Phlebologist on the problems of modern phlebology
Find a job you love, and then you will never have to work a single day in your life.
Revolutionary technology for the treatment of varicose veins
Modern technologies for eliminating varicose veins - laser and radiofrequency obliteration - are very good. Close to ideal. But not ideal. One of the disadvantages is the temperature effect, and it requires anesthesia. Is the new technology - VenaSeal (cyanoacrylate embolization), which does not require anesthesia - a new revolution in phlebology?
We are talking about literally sealing a vein with glue. VenaSeal technology .
The basis of treatment for varicose veins is the elimination of large incompetent veins, which are the source of filling varicose nodes. Usually these are the large or small saphenous veins, otherwise they can be called saphenous veins. In the recent past, the leading method of eliminating reflux (backflow of blood) through the saphenous veins was their removal (classical operation); today, the optimal method is the “welding” of these veins (laser or radiofrequency obliteration, or thermo-obliteration). The outcome of brewing is the independent “resorption” of the vein, its disappearance as an anatomical structure.
Thermal obliteration procedures are good for everyone, except for one thing - it is necessary to create waterproofing , a “sleeve” with an anesthetic around the vein. To do this, the surgeon makes many injections along the vein. You can see how this happens by watching our 3-minute video about radiofrequency obliteration. It is completely tolerable, and with good technique it is almost painless. But only almost. Everyone experiences this “almost” differently. Accordingly, a search is underway for a technology to turn off the saphenous vein without the need for anesthesia.
One of the results of this search was the creation of a method for sealing a vein with cyanoacrylate glue. This kind of glue has been used in vascular surgery for a very long time, more than 30 years, but somehow the idea of gluing a vein never came up.
Relatively recently, it came to light, a number of preliminary studies were carried out and, finally, more or less large-scale studies were launched, allowing us to sum up the first results and assess the prospects of the new technology.
I am familiar with two such studies. Sergei Vladimirovich Drobyazgo wrote beautifully about one of them on his website, but I will put a slightly different emphasis in reviewing this publication.
1. So, the first is a prospective cohort study conducted in several centers. The deadline for monitoring is 1 year, at which time 68 patients out of 70 recruited into the group were assessed. 70 limbs were treated. Only the saphenous vein was removed (sealed). Varicose nodes were not touched.
— absence of recanalization in 93% of cases (95% CI 87% - 99%)
— phlebitis 8 cases (11.4%), average duration 6.5 days (range 2 – 12)
— pain after the procedure (if there was no phlebitis) 5 cases (8.6%), average duration 1 day (range 0 – 12)
There were no serious complications. No paresthesia. Which sometimes occur after thermoobliteration. No knitwear was used!
Good research, however, when there is no comparison with an existing standard, we cannot understand how good the new technology really is. According to modern concepts, the effectiveness of new methods should be assessed only in comparative randomized studies. And this already exists.
2. Randomized comparison of cyanoacrylate embolization ( VenaSeal Sapheon Closure System technology, Sapheon, Inc, Morrisville, NC) and radiofrequency obliteration of the saphenous vein ( ClosureFast RFO technology , Covidien, Mansfield, Mass).
It should be noted that the correct design of the RCT was chosen - for no less effectiveness, with a permissible deviation of 10%. 222 patients (108 - cyanoacrylate embolization, CAE, and 114 - radiofrequency obliteration, RFO). The deadline for control is 3 months. Data loss – 14%.
It has been proven that saphenous vein obliteration using CAE is no less effective than ClosureFAST RFO.
— the proportion of “closure” (obliteration) of the vein is 99% for CAE and 96% for RFO.
— pain during the procedure on a 10-point scale of 2.2 points for CAE and 2.4 points for RFO.
— recording of ecchymoses (bruises) on the third day: after CAE there are significantly fewer of them.
Other side effects in both groups were minor and comparable in frequency. Authors' conclusion:
“CAE is no less effective in saphenous vein obliteration than ClosureFAST RFO, with a control period of 3 months. Both methods are safe. CAE does not require tumescent (local) anesthesia.”
What would I like to say in conclusion?
An RCT comparing CAE with radiofrequency obliteration shows approximately equal levels of pain during the procedure. Then why all this? What is the point? Theoretically, the absence of the need to perform tumescence can still be attractive for a phlebologist - there is no need to buy a pump for tumescence. But, as far as I know, so far the cost of a “gun” for sealing is such that it is equal to the cost of a pump. And the pump for RFO only needs to be purchased once. Another point is that there is no need to use an anesthetic. This can be useful when the volume of work is large, when we are approaching quantities of anesthetic that may have a toxic effect. The way to solve this problem is regional anesthesia (for example, spinal), but it is not available to everyone. Patients allergic to local anesthetic? Alternatively, though this is a rather rare event.
