Varicose veins of the lower limbs are rightly considered to be the most common pathology of the peripheral blood vessels. Epidemiological studies suggest that venous insufficiency occurs in 80% of people of working age. In most cases, the varicose veins in the leg do not cause serious suffering and sometimes you do not notice at all, they do not require any treatment. Nevertheless, there are situations where it is worthwhile to consult a specialist without delay, to perform appropriate therapy. What treatments are used for varicose veins in the lower extremities? What are the advantages and disadvantages?
Ways to get rid of the disease
Every year, thousands of people ask themselves the question: how do you get rid of the "ugly lumps" or "nets" on their feet? Media portals are full of ads from public and private clinics that treat lower limb reflexes. They offer "unique", "guaranteed", "painless" or "completely safe" methods to get rid of this disease. Sometimes it’s hard to understand this ad, to answer the question of which treatment option is best suited. If a person who has chosen to deal with dilated blood vessels and is unsure about the safety or efficacy of one or another treatment method, the best solution is to visit several clinics to seek professional advice from at least two professionals. .
There are several reasons why a patient with varicose veins should see a doctor:
- cosmetic considerations;
- unpleasant symptoms;
- complications of the disease (e. g. , ulcers, bleeding, or thrombophlebitis);
- fear for your health (how the disease will behave in the future if left untreated).
Sometimes the doctor has a hard time knowing what the patient wants. Therefore, during the consultation, it is important to find a mutual understanding with the doctor, to communicate correctly the main reason for contact. Often, patients simply need to make sure that their enlarged vein does not harm them in any way, and they are unlikely to do so in the future.
If therapy is needed, your doctor will often recommend that you self-administer at home within 6 months, which includes:
- use of compression stockings;
- Regular exercise;
- avoid "long downtime" - exclude long stays in a sitting or standing position;
- while resting (in a horizontal position), raise the "endangered" limb above heart level.
If, after the second consultation, the patient is dissatisfied with the result, the doctor may recommend conservative or surgical treatment to treat varicose veins in the lower extremities.
Treatment options for lower limb pathology
Conservative treatment (compression and pharmacological therapy, lifestyle changes), surgical procedures, external and internal laser exposure, radiofrequency ablation, and injection sclerotherapy are used to fight varicose veins in the legs. The choice of this option depends on the patient's preferences. It is also influenced by the patient’s financial capabilities, the qualifications of the doctors, and the equipment of the health care facility. However, which method is used in each case to treat varicose veins in the lower extremities is highly dependent on the disease itself: what symptoms are present, the degree of venous insufficiency, and other characteristics of vascular lesions.
Conservative therapeutic methods
Conservative treatment is usually complicated and involves several ingredients.
A lifestyle change that involves a complex of measures designed to prevent blood from stagnating in the blood vessels. As you know, prolonged standing or sitting position balances the activity of the venous muscle pump (gastrocnemius muscle), which contributes to stagnation. Therefore, patients are advised to walk regularly, periodically raising their legs in a prone position above heart level. You need to pay attention to different diets as well — salt-free, low-calorie. They allow you to adjust your body weight, make up for seasonal vitamin deficiencies. It is necessary to consume foods high 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 should not use heated floors if possible.
Compression stockings improve venous hemodynamics, leading to the disappearance of many manifestations of the disease. Disadvantages of this method:
- use for a limited time (no possibility to wear compression stockings and socks permanently);
- the appearance of discomfort with constant compression, this is especially common in summer, when the symptoms of varicose veins are most "manifested. "
The pharmacy usually offers compression stockings from a single manufacturer. However, there are many different brands, each of which is able to meet the needs of the patient to different degrees.
Medication can eliminate or reduce the symptoms of the disease, prevent and combat complications, and increase the effectiveness of compression therapy. Pharmacology helps to cope with the side effects that occur after sclerotherapy or phlebectomy.
