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

Varicose veins are often referred to as "tired leg disease" in everyday life. In reality, however, the reasons are much more complicated. And the disease itself is by no means just a harmless cosmetic flaw. Varicose veins in the lower extremities lead to chronic venous insufficiency - a condition that can result in the occurrence of a venous trophic ulcer.

Of course, in the vast majority of cases, we are dealing with a moderate varicose vein that is currently being treated effectively and with virtually no relapse. But first the first things.

Why is varicose veins dangerous?

How common is varicose veins, it’s hard to say: many patients consider it a cosmetic defect and don’t go to the doctor. Western scientists say at least a quarter of the population in the United States and Europe suffers from this. In Hungary, the pathology has been registered in more than 30 million people. However, according to some studies, up to 18% of them know about their disease and up to 8% receive treatment.

Varicose veins of the lower extremities are diseases in which the structure of the vein wall changes. The vessels lengthen, become confused, the lumen expands and forms nodes in the areas of wall thinning.

Statistics
Varicose veins are an inherited disease. The probability of this occurring in those whose family has no one suffered from venous pathology is not more than 20%. If one parent is ill, the risk increases: up to 25% in men and up to 62% in women. In the presence of the disease, the probability of varicose vein in both parents is 90%.

In varicose veins, the ratio of the two main structural proteins in the venous walls is disturbed:collagenandelastin. . . When collagen forms stiffness, elastin, as its name suggests, is responsible for flexibility — the ability of the vein wall to return to its original state. In patients with varicose veins, the amount of protein in the venous wall decreases. Collagen itself is also changing: the dominant III. Instead of type collagen, the content of type I collagen, which retains rigid, permanent deformation, increases. In addition, the number of smooth muscle cells that regulate the vascular lumen also changes and the ability to interact with them deteriorates. These pathological changes are inherited. Then comes the gameExternal factors:

• long-term static loads - the need for a stationary position or seat;
• overweight;
• pregnancy and childbirth.

Some experts point to chronic constipation, tight clothing that increases intra-abdominal pressure, and high-heeled shoes that interfere with the normal functioning of the leg muscle pump as predisposing factors.

These factors, individually or in combination, increase the pressure in the venous system of the lower extremities. The altered venous wall ceases to "hold" the pressure, the lumen of the vein dilates. As a result of the dilation of the lumen of the vein, the valves, which provide blood flow in only one direction, stop. It comes uprefluxreverse outflow. The pressure inside the affected vein rises even further and the vicious circle closes.

Increased venous pressure and changes in wall structure over time trigger it togetherinflammatory response- first only on the surface of the valves and on the inner wall of the vessels. Gradually, inflammatory proteins and blood cells begin to "leak" through the damaged venous wall into the surrounding tissues. There they are destroyed, releasing active ingredients -inflammatory mediators. . . They damage the surrounding cells and attract themlymphocyteswhose task is to remove the damaged tissue. As a result, edema, hardening of the skin of the legs (hardening of the skin) and hyperpigmentation develop. These processes can cause venous trophic ulcers. Prolonged inflammation of the venous wall also increases blood clotting. Combined with venous congestion, this leads to blood clots starting to form in the vein. It comes upthrombophlebitis- another dangerous complication of varicose veins.

Manifestations of varicose veins are divided into objective and subjective.Subjective symptoms- these are the patient's complaints about:

• difficulty in the legs;
• rapid fatigue;
• paraesthesia - "goosebumps" discomfort, changes in sensitivity;
• burning sensation in the muscles;
• foot pain, characterized by a decrease in intensity after walking;
• swelling in the evening;
• restless legs syndrome - a condition in which the discomfort of the legs prevents you from falling asleep;
• nocturnal cramps in the lower extremities.

The combination of these symptoms and their severity is individual and does not always correlate with changes in the venous wall and surrounding tissues.

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

• C0- there are complaints, but there is no change in appearance, changes in the veins can only be detected by special examinations and tests;
• C1- "spiders" appear (scientific name - telangiectasias) or a network of intradermal varicose veins (reticular varicose veins) becomes visible;
• C2- dilated saphenous veins greater than 3 mm in diameter, varicose veins appear;
• C3- the affected foot is constantly swollen;
• C4- changes in the surrounding tissues: darkening of the skin (hyperpigmentation), development of eczema, hardening of the tissues under the skin;
• C5- the stage of the healed ulcer;
• C6- stage of open ulcer.

