Varicose veins of the lower extremities are rightly considered to be the most common pathology of peripheral vessels and are among the ten most common so-called lifestyle diseases. 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 ailments, and sometimes they go unnoticed at all, do not require treatment. Nevertheless, there are situations in which it is worthwhile to consult a specialist without delay in order to undergo appropriate therapy. What treatments are there 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 the question every year: How do you get rid of "ugly knots" or "vascular networks" on their legs? Media portals are full of advertisements for public and private clinics treating lower extremity varicose veins. They offer "unique, " "guaranteed, " "painless" or "completely safe" ways to get rid of this disease. Sometimes these advertisements are difficult to understand in order to answer the question of which treatment option is best. If a person has decided to deal with their dilated vessels and is unsure about the safety or effectiveness of this or that method of treatment, it is best for them to go to several clinics and seek qualified advice from at least two professionalsallow .
There are several reasons that compel a patient with varicose veins to see a doctor:
- cosmetic considerations;
- Symptoms of discomfort;
- Complications of the disease (for example, ulcer, 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 know what the patient wants. Therefore, during the consultation, it is important to find a mutual understanding with the doctor in order to properly convey the main reason for contacting him. Often times, patients just need the assurance that their enlarged veins will not harm them in any way and that it is 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, which includes:
- the use of compression stockings;
- do sports regularly;
- Avoid "long downtimes" - exclude sitting or standing for a long time;
- At rest (in a horizontal position), raise the "compromised" limb above the level of the heart.
If the patient is not satisfied with the result after a second consultation, the doctor can recommend conservative or surgical treatment of varicose veins of the lower extremities.
Treatment options for lower limb pathology
To combat varicose veins on the legs, conservative treatments (compression and pharmacological therapy, lifestyle changes), surgical interventions, external and internal laser irradiation, high-frequency ablation, injection sclerotherapy are used. The choice of this or that option depends on the patient's preferences. It is also influenced by the financial possibilities of the patient, the qualifications of the doctors and the equipment of the medical facility. Which method is used to treat varicose veins of the lower extremities in each individual case, however, depends heavily on the disease itself: what symptoms are present, the degree of venous insufficiency and other characteristics of vascular lesions.
Conservative therapy methods
Conservative treatment is usually complex and has several components.
A change in lifestyle that implies a complex of measures aimed at preventing stagnation of blood in the veins. As you know, prolonged standing or sitting balances the activity of the venous-muscular pump (gastrocnemius muscle), which contributes to stagnation. Therefore, patients are advised to walk regularly and regularly raise their prone legs above the level of the heart. You should also pay attention to different diets - salt-free, low-calorie. They allow you to adjust your body weight and compensate for a seasonal vitamin deficiency. It is necessary to eat foods with a high content of bioflavonoids (substances that strengthen the vascular wall).
People with varicose veins should avoid overheating their feet, avoid going to baths and saunas and if possible avoid using underfloor heating.
Compression stockings improve venous hemodynamics, which leads to the disappearance of many manifestations of the disease. Disadvantages of this method:
- temporary use (it is not possible to wear compression stockings and socks all the time);
- the appearance of discomfort with constant compression, this is observed especially often in summer, when the symptoms of varicose veins are most "manifested".
The pharmacy usually only offers compression stockings from one manufacturer. However, there are many different brands, each of which can meet the needs of the patient to different degrees.
Drug treatment can eliminate the symptoms of the disease or reduce their manifestation, is aimed at preventing and controlling its complications, and can increase the effectiveness of compression therapy. Pharmacology helps manage side effects that occur after sclerotherapy or phlebectomy.
Modern treatment for varicose veins of the lower extremities is not complete without the use of venotonics (phleboprotectors), drugs that can improve symptoms, and strengthen the vein wall. They are considered basic pharmacotherapeutic agents. These include:
- Horse chestnut fruit extract and thiamine (vitamin B1) are part of medicines used to treat pain and heaviness in the legs, edema observed in chronic venous insufficiency. The funds have proven their effectiveness in clinical studies. There are dosage forms: oral solution (10-15 drops 3 times a day) and tablet form (usually taken 1 tablet 3 times a day after meals).
- 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, clinical data confirming safety and efficacy have not been performed.
- Deproteinized hemoderivative from the blood of young calves is part of popular drugs that are excellent phleboprotectors and have a good therapeutic effect on varicose veins of the lower extremities.
As a rule, venotonics is prescribed in courses. The duration of the course depends on the dynamics of symptom improvement and the duration of the remission achieved. Therefore, the doctor may vary the intake of the drug from 3 to 6 months or more.
Ointments and gels (topical medicines) are also commonly used. The treatment regimen for varicose veins of the lower extremities is chosen by the doctor depending on the condition and the course of the disease. The therapeutic effects of these topical drugs are realized through two mechanisms: distracting and actually therapeutic. First, the alcohol base or essential oils contained in the gel evaporate, which leads to a decrease in the skin temperature or improves the symptoms of the disease. As a result of the second, the medicinal substance, which has penetrated the vein directly through the skin, begins to exert its therapeutic effects.
Ointments and gels for varicose veins of the legs are classified according to the main active ingredient they contain. They include such medicines:
- Phleboprotectors (mostly rutin and plant substances that strengthen the vascular wall).
- Nonsteroidal anti-inflammatory drugs are usually used to relieve pain.
- Topical corticosteroids are used for allergic dermatitis, which can be a complication of venous insufficiency.
- H1 histamine receptor blockers are prescribed in place of corticosteroids when the latter are contraindicated.
