanced, traumatic and minimally invasive treatments for varicose veins, we will take a closer look at this technique.

Indications for laser coagulation

The main indication is varicose veins, regardless of the diameter of the venous trunk and options for its anatomical structure. Thanks to the perfection of modern devices - two-wave lasers, radial fibers - EVLK's range of indications has been expanded.

Contraindications to the procedure

In most cases, they boil down to severe somatic conditions in the patient:

• deep vein thrombosis (obstruction, occlusion, blockage);
• decompensated type 1 diabetes mellitus;
• severe atherosclerosis of the arteries and ischemia of the lower extremities;
• severe cardiovascular diseases: ischemic heart disease, especially angina pectoris at rest, extensive myocardial infarction with a decrease in cardiac output, severe forms of cardiac arrhythmias, strokes;
• severe bleeding disorders, both down and up;
• Pregnancy and breast feeding period;
• individual intolerance of the anesthetic used;
• Impossibility of physical activity immediately after the procedure;
• Inability to use compression stockings.

It is characteristic that the age of the patient is not a contraindication.

How is the laser coagulation of veins done?

Shortly before the manipulation, you should buy compression stockings of the 2nd degree of compression (25–32 mm Hg). The doctor will tell you exactly what size is needed. Endovascular 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 procedure begins, the vein is "marked": the doctor makes markings 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 is carried out, the vein is punctured (punctured). The sensations are no different from the usual intravenous injection. A radial light guide is inserted into the vein via a special catheter.
3. Next, a protective "sleeve" of the anesthetic is placed around the vein. Under ultrasound control, the doctor uses a special pump to inject a local anesthetic into the space around the vessel. This not only relieves pain, but also protects the surrounding tissue from excessive laser heat.
4. The procedure itself is EVLO varicose veins. With modern fiber optic cables, the laser radiation is fed evenly over the entire circumference of the device and thus ensures that the vein is evenly heated from the inside. After removing the light guide, the patient is subjected to ultrasound monitoring of the condition of the treated vessel, as well as the deep veins of the extremity.
5. A compression stocking is put on the patient.

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

Possible complications

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

• Deep vein thrombosis -can occur in patients who are prone to increased thrombosis. Therefore, to prevent this complication, patients are prescribed drugs that reduce blood clotting. Usually they are used within 4-5 days of the procedure.
• Thrombophlebitis- mostly in connection with insufficient laser exposure intensity.
• Pigmentation along the treated veindissolves within 1. 5–2 months.
• Sensation of a "stretched" vein- goes within 1. 5 months.

In order to avoid the development of complications as much as possible, you should follow a few simple rules, compliance with which is necessary for successful rehabilitation.

rehabilitation

There may be pain and pulling pain along the vein on the first day. To get rid of them, conventional pain relievers are enough. The temperature can rise in the first few days. It is enough to use traditional means to reduce them.

In general, there are 2 main conditions that must be observed for successful rehabilitation - wearing compression garments and maintaining adequate physical activity.

• Compression underwear -it is not removed during the first 5 days, even during a night's rest. This is necessary so that the vein is completely "glued" and healed. In addition, compression stockings are only worn during the day. Wearing compression stockings is sufficient for 2, 5–3 months, but risk factors (sitting, standing work, taking female sex hormones)further preventive wearing of compression stockings is desirable.
• Physical activity- It is recommended that you walk for at least an hour a day. However, you have to avoid intense sport 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%. Errors can be traced back to several groups of factors:

• anatomical features of the operated vein;
• violations of the technical performance of EVLK (insufficient laser power, insufficient compression of the vein with an anesthetic solution);
• Failure by the patient to comply with 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 a laser is significantly better tolerated, the rehabilitation time is shorter and the number of complications is lower than with conventional operations.

How much does EVLK cost?

The endovascular laser coagulation procedure requires high-tech equipment and expensive, single-use consumables (light guides), which explains its cost. The total amount depends on the scope and complexity of the procedure, the medical equipment used, and the qualifications of the doctor.

Endovenous laser coagulation is a modern, effective method for treating varicose veins. It gives excellent clinical results and leaves no residue. The minimal exposure trauma allows you to return to a normal life as early as the day of the operation (with minor limitations) without the need for hospital treatment and 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 and the technical properties of the devices used. This means that the equipment used must be modern and the doctors must be qualified. Hence, I would recommend choosing a clinic that specializes in this particular type of service that has been operating for several years and has a proven reputation. "