With varicose veins, the veins become elongated, dilated, and appear nodular.At the same time, the function of the valve mechanism is disrupted, resulting in interruption of blood flow in the affected veins.
Varicose veins not only cause visible cosmetic imperfections, but they may also be accompanied by obstruction of blood flow to the heart, stagnation of blood in organs, dermatitis, eczema, cellulite and trophic ulcers.In addition, inflammation and venous thrombosis may occur.
Symptoms include dilatation, vein tortuosity and formation of nodules, spider veins or spider veins, intermittent and then permanent swelling, bronze discoloration of the legs, inflammation of the skin and subcutaneous fat, and the development of trophic ulcers.
Fortunately, there are treatments available today for treating varicose veins that don’t require surgery.
Modern treatment without surgery
The essence of all surgeries is to eliminate varicose veins.Phlebology (the science of treating veins) has changed a lot in recent years, and now you can get rid of varicose veins quickly and easily.There are several ways to eliminate venous lesions:
- Sclerotherapy.
- Applications of bioglue.
- Laser coagulation.
- Radiofrequency ablation.
- Traditional operation.
- Venectomy.
Sclerotherapy
The essence of this technique is to use a syringe to inject a special liquid preparation - a sclerosing agent - into the diseased vein through a small puncture.
A tightly held clot "seal" forms in the vein, blocking the flow of blood in the vessel.As a result, the vein gradually dissolves.
The drug is administered under visual control and ultrasound control.This allows you to harden the blood vessels that are not visible on the surface and control the spread of the drug in the blood vessels.
To consolidate the effects of sclerotherapy injections, patients are advised to wear compression stockings for several weeks or even months.Repeated applications of sclerotherapy are often required; in this case, they talk about having a sclerotherapy course consisting of multiple sessions.
Today, sclerotherapy is used only to remove intradermal spider veins.When resecting the great saphenous vein, this technique can be used as a complement to other methods of resecting small-diameter venous tubes (EVLT, RFA, conventional surgery).
Seal veins with bioglue
A special drug can successfully close veins in different stages of varicose veins.The process is similar to the previous one, but in this case a sticky substance is introduced into the lumen, which polymerizes on contact with blood, squeezing out the blood and forming a polymer "seal."As with sclerotherapy, after venous blood flow is stopped, fibrous tissue forms and the blood vessels are partially resorbed.Materials for this process are very expensive.
Laser coagulation (EVLC)
Lasers are used for two purposes:
Endovenous laser coagulation/ablation/occlusion or endovenous laser therapy (EVLK, EVLA, EVLO, EVLT) can be used to remove both large major veins and smaller, deeper veins such as perforator veins.
The procedure requires local anesthesia and takes 20 minutes to an hour.A laser light guide is inserted into a vein through a small hole. With the help of light energy, it causes blood proteins to coagulate ("fold") and form a protein-red blood cell clot ("seal") in the lumen, thus blocking the lumen of the blood vessel.
After blood flow ceases, fibrous tissue grows within the vein lumen and then gradually subsides.
The effectiveness of the laser can be compared to vein removal.Patients can go home immediately after surgery and wear compression stockings for weeks or months.
Percutaneous laser coagulation (PLC).In this case, a focused laser beam is used to target the vein directly through the skin.This method removes only very thin, less than 0.1 mm intradermal blood vessels (usually capillaries, venules, or arterioles).The disadvantages of this method are frequent recurrences and burns.
By the way, the cost of laser treatment of varicose veins is generally lower than the price of previous methods.
Radiofrequency ablation/occlusion (RFA, RFO)
Only large veins are removed using radiofrequency ablation.The method is basically similar to laser ablation, however, with RFA, instead of a laser being applied to the vein, a very high (radio wave) frequency electrical current is applied.
RFA technology is effective, but it has a big drawback - it is quite expensive (due to the high cost of equipment and consumables).
Surgical Treatment - Phlebectomy
The operation is as shown in the figure:
- If the patient wishes;
- Large venous structures have some anatomical features that preclude minimally invasive intervention (EVLT, RFA);
- Venous thrombosis with large venous trunks.
Fortunately, the way we perform surgery to treat varicose veins (phlebectomy) today has also changed.
Previously, to remove a diseased vein, you had to make an incision along the entire length of the leg, but now just two small incisions are made (sometimes one is enough) and a special probe is used to remove the large vein.
Not only does this preserve the beauty of the leg (without leaving a very visible scar), but it makes the surgery itself less invasive and the recovery period faster.
If the situation is not serious, you don't even need to go to the hospital for surgery. You can go home after the anesthesia is over.
venous resection
It consists of the fact that, through small punctures in the skin (up to 1-2, less commonly 3 mm), the veins are caught and pulled out by special "hooks" that look like crochet hooks, where they are crossed and cut into pieces.
The surgery is performed under local or general anesthesia.Disadvantages of this surgery are labor intensity, inability to remove deep and large tree trunks, and a high proportion of residual veins and their fragments.Today, this technology is used as a complement to EVLT, RFA, or traditional surgery.
The results of minimally invasive surgery and traditional surgical methods are generally the same, depending mainly on the advanced stage of the disease.In order to obtain better treatment results, a combination of methods can be used, such as EVLT and sclerotherapy or venous resection, RFA and sclerotherapy, surgery and venous resection, etc.
Only an experienced doctor can choose a treatment option based on the anatomical characteristics of varicose veins, the extent and severity of the disease, the presence of complications, the general state of health, and taking into account the patient's personal needs and wishes.