Another point that is currently being discussed only on the sidelines. What will ultimately happen to the vein after sealing? After tremoobliteration (laser or radiofrequency), the vein actually “resolves” and disappears. We know that the ultimate result of thermoobliteration is the same as removing a vein, but thermoobliteration techniques are generally less traumatic. And after the glue? As far as I remember, in a pilot study of VenaSeal at a period of 3 months, on ultrasound, a “plastic” strand was still hanging in the subcutaneous tissue.
As a result , in my opinion, the technology is interesting and promising. Most likely, the cost of consumables will decrease significantly with mass production, and the technology itself will improve. But for now we can only wait for this near future and distant, at least three-year, results.
Proebstle T, Alm J, Gockeritz O, et al. One year followed up of the European Multicenter Study on cyanoacrylate embolization of incompetent great saphenous veins. International Union of Phlebology World Meeting; September 8–13, 2013; Boston, MA.
And first published at the end of last year
TM Proebstle et al. The European multicenter cohort study on cyanoacrylate embolization of refluxing great saphenous veins. J Vasc Surg: Venous and Lym Dis 2014;-:1-6.
(c) Evgeny Ilyukhin
FACEBOOK PAGE WHERE ALL THIS CAN BE DISCUSSED
Effective methods of treating varicose veins eliminate the clinical signs of varicose veins, prevent the occurrence of complications, as well as relapses of the disease. An integrated approach to treatment, the use of minimally invasive techniques that complement each other, drug therapy, compression stockings, a healthy diet, and gymnastic exercises are the key to successful treatment of varicose veins.
Unpleasant symptoms of the disease force you to act independently. As a rule, having felt heaviness and heat in the legs, and noticing swelling in the ankles in the evening, a person does not see a doctor, but goes to the pharmacy, where he purchases an ointment or gel that relieves the painful manifestations of varicose veins. At first, help will be felt immediately. The venotonics contained in the ointments, which normalize the structure of the blood vessel wall, increase tone and improve microcirculation, help at first. Well relieves the manifestations of varicose veins:
The disadvantages of treatment with ointments and gels include the fact that the effect of medicinal substances is limited to superficial blood vessels; to treat internal veins, you need to take pills. Only a phlebologist can make an appointment. At this stage, the patient tries to make do with his own means and the next stage of treatment is the purchase of compression garments.
Like ointments, compression stockings, over the knee boots or tights do not solve the problem or treat varicose veins. It is very difficult to choose the right compression level on your own. Compression is prescribed by a doctor after treatment or in particularly difficult cases in the later stages of the disease. Nevertheless, wearing compression garments helps to stop varicose veins, reduce painful manifestations, a feeling of fullness, and heaviness in the legs at the end of the working day. Wearing such underwear is useful for sedentary work, when standing for a long time, and for people engaged in heavy physical labor.
There are restrictions on the use of stockings: they cannot be worn all day, since the leg muscles must work. Weakening muscle tone leads to increased manifestations of venous valve insufficiency; treatment of varicose veins with compression alone is impossible, and the disease continues to worsen. The patient faces the need to resort to effective treatment, but since going to the doctor is still scary, the person resorts to traditional methods of treatment.
Due to the prevalence of the disease, there are an endless variety of treatment options for varicose veins. In terms of accessibility and efficiency, the following stand out:
All of the listed methods of traditional medicine help reduce the manifestations of varicose veins, but are not able to cure it. In the arsenal of non-traditional methods of treating varicose veins, there are many techniques, among which hirudotherapy should be especially highlighted.
The method is aimed at reducing the manifestation of varicose veins and cannot serve as a treatment. According to supporters of hirudotherapy, the hirudin contained in the saliva of leeches with a bite enters the patient’s blood, reduces its viscosity, which reduces the risk of thrombus formation in dilated, deformed varicose vessels.
The decision on the advisability of the procedure is made by the attending physician, since there are contraindications:
Treatment of varicose veins is achieved using minimally invasive techniques, low-traumatic procedures that do not require a hospital stay, anesthesia, or long-term rehabilitation after the intervention. Non-surgical intervention can be performed in the treatment room, and there is no need to follow a special regime or prepare the operating room. Minimally invasive procedures have a less traumatic effect than surgical operations on dilated veins.
