Treatment of varicose veins by laser coagulation. there is truth in my legs

Varicose veins, or varicose veins, in everyday life are often called "the disease of tired legs". But actually the factors causing this 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 whose end result can be the occurrence of a trophic venous ulcer.

Of course, in the overwhelming majority of cases, we are dealing with moderately severe varicose veins, which are now effectively treated with virtually no relapse. But first things first.

Why are varicose veins dangerous?

How common varicose vein disease is is difficult to say: many patients consider it an esthetic defect and do not go to the doctor. According to Western scientists, at least a quarter of the population in the United States and Europe suffers from it. In our country, the pathology was registered in more than 30 million people. At the same time, according to some studies, no more than 18% know about their illness and no more than 8% receive treatment.

Lower extremity varicose veins are a disease in which the structure of the vein wall changes. Vessels become longer, convoluted, in areas of thinning of the walls, the lumen expands, forming nodules.

Statistics
Varicose veins are a disease with a hereditary predisposition. The probability of its occurrence in people in whose family no one has suffered from venous pathology does not exceed 20%. If one of the parents is sick, the risk increases: for men - up to 25%, for women - up to 62%. In the presence of the disease in both parents, the probability of varicose veins in the offspring is 90%.

With varicose veins, the proportion of the two major structural proteins of the venous walls is disturbed:collagenandelastin. . . If collagen forms rigidity, elastin, as its name implies, is responsible for elasticity - the ability of the vein wall to return to its original state. In patients with varicose veins, the amount of this protein in the venous wall is reduced. Collagen itself also changes: instead of the predominant type III collagen, which is responsible for elasticity, the content of type I collagen - rigid, retaining residual deformation, increases. In addition, the number of smooth muscle cells that regulate the vessel lumen also changes and the ability to interact with each other is impaired. These pathological changes are hereditary in nature. So the game comes into playexternal factors:

• long-term static loads - the need to stand still or sit;
• overweight;
• pregnancy and childbirth.

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

Individually or in combination, these factors increase the pressure within the venous system of the lower extremities. The altered venous wall ceases to "hold" pressure, the vein lumen expands. As a result of the expansion of the vein's lumen, the valves, which provide blood flow in only one direction, stop working. Comes upreflux- reverse flow. The pressure inside the affected vein builds up even more and the vicious circle closes.

Increased venous pressure, combined with changes in wall structure over time, triggersinflammatory response- at 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 tissue. There they are destroyed, releasing active substances -inflammatory mediators. . . They damage surrounding cells and attractlymphocyteswhose function is to remove the damaged tissue. As a result, edema, induration (hardening) of the skin on the legs and hyperpigmentation develop. These processes can cause trophic venous ulcers. Prolonged inflammation of the venous wall also increases blood clotting. In combination with venous congestion, this leads to the fact that blood clots start to form in the varicose vein. Comes upthrombophlebitis- another dangerous complication of varicose veins.

Varicose vein manifestations are divided into objective and subjective.subjective symptoms- these are the patient's complaints about:

• heaviness in the legs;
• rapid fatigue;
• paresthesias - unpleasant "shivering" sensations, changes in sensitivity;
• burning sensation in muscles;
• pain in the legs, whose characteristic is that the intensity decreases after walking;
• swelling at night;
• restless legs syndrome - a condition in which discomfort in your legs prevents you from falling asleep;
• nocturnal cramps in the lower extremities.

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

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

• C0- there are complaints, but there are no changes in appearance, lesions in the veins can only be detected with special exams and tests;
• C1- "spiders" appear (scientific name - telangiectasias) or a network of dilated intradermal veins (reticular varicose veins) becomes visible;
• C2- the diameter of the dilated saphenous veins exceeds 3 mm, varicose ganglia appear;
• C3- the affected leg is constantly swollen;
• C4- changes appear in the surrounding tissues: the skin darkens (hyperpigmentation), eczema develops, induration of the subcutaneous tissue;
• C5- the stage of the healed ulcer;
• C6- the stage of an open ulcer.

