Varicose veins of the lower limbs are rightfully considered the most common pathology of peripheral vessels, it is one of the top 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 in the legs do not cause severe suffering and sometimes go unnoticed, do not require any treatment. However, there are situations when it is worthwhile, without delay, to consult a specialist, to undergo appropriate therapy. What are the treatments for varicose veins of the lower limbs? What are their advantages and disadvantages?
Ways to get rid of the disease
Thousands of people every year ask themselves the question: how to get rid of the "ugly knots" or "vascular mesh" on the legs? Media portals are filled with advertisements for public and private clinics that treat varicose veins of the lower limbs. They offer "unique", "guaranteed", "painless" or "completely safe" ways to get rid of this ailment. Sometimes it is difficult to understand this advertising, to answer the question of which treatment option is the most suitable. If a person who has decided to take care of 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 least two professionals. .
There are various reasons that force a patient with varicose veins to consult a doctor:
- aesthetic considerations;
- symptoms of discomfort;
- complications of the disease (for example ulcers, bleeding or thrombophlebitis);
- fear for one's health (how the disease will behave in the future if it is not treated).
Sometimes, it is difficult for the doctor to know what the patient wants. Therefore, during the consultation, it is important to find mutual understanding with the doctor, to correctly convey the main reason for contacting him. Quite often, patients simply need to be reassured that their enlarged veins will not harm them in any way and are unlikely to do so in the future.
If therapy is needed, doctors often recommend having a home self-treatment within 6 months, which includes:
- the use of compression stockings;
- getting regular exercise;
- avoid "long periods of inactivity" - exclude a 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.
Treatment options for lower limb pathology
To combat varicose veins of the legs, conservative treatment is used (compression and drug therapy, lifestyle modification), surgical interventions, external and internal laser exposure, radiofrequency ablation, injection sclerotherapy. The choice of this or that option depends on the patient's preferences. It is also influenced by the financial capabilities of the patient, the qualifications of the doctors and the equipment of the medical institution. However, which method of treatment of varicose veins of the lower extremities will be used in each specific case largely depends on the disease itself: what symptoms are present, the degree of venous insufficiency and other characteristics of vascular lesions.
Conservative therapy methods
Conservative treatment, as a rule, is complex and includes several components.
A change in lifestyle, which involves a complex of measures aimed at preventing stagnation of blood in the veins. As you know, a 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 prone position. You should also pay attention to various diets: salt-free, low-calorie. They will allow you to regulate body weight, compensate for seasonal vitamin deficiency. It is necessary to consume foods rich 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 in time (it is not possible to always wear compression stockings and socks);
- the appearance of discomfort with constant compression, this is particularly often observed in the summer, when the symptoms of varicose veins are more "manifested".
The pharmacy, as a rule, offers compression stockings from only one manufacturer. However, there are many different brands, each of which can cater to the patient's needs to a different extent.
Drug treatment can eliminate the symptoms of the disease or reduce its manifestation, aims to prevent and combat its complications and can improve the effectiveness of compression therapy. Pharmacology helps to cope with 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 basic pharmacotherapy agents. These include:
- Horse chestnut fruit extract and thiamine (vitamin B1) are among the medicines used to treat pain and heaviness in the legs, edema observed in chronic venous insufficiency. Funds have proven their effectiveness in clinical trials. There are dosage forms: oral solution (10-15 drops 3 times a day) and in tablets (usually taken after meals 1 tablet 3 times a day).
- Butcher's broom (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, no clinical data have been performed to confirm its safety and efficacy.
- Deproteinized hemoderivative of the blood of young calves is part of the popular drugs, which are excellent phleboprotectors, have a good therapeutic effect for varicose veins of the lower extremities.
As a rule, venotonic is prescribed in courses. The duration of the course depends on the dynamics of symptom improvement, the duration of 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 widely used. The treatment regimen for varicose veins of the lower extremities is chosen by the doctor based on the condition and course of the disease. The therapeutic effect of these topical drugs is achieved through two mechanisms: distracting and actually therapeutic. At first, evaporation of the alcohol base or essential oils contained in the gel occurs, which respectively leads to a decrease in skin temperature and improves the symptoms of the disease. As a result of the second, the medicinal substance that has penetrated through the skin directly into the vein begins to exert its therapeutic effect.
Ointments and gels used for varicose veins of the legs are classified according to the main active ingredient they contain. They include such medicinal substances:
- Phleboprotectors (usually rutin and plant substances that strengthen the vessel wall).
- Non-steroidal anti-inflammatory drugs are usually used for pain relief.
- Topical corticosteroids are used for allergic dermatitis, which can occur as a complication of venous insufficiency.
- Histamine H1 receptor blockers are prescribed in place of corticosteroids when these are contraindicated.