Modern treatment of varicose veins in the lower extremities is not complete without the use of venotonics (phleboprotectors), drugs that can improve symptoms, strengthen the venous wall. These are considered essential pharmacotherapeutic agents. These include:
- Horse chestnut fruit extract and thiamine (vitamin B1) are part of medicines used to treat leg pain and edema, as well as edema in chronic venous insufficiency. The funds have proven their effectiveness in clinical trials. There are dosage forms: oral solution (10-15 drops three times a day) and tablets (usually after a meal, 1 tablet three times a day).
- Butcher broom (butcher broom) is used as a food additive. It helps relieve vein congestion. It is believed to be effective against spider blood vessels. However, no clinical data on safety and efficacy have been provided.
- The low-protein hemoderivative of the blood of young calves is part of the popular drugs that are excellent phleboprotectors and have a good therapeutic effect on varicose veins in the lower extremities.
Typically, courses prescribe venotonia. The duration of the course depends on the dynamics of symptom improvement, the duration of remission achieved. Therefore, your doctor may change your dose for 3 to 6 months or more.
Ointments and gels (topical medicines) are also widely used. The treatment regimen for lower limb varicose veins is selected by the physician depending on the condition and course of the disease. The therapeutic effect of these topical drugs is realized through two mechanisms: disruptive and actually therapeutic. First, the alcohol base or essential oils in the gel evaporate, which leads to a decrease in skin temperature and improves the symptoms of the disease. As a second result, the drug begins to exert its therapeutic effect by penetrating the skin directly into the vein.
Ointments and gels used to repel the legs are classified according to the main active ingredient they contain. Such medicinal substances include:
- Phleboprotectors (usually routine as well as vascular wall strengthening plant materials).
- Non-steroidal anti-inflammatory drugs are commonly used to relieve pain.
- Topical corticosteroids are used for allergic dermatitis, which can occur as a complication of venous insufficiency.
- H1-histamine receptor blockers are prescribed instead of corticosteroids if the latter are contraindicated.
- Proteolytic enzymes are able to effectively clean the trophic ulcer (complications of retinal varicose veins in the legs).
- Ionized silver is an effective antiseptic, perfectly cleanses and dries the wound, making it an essential drug in the treatment of infected trophic ulcers.
- Antibiotics are used topically to infect complications of varicose veins (thrombophlebitis, dermatitis).
- Moisturizers and skin protectors protect the skin from external influences and improve its elasticity. They are usually prescribed for atrophic skin changes (if compression stockings are used for a long time).
- In addition to antithrombotic activity (prevents the formation of blood clots), heparin has an anti-inflammatory effect, able to relieve pain.
Surgery
The main goal of surgical treatment is to eliminate the pathological mechanism that led to the onset of the disease - the venous reflex as well as the main manifestation - the removal of varicose veins. Surgical treatment is recommended: in patients with painful pain and constant fatigue in the legs, edema, chronic venous insufficiency, cosmetic problems, premature hyperpigmentation (excessive pigmentation on the skin), external bleeding, and progressive in superficial thrombophlebitis, in the presence of trophic ulcers, can be treated by conservative methods.
Currently, the three most popular actions are:
- sapheno-femoral ligation (ligation and removal of the upper section of the large saphenous vein);
- striping of the large saphenous vein:
- a conventional or Bebkokk operation in which a special probe is inserted into the large saphenous vein (two incisions are made beforehand: one in the lumbar region, the second at the level of the upper third of the foot) and extends along its entire length and then removed along with the varicose veins;
- cryostriptation, an operation almost similar to the previous one, but differing in that the probe is cooled to -85 ° C, as a result of which the vein adheres to the probe, allowing it to be removed less traumatically;
- Phlebectomy is a procedure to remove varicose veins through several tiny incisions of 2-3 mm in the skin.