From the fourth phase onwards, the described trophic skin changes can no longer be completely eliminated. At this stage, even healed varicose veins do not lead to complete resorption of hyperpigmentation or induration. In addition, one must remember a rather dangerous complication -thromboembolism. . .

For a note
30-60% of deaths due to sudden deep vein thrombosis and further thromboembolism occur in the background of varicose veins, and thrombophlebitis is not detected and cured in time.

Therefore, the treatment of varicose veins should not be postponed, especially in the context of the achievements of modern phlebology.

Modern methods for treating varicose veins

Methods and techniques that meet several criteria can be considered modern: minimal invasiveness (trauma), high efficacy, low likelihood of relapses 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 may reduce itsubjectivemanifestations (complaints) in the early stages of the disease and reduce edema, but in no way affect the condition of the venous wall. Different ointments have the same effect. Compression stockings are considered to be a very effective treatment for varicose veins as it reduces the manifestations of venous insufficiency, alleviates the patient’s subjective complaints and prevents the varicose veins from progressing. However, compression stockings cannot cure varicose veins - dilated veins will not function properly.
• Conventional surgical removal.The affected large or small saphenous vein is ligated at the site of inflow into the deep vein system and then removed with a special metal probe. This operation is effective but quite traumatic and requires a long recovery. There is a high probability of postoperative complications - hematomas, postoperative paraesthesia and neuralgia.
• Sclerotherapy.Inside the varicose veins, a special drug is injected that "glues" the walls. The procedure is recommended for the treatment of low-traumatic and small-diameter veins. However, it is rarely used to remove inoperable strains of large and small saphenous veins because it is characterized by a higher recurrence rate. In addition, an unpleasant complication such as hyperpigmentation in sclerosis is possible.
• Endovenous laser coagulation (EVLK)- minimally invasive, safe, modern and effective treatment for varicose veins. It has synonymous names: endovenous laser ablation, endovascular coagulation of the veins of the lower extremities, endovenous laser obliteration (EVLO). But whatever its name, the laser coagulation technique remains the same. The radial fiber optic light guide is inserted into the vein through the hole. A special anesthetic solution is then pumped around the vein, which not only anesthetizes the procedure but also compresses the vein, reducing its diameter and thus protecting the surrounding tissues from overheating. The procedure uses modern vascular lasers that generate two waves: one absorbed by the hemoglobin of the blood and the other by the vessel wall. Vienna is "baking". Each step (the position of the light guide, the infiltration of the solution around the vein, the process of "cooking") is monitored in real time by ultrasonic devices. The duration of the EVLK procedure on a limb is 30-60 minutes.

Important to know!
The only effective way to treat varicose veins is to remove the altered vein that is unable to perform its functions.

Advantages of laser removal:

• Minimal trauma that allows the procedure to be performed on an outpatient basis and under local anesthesia;
• you can go home immediately after surgery;
• rapid recovery;
• good cosmetic result: no traces or scars remain;
• high efficiency, low relapse rate.

Because endovenous laser coagulation is currently considered one of the most advanced, low-traumatic, and minimally invasive treatments for varicose veins, this technique will be examined in more detail.

Indications for laser coagulation

The main indication is varicose veins, regardless of the diameter of the venous trunk and its anatomical structure. Due to the perfection of modern equipment - two-wave lasers, radial fibers - it was possible to expand the range of EVLK signals.

Contraindications to the procedure

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

• deep vein thrombosis (occlusion, occlusion, occlusion);
• decompensated type 1 diabetes;
• severe atherosclerosis of the arteries and ischemia of the lower extremities;
• severe cardiovascular disease: ischemic heart disease, especially resting angina pectoris, extensive myocardial infarction with decreased cardiac output, severe arrhythmias, stroke;
• severe coagulation disorders, both downward and upward;
• pregnancy and lactation;
• individual intolerance to the anesthetic used;
• the impossibility of physical activity immediately after the procedure;
• inability to use compression stockings.

Typically, the age of the patient is not a contraindication.

How does laser coagulation of veins occur?