- Proteolytic enzymes are able to effectively cleanse a trophic ulcer (complications of far-reaching varicose veins in the legs).
- Ionized silver is an effective antiseptic, it perfectly cleans and dries the wound, so it is an indispensable remedy for the treatment of an infected trophic ulcer.
- Antibiotics are used locally for the infection of complications of varicose veins (thrombophlebitis, dermatitis).
- Moisturizing and dermatoprotective preparations protect the skin from external influences, improve its elasticity. They are usually prescribed for atrophic changes in the skin (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 remove its main manifestation - varicose veins. Surgical treatment is indicated: for patients with painful pain and constant fatigue in the legs, in the presence of edema, chronic venous insufficiency, aesthetic problems, premature hyperpigmentation (excessive deposition of pigment in the skin), external bleeding, as well as when superficial thrombophlebitis progresses, in presence of trophic ulcers that cannot be treated with conservative methods.
At the moment, the most popular are three types of operations:
- saphenous-femoral ligation (ligation and removal of the upper part of the great saphenous);
- striation of the great saphenous vein:
- traditional or Bebkokk operation, in which a special probe is inserted into the lumen of the great saphenous vein (two incisions are preliminarily made: one in the groin area, the second at the level of the upper third of the leg) and extends along its entire length , after which it is removed along with the varicose vein;
- cryostripping, an operation 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 allows it to be removed in a less traumatic way;
- Phlebectomy is a procedure to remove varicose veins through several small 2 to 3 mm incisions in the skin.
The aforementioned surgical interventions contribute to improving the patient's quality of life, their therapeutic and economic effectiveness has been demonstrated in clinical studies. 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, therefore, after surgical manipulation, temporary or even permanent numbness of some parts of the legs is sometimes observed, but this does not lead to severe disabilities.
New treatments
The main goal of using new treatment methods is to minimize tissue trauma observed during surgery, which allows the patient to recover more quickly. They began to be used extensively in the early 2000s.
Intravenous ablation (RF and laser)
Radiofrequency and laser ablation are methods of treating varicose veins in the legs by "sealing" the great saphenous (or small) with high temperature, which leads to the regression of dilated vessels (their walls stick together). While these options do not involve surgical procedures, it is quite common to resort to additional phlebectomy and sclerotherapy. Both methods involve:
- Insert a catheter into the great saphenous vein through a tiny incision in the upper third of the leg and advance under ultrasound guidance to the saphenofemoral junction. No incision is made in the groin area.
- Performed under local anesthesia (the anesthetic penetrates extensively into the subcutaneous tissue of the thigh). Additional general anesthesia may be required if a large number of miniphlebectomies are to be performed at the same time.
- The need to use bandages or stockings after the procedure for two weeks.
- The dependence of their result on the anatomy of the saphenous veins in the patient is positive in the presence of straight lines, doubtful when the vessels are tortuous.
The use of intravenous ablation, which has been widely used over the past decade, has shown no 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 likelihood of wound infection and the appearance of hematomas.
However, complications are typical of this procedure: skin burns, temporary paraesthesia, 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 the sclerosant is injected into the varicose vein, a substance that sticks to its walls, the blood flow moves to healthy vessels. Sclerotherapy is often combined with classic interventions and, in the case of telangiectasias and varicose 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 simple sclerotherapy, with foam, sclerosing is injected into a vein after mixing it with a gas (usually air). As a result, a foam is obtained, which, spreading through the vein, displaces blood from it and causes a spasm of the vessel. Manipulation is usually performed under the guidance of duplex ultrasound.
In addition to simple foam sclerotherapy, compression stockings should be worn after manipulation for 14 days.
Recovery after the procedure is faster than if a classic operation was performed. However, the medium-term treatment outcomes (the likelihood of reflux recurrence) of foam sclerotherapy are slightly worse than those of surgery.
Treatment of "microvaricose": telangiectasias, varicose veins
Treatment of varicose veins is almost always done for cosmetic reasons only, although they can sometimes cause a sensation of heat and pulsation, which indicates the presence of reflux. Two types of therapy are usually used:
- Microsclerotherapy: the introduction of a sclerosing substance using a fine needle. Usually several varicose veins sclerose at the same time. A compression bandage or stocking is applied for 1 to 2 days. If sclerosis comes out of the vessel during the injection, an ulceration may develop in this area, which heals slowly, after which a scar remains. This rarely happens, as long as "if the doctor's hands don't 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 looks like a birthmark).
There are many effective ways to get rid of varicose veins of the lower limbs offered by traditional medicine. The choice of treatment option largely depends on the patient's own decision. 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 ailment, but it is quite in the power of modern medicine to save the patient from the manifestations of the disease as much as possible and prevent its further progression.