The above surgical interventions improve the patient’s quality of life, and their therapeutic and economic efficacy has been demonstrated in clinical trials. It is usually performed under general anesthesia, but the majority of patients are discharged on the day of surgery. Full recovery, a return to normal daily activity, usually takes 2-3 weeks. Complications are possible that are more common in patients with advanced varicose veins. During surgery, the nerves in the tissues under the skin can be damaged, so after surgical manipulation, temporary or even permanent numbness of some parts of the legs is sometimes observed, but this does not lead to severe disability.
New treatments
The main goal of applying the new treatment methods is to minimize the tissue traumas observed during the surgical procedures, which allows the patient to recover faster. It began to be widely used in the early 2000s.
Intravenous ablation (RF and laser)
Radiofrequency and laser ablation are methods of healing varicose veins in the legs by "closing" large (or small) sapena veins at high temperatures, leading to regression of dilated blood vessels (their walls stick together). Although these options do not involve surgery, additional phlebectomy and sclerotherapy are quite common. Both methods include:
- Insertion of a catheter into the large saphenous vein, through a small incision in the upper third of the leg, and under ultrasound guidance leading to the saphenofemoral node. No incision is made in the groin area.
- Execution under local anesthesia (the anesthetic infiltrates extensively into the subcutaneous tissue of the thigh). Additional general anesthesia may be required if a large number of miniflebectomies are to be performed simultaneously.
- The need to use a knit or stocking for two weeks after the procedure.
- Dependence of their result on the anatomy of the patient’s saphenous veins in the presence of positive straight lines is doubtful if the blood vessels are tortuous.
The use of intravenous ablation, which has been widely used in the last ten years, did not show significant differences in its effectiveness compared to surgery.
The main advantage of this technique is the rapid healing after the procedure, which results in a lower probability of the occurrence of wound infection and hematoma.
Nevertheless, complications are characteristic of this procedure: skin burns, transient paraesthesia, deep vein thrombosis (occurring in less than 1% of patients).
Simple sclerotherapy
This method of treatment is currently used by many clinics due to its easy implementation and low trauma. The point is that sclerosan is injected into the vein, a substance that sticks to its walls, the blood flow to healthy blood vessels. Sclerotherapy is often combined with classical surgeries and is the only therapeutic method for telangiectasia and spider veins.
Contraindications:
- pregnancy,
- breastfeeding period,
- dermatitis,
- thrombophlebitis.
Sclerotherapy gives acceptable results that satisfy many patients.
Foam sclerotherapy
Unlike simple sclerotherapy, with foam, sclerosant is injected into a vein after it is mixed with gas (usually air). This results in foam that spreads through the vein and displaces the blood from it and causes cramps in the vessel. Generally, manipulation is performed under the control of duplex ultrasound scanning.
In addition to simple foam sclerotherapy, compression stockings should also be worn for 14 days after manipulation.
Post-procedure recovery is faster than if a classic operation had been performed. However, the medium-term outcomes of foam sclerotherapy treatment (likelihood of recurrence of reflux) are slightly worse than surgery.
Treatment of "microvaricose": telangiectasia, spider veins
Spider veins are almost always treated for cosmetic reasons only, although they can sometimes cause a hot, throbbing sensation, indicating the presence of reflux. There are usually two types of therapy used:
- Microsclerotherapy - introduction of a sclerosing agent using a thin needle. Usually, multiple spider veins are sclerosed at the same time. The compression bandage or stocking is applied for 1-2 days. If the sclerosis gets outside the vessel during the injection, an ulcer may develop in this area, which heals slowly and then a scar remains. This is rare, provided "if the doctor's hand does not shake during surgery. "Hyperpigmentation (darkening of the skin) at the injection site is also possible.
- Laser ablation. The method works well for treating telangiectasias (intradermal vascular growth that looks like a birthmark).
Traditional medicine offers a number of effective ways to relieve varicose veins in the lower extremities. The choice of treatment option depends largely on the patient's decision. Don’t immediately "go under the knife, " there are effective options for conservative therapy in the arsenal of doctors. Doctors say it is impossible today to completely cure this disease, but the power of modern medicine completely saves the patient from the manifestations of the disease as much as possible and prevents its further progression.