From the fourth stage on, the described trophic skin changes can no longer be completely eliminated. Even varicose veins healed at this stage will not lead to complete resorption of hyperpigmentation or hardening. Also, it is necessary to remember about a very dangerous complication -thromboembolism. . .

on a note
30% to 60% of deaths due to sudden-onset deep vein thrombosis and additional thromboembolism occur in the setting of varicose veins in combination with undetected and not cured thrombophlebitis in time.

Therefore, you should not postpone treating varicose veins until later, especially in the context of the achievements of modern phlebology.

Modern methods of treating varicose veins

Methods and techniques that meet several criteria can be considered modern: minimal invasiveness (trauma), high efficiency, low probability of relapses and complications, and a short rehabilitation period.

• Conservative therapy.It includes the use of compression stockings, ointments and venotonics (oral medications). Current clinical guidelines suggest that venotonics can reducesubjectivemanifestations (complaints) in the early stages of the disease and reduce edema, but in no way affect the state of the venous wall itself. Different types of ointments have the same effect. Compression stockings are considered a very effective treatment for varicose veins, as it reduces the manifestations of venous insufficiency, alleviates the patient's subjective complaints and prevents the progression of varicose veins. However, compression stockings cannot cure varicose veins - dilated veins do not work properly.
• Traditional surgical removal.The affected large or small saphenous vein is tied where it flows into the deep venous system, after which it is removed with a special metallic probe. This operation is effective, but quite traumatic and requires a long recovery. There is a high probability of postoperative complications - hematomas, postoperative paresthesias and neuralgia.
• Sclerotherapy.A special drug is injected into the varicose vein, which "glues" its walls. The procedure is not very traumatic and is recommended for the treatment of small diameter veins. However, it is rarely used to remove the inoperative trunk from the great and small saphenous vein, as it is characterized by having a higher rate of recurrence. In addition, an unpleasant complication such as hyperpigmentation in sclerosis is possible.
• Intravenous laser coagulation (EVLK)- type of minimally invasive, safe, modern and effective treatment for varicose veins. It has synonymous names: endovenous laser ablation, endovasal coagulation of veins of the lower extremities, endovenous laser obliteration (EVLO). But whatever the name, the laser coagulation technique remains the same. A radial fiber optic light guide is inserted through the vein puncture. Then, with the aid of a special pump, an anesthetic solution is pumped around the vein, which not only anesthetizes the procedure, but also compresses the vein, reducing its diameter and protecting the surrounding tissues from overheating. For the procedure, modern vascular lasers are used, which generate two waves: one of them is absorbed by the blood hemoglobin, the second - by the vascular wall. Vienna is "fermenting". All steps (position of the light guide, infiltration of the solution around the vein, the "fermentation" process itself) are monitored in real time by ultrasound devices. The duration of the EVLK procedure on a limb is 30-60 minutes.

It's important to know!
The only effective method of treating varicose veins is to remove the altered vein that is unable to carry out its functions.

The advantages of laser removal method:

• Minimal trauma, which allows the procedure to be performed on an outpatient basis and under local anesthesia;
• you can go home immediately after the operation;
• quick recovery;
• good cosmetic result: no marks and scars;
• high efficiency, low relapse rate.

As endovenous laser coagulation is currently considered one of the most advanced, less traumatic and minimally invasive types of treatment for varicose veins, we will consider this technique in more detail.

Indications for laser coagulation

The main indication is varicose veins, regardless of the diameter of the venous trunk and the options for its anatomical structure. It was possible to expand the range of indications of the EVLK due to the improvement of modern equipment - two-wave lasers, radial fibers.

Contraindications for the procedure

In most cases, they boil down to the patient's severe somatic conditions:

• deep vein thrombosis (obstruction, occlusion, blockage);
• decompensated type 1 diabetes mellitus;
• severe atherosclerosis of the arteries and ischemia of the lower extremities;
• serious cardiovascular diseases: ischemic heart disease, in particular angina pectoris at rest, extensive myocardial infarction with decreased cardiac output, severe forms of cardiac arrhythmias, strokes;
• severe disorders of blood clotting, both downward and upward;
• pregnancy and breastfeeding;
• individual intolerance to the anesthetic used;
• impossibility of physical activity immediately after the procedure;
• inability to wear compression stockings.

It is characteristic that the age of the patient is not a contraindication.

How is the laser vein coagulated?