In all non-surgical methods, the impact on the patient’s body is limited to a needle prick or a small incision. In 95% of all cases of varicose veins, non-surgical interventions are used, and only 5% of patients are offered phlebectomy. Minimally invasive procedures include:
The essence of this minimally invasive method of combating varicose veins is to transform the deformed vein into a fibrous cord. The method has been known since the 17th century; acid, iodine, perchlor, and tannin were used as a sclerosant injected into a vein. The reagents produced many side effects. With the advent of fibrovein sclerosant in the 20th century, this treatment method became widespread. The decision to use sclerotherapy is made by the doctor based on the results of an ultrasound examination.
Sclerotherapy is used as the main treatment for varicose veins of the saphenous veins and is carried out under constant ultrasound monitoring. The recently introduced method of “foam sclerotherapy” further increases the effectiveness of the procedure. This method is used for veins with a diameter of no more than 10 mm. In these cases, the intervention has virtually no complications. To consolidate the success of the procedure, the patient is recommended to walk for 30-40 minutes immediately after the intervention and wear compression stockings for a month.
The procedure is performed on an outpatient basis, takes from 30 minutes to 2 hours, the patient is able to go home independently after the manipulations. The intervention is performed under local anesthesia. A light guide is inserted into the affected vein and pushed along the vein. Then the laser is turned on and the light guide is led back. Under the influence of radiation, the blood coagulates, the walls of the blood vessels burn and stick together, forming a cord that dissolves over time. It is allowed to use light guides:
After the procedure, the patient must wear compression stockings as prescribed by the doctor and undergo examinations by a phlebologist.
The radiofrequency ablation procedure is considered one of the least traumatic and is an effective way to combat varicose veins. The method is used on veins of any diameter; thrombophlebitis and trophic skin changes are contraindications. The intervention is performed under local anesthesia and ultrasound guidance.
A radiofrequency catheter is inserted into the vein through a puncture. After inserting the catheter to the desired length, an anesthetic is injected into the tissues located around the vessel. It creates a “water feather bed” around the affected vessel, protecting surrounding tissues from the effects of radio waves. The method allows you to play sports after 15 days; this is the method preferred by most specialists.
During the intervention, the diseased vein is removed using special hooks, which are inserted into the vein under local anesthesia through an incision in the skin (up to 1 mm). The patient can begin work 3-5 days after the procedure; small bruises that form during non-surgical intervention resolve within 3-4 weeks. The patient should wear compression stockings for 1-2 weeks after the procedure. The advantages of the technique include the removal of a deformed vein and the applicability of this method to veins of any diameter.
In some cases, the only way to treat varicose veins of the lower extremities is a classic operation to remove the affected veins - phlebectomy. Anesthesia: spinal anesthesia or endotracheal anesthesia. The patient should remain in the hospital for 1-2 days after surgery. Indications for surgical intervention are:
Phlebectomy is used in cases where all other methods are ineffective. The risk of the operation is minimized today. There are a limited number of contraindications:
The operation is performed using a special probe, which is inserted into the lumen of the vein through a skin incision. The expanded area is removed by mechanical pulling. After the vein is removed, the incisions are sutured. The operation usually lasts no more than two hours.
On the first day after surgery, bed rest is recommended; with the doctor's permission, you are allowed to walk around the hospital room a little. After 2-3 days the patient is discharged home. In the postoperative period, the patient should take venotonics and drugs to reduce blood viscosity, wear compression garments for 1.5 months, perform gymnastics, and take walks.
Video about treatment methods for varicose veins:
The choice of treatment method depends on the results of a comprehensive examination of the patient; often the phlebologist turns to combined methods of treating the patient. Modern gentle methods of non-surgical procedures when treated in the early stages of the disease give excellent results. It is important not to self-medicate and not to allow varicose veins to interfere with your life.
Varicose veins are a pressing disease of our time that affects every second person in our country. It slowly and aggressively reduces the patient’s usual level of quality of life, and in some cases causes death. To prevent the progression of pathology, it is necessary to promptly seek qualified help.
Varicose veins in the legs never occur on their own. This is always accompanied by certain factors, which include:
Varicose veins of the lower extremities have quite different clinical symptoms. Initially, there is heaviness in the legs, pain and swelling. Then spider veins, hematomas, skin sensitivity disorders and night cramps appear. The culmination of varicose veins is skin hyperpigmentation and trophic ulcer.