Buy compression grade 2 (25-32 mmHg) compression stockings shortly before manipulation. Your doctor will tell you in detail what size is needed. Endovascular laser coagulation alone does not require special preparation.

All stages of endovenous laser erasure are performed under constant ultrasound monitoring.

1. Before the procedure begins, the vein is "marked": the doctor places traces on the skin that correspond to the places where the blood flows back, the tributaries flowing into the vein.
2. At the beginning of the manipulation, local anesthesia occurs, the vein is punctured (punctured). Feelings are no different from a standard intravenous injection. The radial light guide is inserted into a vein using a special catheter.
3. A protective sleeve of the anesthetic drug is then created around the vein. Under ultrasound monitoring, a doctor uses a special pump to inject a local anesthetic into the space around the vessel. This not only alleviates the pain, but also protects the surrounding tissues from the excessive heat of the laser.
4. The procedure itself is EVLO varicose veins. In modern optical fibers, the laser radiation travels evenly around the entire circumference of the device, ensuring even heating of the vein from the inside. After removal of the light guide, the patient undergoes ultrasound monitoring of the condition of the treated vessel as well as the deep veins of the limb.
5. A compression suit is placed on the patient.

Immediately after completion of the manipulation, the patient should walk for at least 40 minutes.

Possible complications

There are few of them, they are temporary in nature, and the likelihood of complications is primarily related to the use of outdated medical equipment and the low skill of the physician.

• Deep vein thrombosis -may occur in patients who are prone to increased thrombosis. Therefore, to prevent this complication, patients are prescribed drugs that reduce blood clotting. It is usually used within 4-5 days of the procedure.
• Thrombophlebitis- is most often associated with insufficient intensity of laser exposure.
• Pigmentation along the treated vein1, 5-2 months will be resolved.
• Feeling of "stretched" vein- In 1, 5 months will pass.

In order to prevent complications as much as possible, you need to follow some simple rules that need to be followed for successful rehabilitation.

Rehabilitation

On the first day, there may be painful and pulling pains along the vein. Conventional painkillers are sufficient to eliminate these. The temperature may rise in the first few days. It is sufficient to use traditional tools to reduce it.

In general, 2 main conditions must be met for successful rehabilitation - wearing compression underwear and maintaining adequate physical activity.

• Compression underwear -they are not removed during the first 5 days even during sleep at night. This is necessary for the vein to be completely "glued" and healed. In addition, compression stockings are only worn during the day. It is enough to wear compression clothing for 2, 5–3 months, but if there are risk factors (sitting, standing work, taking female sex hormones), it is desirable to wear compression stockings further preventively.
• Physical activity- It is recommended to walk at least one hour a day. But you have to give up intense sports for about a month.

Avoid hot tubs, baths and saunas during the month.

Evaluating 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%. The failures can be attributed to several groups of factors:

• anatomical features of the operated vein;
• violation of the technical performance of EVLK (insufficient laser power, insufficient compression of the vein with anesthetic solution);
• the patient does not follow the rules of the postoperative system (usually - refusal of compression).

The immediate and long-term results of laser coagulation of the veins of the lower extremities are better than radiofrequency ablation and sclerotherapy and are comparable to traditional surgical techniques. However, laser treatment of varicose veins is much better tolerated, rehabilitation time is shorter, and the number of complications is less than with classical surgeries.

How much does EVLK cost?

The endovascular laser coagulation process requires state-of-the-art equipment and expensive disposable consumables (light guides), which explains its cost. The total amount depends on the amount and complexity of the procedure, the medical equipment used and the qualifications of the doctor.

Thus, endovenous laser coagulation is a modern effective method for the treatment of varicose veins. It gives excellent clinical results and leaves no residue. Minimal trauma of exposure allows you to return to normal life (with minor restrictions) as early as the day of surgery, without requiring hospitalization and special recovery conditions.

How to choose a clinic

Says a vascular surgeon, phlebologist:

"The result of laser coagulation of the veins in the lower extremities is highly dependent on the professionalism of the medical staff as well as the technical characteristics of the equipment used. This means that the equipment used must be modern and doctors must be qualified. Therefore, I suggest that you choose a clinic that specializes in this type of service and that has been operating for several years and has a good reputation. "