Shortly before manipulation, compression stockings for 2nd degree compression (25–32 mm Hg) should be purchased. The doctor will tell you in detail the size needed. Endovasal laser coagulation itself does not require any special preparation.

All steps of endovenous laser obliteration are performed under constant ultrasound control.

Before starting the procedure, the vein is "marked": the doctor makes marks on the skin, corresponding to the places where the blood returns, the tributaries flowing into the vein.

At the beginning of the manipulation, local anesthesia occurs, the vein is punctured (punctured). The sensations are no different from the usual intravenous injection. A radial light guide is inserted into the vein using a special catheter.

Next, a protective "sheath" of the anesthetic is created around the vein. Under ultrasound control, using a special pump, the doctor injects a local anesthetic into the space around the vessel. This not only allows pain relief, but also protects the surrounding tissue from the excess heat of the laser.

The procedure itself is EVLO varicose veins. In modern optical fibers, laser radiation is uniformly delivered around the entire circumference of the device, providing uniform heating of the vein from within. After removing the light guide, the patient is submitted to ultrasonographic monitoring of the condition of the treated vessel, as well as of the deep veins of the limb.

A compression strap is placed on the patient.

Immediately after the end of the manipulation, the patient must take a walk, lasting at least 40 minutes.

Possible complications

They are few, they are temporary and the probability of complications is mainly associated with the use of outdated medical equipment and low medical qualification.

• Deep vein thrombosis -may appear in patients with a tendency to increase thrombosis. Therefore, to avoid this complication, patients are prescribed medications that reduce blood clotting. As a rule, they are used 4-5 days after the intervention.
• Thrombophlebitis- most often associated with insufficient intensity of laser exposure.
• Pigmentation along the treated veinresolves within 1, 5–2 months.
• Feeling of "stretched" vein- passes within 1, 5 months.

In order to avoid the development of complications as much as possible, you should follow some simple rules, observance of which is necessary for successful rehabilitation.

Rehabilitation

On the first day, there may be pain and pulling along the vein. To eliminate them, conventional pain relievers are sufficient. The temperature can rise in the first few days. Just resort to traditional means to reduce it.

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

• Compression underwear -for the first 5 days, it is not removed even during a night's sleep. This is necessary for the vein to be completely "glued" and healed. Also, compression socks are only worn during the day. It is sufficient to wear compression garments for 2, 5–3 months, but if there are risk factors (sedentary lifestyle, standing work, use of female sex hormones), additional preventive use of compression stockings is desirable.
• Physical activity- It is recommended to walk at least one hour daily. But you will have to give up on intensive sports for about a month.

During the month, you should avoid hot baths, baths and saunas.

Evaluation of method effectiveness

The analysis of foreign and national publications shows that the efficiency of laser coagulation of varicose veins ranges from 93 to 100%. Failures can be attributed to several groups of factors:

• anatomical characteristics of the operated vein;
• violations of the technical performance of EVLK (insufficient laser power, insufficient compression of the vein with an anesthetic solution);
• non-compliance by the patient with the rules of the postoperative regimen (usually - refusal of compression).

The immediate and long-term results of laser coagulation of the veins of the lower extremities are better than those of radiofrequency ablation and sclerotherapy, and are comparable to traditional surgical techniques. At the same time, laser treatment of varicose veins is much better tolerated, rehabilitation time is shorter and the number of complications lower than in classic operations.

How much does EVLK cost?

The laser endovasal coagulation procedure requires high-tech equipment and expensive disposable consumables (light guides), which explains its cost. The total amount will depend on the volume and complexity of the procedure, the medical equipment used and the qualification of the physician.

Therefore, intravenous laser coagulation is a modern and effective method of treating varicose veins. It presents excellent clinical results and, in fact, leaves no residue. The minimal exposure trauma allows you to return to normal life (with minor restrictions) on the day of surgery, without the need for a hospital regimen and any special recovery conditions.

How to choose a clinic

Says a vascular surgeon, phlebologist:

"The result of laser coagulation of the veins of the lower limbs depends largely on the professionalism of the medical team, as well as the technical characteristics of the equipment used. This means that the equipment used must be modern and the physicians qualified. Therefore, I would recommend choosing to choose a clinic specializing in this particular type of service, which has been operating for several years and has a proven reputation. "