Varicose veins of the lower extremities are correctly considered the most common pathology of peripheral vessels, it is one of the ten main 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 serious suffering and sometimes go unnoticed and do not require treatment. However, there are situations in which it is worthwhile, without postponing, to consult a specialist for the appropriate therapy. What are the treatments for varicose veins in the lower extremities? What are its advantages and disadvantages?
Ways to get rid of the disease
Thousands of people every year ask themselves: how to get rid of "ugly knots" or "vascular mesh" in the legs? The media portals are full of advertisements for public and private clinics dealing with varicose veins in the lower limbs. They offer "unique", "guaranteed", "painless" or "completely safe" ways to get rid of this disease. It is sometimes difficult to understand this ad, to answer the question of which treatment option is the most suitable. If a person who has decided to treat their dilated vessels is unsure about the safety or efficacy of this or that method of treatment, the best option for them is to contact several clinics to obtain qualified advice from at least two professionals.
There are several reasons to force a patient with varicose veins to see a doctor:
- cosmetic considerations;
- symptoms of discomfort;
- disease complications (eg, ulcers, bleeding, or thrombophlebitis);
- fear for your health (how the disease will behave in the future if left untreated).
Sometimes it is difficult for the doctor to know what the patient wants. Therefore, during the consultation, it is important to seek mutual understanding with the physician, in order to correctly convey the main reason for the contact. Often, patients simply need to make sure that their dilated veins won't harm them in any way and probably won't in the future.
If therapy is needed, the doctor usually recommends self-treatment at home within 6 months, which includes:
- wearing compression stockings;
- do regular exercise;
- avoid "long periods of inactivity" - excludes a long stay in a sitting or standing position;
- while resting (in a horizontal position), raise the "involved" limb above the level of the heart.
If, after a second visit, the patient is not satisfied with the result, the physician may recommend conservative or surgical treatment for varicose veins in the lower limbs.
Treatment options for lower limb pathology
To combat varicose veins in the legs, conservative treatment is used (compression and pharmacological therapy, lifestyle modification), surgical interventions, exposure to external and internal laser, radiofrequency ablation, injection sclerotherapy. The choice of this or that option depends on the patient's preferences. It is also influenced by the financial strength of the patient, the qualifications of physicians, and the equipment of the medical institution. However, the method of treatment of varicose veins in the lower limbs that will be used in each specific case depends very much on the disease itself: what are the symptoms, the degree of venous insufficiency and other characteristics of the vascular lesions.
Conservative Therapy Methods
Conservative treatment, as a rule, is complex and includes several components.
Lifestyle change, which involves a complex of measures aimed at preventing blood stagnation in the veins. As you know, prolonged standing or sitting levels out the activity of the venous-muscle pump (gastrocnemius muscle), which contributes to stagnation. Therefore, it is recommended that patients walk regularly, periodically raising their legs above heart level in a prone position. You should also pay attention to various diets - no salt and low calorie. They will allow you to adjust your body weight, compensating for seasonal vitamin deficiencies. 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 going to baths and saunas and, if possible, not using heated floors.
Compression stockings improve venous hemodynamics, which leads to the disappearance of many manifestations of the disease. Disadvantages of this method:
- time-limited use (there is no possibility to wear compression stockings and socks all the time);
- the appearance of discomfort with constant compression, this is especially frequently observed in the summer, when the symptoms of varicose veins are more "manifest".
The pharmacy, as a rule, offers compression stockings from only one manufacturer. However, there are many different brands, each of which can meet the patient's needs to varying degrees.
Drug treatment can eliminate the symptoms of the disease or reduce its manifestation, aim to prevent and combat its complications, and can increase the effectiveness of compression therapy. Pharmacology helps to deal with the side effects that occur after sclerotherapy or phlebectomy.
Modern treatment of varicose veins in the lower limbs is not complete without the use of venotonics (phleboprotectants), medications that can improve symptoms, strengthen the venous wall. They are considered basic pharmacotherapy agents. These include:
- Horse chestnut extract and thiamine (vitamin B1) are part of the medications used to treat pain and heaviness in the legs, edema observed in chronic venous insufficiency. The funds have shown their effectiveness in clinical trials. There are pharmaceutical forms: oral solution (10-15 drops 3 times a day) and tablet form (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.
- The deproteinized blood product from the blood of young calves is part of popular medicines, which are excellent phleboprotectors and have a good therapeutic effect on varicose veins in the lower limbs.
As a rule, venotonic is prescribed in courses. The duration of the course depends on the dynamics of symptom improvement, on the duration of remission achieved. Therefore, your doctor may vary your medication intake 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 depending on the condition and course of the disease. The therapeutic effect of these topical drugs is accomplished through two mechanisms: distraction and, in fact, therapeutic. In the first, the alcohol base or essential oils contained in the gel evaporate, which leads to a decrease in skin temperature, respectively, and improves the symptoms of the disease. From the second, the medicinal substance penetrated through the skin directly into the vein starts to exert its therapeutic effect.
Ointments and gels used for leg varicose veins are classified according to the main active ingredient they contain. They include such medicinal substances:
- Phleboprotectors (usually rutin as well as plant substances that strengthen the vessel wall).