- Proteolytic enzymes are able to effectively clean a trophic ulcer (complications of extensive varicose veins of the legs).
- Ionized silver is an effective antiseptic, it perfectly cleans and dries the wound, so it is an indispensable tool in the treatment of an infected trophic ulcer.
- Antibiotics are used topically to infect complications of varicose veins (thrombophlebitis, dermatitis).
- Rehydrating preparations and dermatoprotectors protect the skin from external influences and improve its elasticity. They are usually prescribed for atrophic changes in the skin (when wearing compression stockings for a long time).
- In addition to its antithrombotic effect (prevents the formation of blood clots), heparin has an anti-inflammatory effect and can 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 the removal of its main manifestation - varicose veins. Surgical treatment is indicated: in patients with aching pain and constant fatigue in the legs, with edema, chronic venous insufficiency, cosmetic problems, premature hyperpigmentation (excessive pigment deposition in the skin), external bleeding, as well as with superficial thrombophlebitis progressing, with trophic ulcers thatcannot be treated with conservative methods.
At the moment the most popular three types of operations are:
- sapheno-femoral ligation (ligation and removal of the upper portion of the great saphenous vein);
- Banding of the great saphenous vein:
- traditional or Bebkokk operation, during which a special probe is inserted into the lumen of the great saphenous vein (two incisions are provisionally made: one in the groin, the second at the level of the upper third of the leg) and along its entire length, after thatit is removed along with the varicose vein;
- cryostripping, an operation almost similar to the previous one, but different in that the probe is cooled to -85 ° C, which makes the vein stick to the probe, making it less traumatic to remove;
- Phlebectomy is a procedure for removing varicose veins through several small, 2-3 mm long incisions in the skin.
The above surgical interventions contribute to the improvement of the patient's quality of life, their therapeutic and economic efficiency has been proven in clinical studies. They are usually done under general anesthesia, but most patients are discharged on the day of surgery. Full recovery, returning 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, so after surgical interventions, temporary or even permanent numbness of some parts of the legs is sometimes observed, but this does not result in a serious disability.
New treatments
The main goal of using new treatment methods is to minimize tissue trauma observed during surgical interventions, which allows the patient to recover faster. They started to be widespread in the early 2000s.
Intravenous ablation (HF and laser)
Radiofrequency and laser ablation are methods of treating varicose veins of the legs by "sealing" the large (or small) trunk vein at high temperatures, causing the enlarged vessels to regress (their walls stick together). Although these options do not involve surgery, it is quite common to resort to additional phlebectomy and sclerotherapy. Both methods include:
- A catheter is inserted into the great saphenous vein through a tiny incision in the upper third of the leg and advanced under ultrasound guidance to the saphenofemoral junction. No incision is made in the groin area.
- Carried out under local anesthesia (the anesthetic penetrates extensively into the subcutaneous tissue of the thigh). Additional general anesthesia may be required if many miniflebectomies are to be performed at the same time.
- The need to use bandages or stockings for two weeks after the procedure.
- The dependence of their result on the anatomy of the patient's saphenous veins is positive in the case of straight lines, and doubtful in the case of tortuous vessels.
The use of intravenous ablation, which has been widely used over the past decade, has not shown any significant differences in its effectiveness compared to surgery.
The main advantage of this technique is quick recovery after the procedure, which is associated with a lower chance of wound infections and bruises.
However, complications are typical of this procedure: skin burns, temporary paresthesias, deep vein thrombosis (occurs in less than 1% of patients).
Simple sclerotherapy
This treatment method is currently used by many clinics due to its ease of implementation and low trauma. Its essence lies in the fact that sclerosant is injected into the varicose veins, a substance that clogs their walls, blood flow goes into healthy vessels. Sclerotherapy is often combined with classic operations and used as the only therapeutic method for telangiectasias and spider veins.
Contraindications:
- Pregnancy,
- Breastfeeding,
- Dermatitis,
- Thrombophlebitis.
Sclerotherapy gives quite acceptable results that satisfy many patients.
Foam sclerotherapy
In contrast to simple foam sclerotherapy, the sclerosant is injected into a vein after it has been mixed with a gas (usually air). As a result, foam is obtained, which spreads through the vein, displacing blood from it and causing a spasm of the vessel. Usually the manipulation is carried out under the guidance of duplex ultrasound.
In addition to simple foam sclerotherapy, compression stockings must be worn for 14 days after manipulation.
The recovery after the procedure is faster than with a classic operation. However, the medium-term treatment results (likelihood of recurrence of reflux) of foam sclerotherapy are somewhat worse than those of surgery.
Treatment of "microvaricosis": telangiectasias, spider veins
Treatment for spider veins is almost always done for cosmetic reasons alone, although they can sometimes cause a hot, throbbing sensation that indicates the presence of reflux. As a rule, two forms of therapy are used:
- Microsclerotherapy - the introduction of a sclerosing substance with a thin needle. Usually several spider veins are destroyed at the same time. A compression bandage or stocking is put on for 1 to 2 days. If the sclerosis gets out of the vessel during the injection, an ulcer may develop in that area, which will slowly heal and leave a scar. This rarely happens provided "the doctor's hands do not tremble during the operation". Hyperpigmentation at the injection site (darkening of the skin) is also possible.
- Laser ablation. The method works well for treating telangiectasia (intradermal vascular growth that looks like a birthmark).
There are many effective ways to get rid of lower extremity varicose veins that traditional medicine offers. The choice of treatment option depends largely 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 disease, but it is within the power of modern medicine to save the patient as much as possible from the manifestations of the disease and prevent its further progression.