- Nonsteroidal anti-inflammatory drugs are often used to relieve pain.
- 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 they are contraindicated.
- Proteolytic enzymes are able to effectively clear a trophic ulcer (long-range varicose vein complications in the legs).
- Ionized silver is an effective antiseptic, it cleans and dries the wound perfectly, so it is an indispensable remedy in the treatment of an infected trophic ulcer.
- Antibiotics are used topically for the infection of varicose vein complications (thrombophlebitis, dermatitis).
- Moisturizing and dermatoprotective products protect the skin from external influences, improving its elasticity. They are usually prescribed for atrophic skin changes (when compression stockings are worn for a long time).
- Heparin, in addition to its antithrombotic activity (prevents the formation of blood clots), has an anti-inflammatory effect and is capable of relieving pain.
Surgery
The main objective of surgical treatment is to eliminate the pathological mechanism that led to the onset of the disease - the venous reflex, as well as to remove its main manifestation - the 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 pigment deposition in the skin), external bleeding, as well as when superficial thrombophlebitis progresses, in the 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 superior section of the great saphenous vein);
- striping 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 preliminary incisions are made: one in the groin region, the second at the level of the upper third of the leg) and extends along its length total, after which it is removed along with the varicose vein;
- cryoextracting, an operation almost similar to the previous one, but differentiated by the fact that the tube is cooled to -85 °C, making the vein adhere to the tube, which allows its less traumatic removal;
- Phlebectomy is a procedure to remove varicose veins through several small 2-3 mm incisions in the skin.
The above surgical interventions help to improve the patient's quality of life and their therapeutic and economic effectiveness has been proven in clinical trials. They are usually performed under general anesthesia, but most patients are discharged on the day of surgery. Full recovery, returning to normal daily activities usually takes 2-3 weeks. Complications are possible, 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 observed, but this does not lead to serious disabilities.
new treatments
The main objective of using new treatment methods is to minimize tissue trauma observed during surgical interventions, which allows for a faster recovery of the patient. They began to be widely used 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 large (or small) saphenous vein with a high temperature, which leads to the regression of the dilated vessels (their walls stick together). Although these options do not involve surgical procedures, it is quite common to resort to additional phlebectomy and sclerotherapy. Both methods involve:
- Inserting a catheter into the great saphenous vein through a tiny incision in the upper third of the leg and advancing to the saphenous-femoral junction under ultrasound guidance. No incisions are made in the groin area.
- Performed under local anesthesia (the anesthetic extensively infiltrates the subcutaneous tissue of the thigh). Additional general anesthesia may be necessary if a large number of miniphlebectomies are performed at the same time.
- Need to wear dressings or stockings after the procedure for two weeks.
- The dependence of its result on the anatomy of the patient's saphenous veins is positive in the presence of straight lines, doubtful when the vessels are tortuous.
The use of intravenous ablation, 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 quick recovery after the procedure, which is associated with a lower probability of surgical wound infection and occurrence of hematoma.
However, complications are typical of this procedure: skin burns, temporary paresthesia, deep vein thrombosis (occurs in less than 1% of patients).
simple sclerotherapy
This treatment method, due to its ease of implementation and low trauma, is currently used by several 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 operations, and in the case of telangiectasia and spider veins, it is used as the sole method of therapy.
Contraindications:
- pregnancy,
- breastfeeding period,
- dermatitis,
- thrombophlebitis.
Sclerotherapy gives quite acceptable results that satisfy many patients.
Foam Sclerotherapy
Unlike simple foam sclerotherapy, the sclerosant is injected into a vein after mixing it with a gas (usually air). As a result, foam is obtained, which, spreading through the vein, draws blood from it and causes the vessel to spasm. Typically, manipulation is performed under the guidance of duplex ultrasound scanning.
As with simple foam sclerotherapy, compression stockings are required after handling for 14 days.
Recovery after the procedure is faster than if a classic operation were performed. However, the medium-term treatment outcomes (the likelihood of reflux recurrence) of foam sclerotherapy are somewhat worse than those of surgery.
Treatment of "microvarices": telangiectasia, spider veins
Treatment of spider veins is often done for cosmetic reasons only, although they can sometimes feel hot and throbbing, indicating the presence of reflux. Two types of therapy are typically used:
- Microsclerotherapy - introduction of a sclerosing substance through a fine needle. Typically, several spider veins are sclerosed at the same time. A compression bandage or sock is applied for 1 to 2 days. If the sclerosis leaves the vessel during the injection, ulceration may occur in this area, which slowly heals, after which a scar remains. This rarely happens as long as "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 treating telangiectasias (intradermal vascular growth that looks like a birthmark).
There are many effective ways to get rid of varicose veins in the lower extremities that traditional medicine offers. The choice of treatment option depends largely on the patient's own decision. Don't "go under the knife immediately" in the arsenal of doctors there are effective options for conservative therapy. According to doctors, today it is impossible to completely cure this disease, but it is within the reach of modern medicine to save the patient from the manifestations of the disease as much as possible and prevent its further progression.