In some cases, if varicose veins are not treated, severe complications also develop: bleeding from varicose nodes, thrombosis, phlebitis, thromboembolism.
If the patient does not undergo timely and adequate treatment, then in the future he will have to limit himself throughout his life in order to get rid of pain and complications.
The result of future treatment directly depends on the accuracy of the diagnosis. Our center has everything you need for this.
The first is the latest equipment in the form of color duplex and triplex ultrasound. Today in Moscow very few clinics use this equipment due to the fact that it is expensive equipment. Most often, the market for medical services of this kind offers phlebography, which is considered an outdated and unsafe method using radiation. We put the comfort and safety of our clients above all else, so we offer diagnostics that are extremely painless and highly accurate.
Secondly, our highly qualified specialists. All of them have completed internships in leading phlebological clinics in Europe and have extensive experience in the diagnosis and treatment of varicose veins using innovative equipment.
Patients with varicose veins who contact us always receive effective treatment without traumatic surgery, hospitalization, pain and scars.
At the same time, our services are available to a wide range of patients. The center's pricing policy is based primarily on the consistently high quality of services provided at an always affordable cost.
To treat varicose veins of the legs and lower extremities, you should contact a specialized phlebological center, and not a beauty parlor or a clinic with questionable sanitary conditions.
A unique diagnostic base and innovative equipment allow us to always provide patients with a guarantee for the treatment of varicose veins. Not a single clinic in Moscow does this, since they use outdated equipment, which in some cases leads to complications.
We use modern technologies that completely eliminate medical errors and allow us to control and perform all manipulations automatically.
In particular, we use:
The cost of each procedure includes free observation with ultrasound control for 6 months. At the same time, the patient can count on European-level medical care and affordable prices for treatment of leg veins.
New technologies in the treatment of varicose veins
The first publications about the laser method of treating varicose veins in Russia appeared in 2002. By 2004, there were only a few phlebologists in our country who widely used this method in their practice, and some of them created our Innovative Vascular Center.
The total experience of phlebologists at the Innovative Vascular Center exceeds 10,000 operations of endovenous laser treatment of varicose veins, without any serious complications. The relapse rate within 5 years does not exceed 5% and is eliminated with minimal intervention.
Automatic light guide traction. A unique proposal that made it possible to obtain a detailed understanding of the mechanism of laser treatment of varicose veins. The use of this device made it possible to standardize the EVLT method and make treatment results predictable.
Introduction of hydraulic pumps into domestic practice. For the first time in Russia, the Innovative Vascular Center began using an electric hydropump for local anesthesia during laser coagulation of veins. Such a hydropump allows you to almost completely avoid postoperative hematomas and reduce the likelihood of sensitivity disorders after EVLT.
Development of laser treatment technology for lateral and accessory varicose veins. Works by Parikov M.A. the need for laser treatment of accessory trunks of the great saphenous vein during their varicose transformation is shown. This approach makes it possible to preserve the intact main trunks of the great saphenous veins and makes laser phlebology a highly accurate treatment method.
Collegial relations with leading phlebologists in Europe. Our phlebologists maintain close professional contacts with the world's leading phlebologists. Several times a year, lectures and reports are held at the international and European level on laser treatment methods. Leading phlebologists of the center are invited to participate and conduct master classes in the Baltic countries, Germany, Azerbaijan and Ukraine.
Wide range of laser technology . We have laser devices of various wavelengths and powers, which allows us to treat varicose veins without surgery in the vast majority of patients. A laser with a wavelength of 1470 nm is actively used for more effective treatment of large varicose veins. This is the most modern technology for laser vein treatment.
Laser treatment of trophic ulcers. Endovasal laser coagulation of veins is widely and successfully used by us for the treatment of trophic ulcers in patients with varicose and post-thrombotic disease.
*Calls are accepted from 10-00 to 20-00
Endovenous laser obliteration (EVLO) or endovasal laser coagulation (EVLC) in Russia has undergone significant changes over the past few years and has become an integral, and for some phlebologists, the main procedure for removing main varicose veins. These changes affect not only the laser generators used by surgeons, but also laser light guides.
The introduction of new high-energy laser units with a wavelength of 1470 nm instead of outdated generators with a wavelength of 980 nm allowed phlebologists to significantly reduce the power during the intervention (which does not lead to heating of nearby tissues). This significantly reduced pain after the procedure and, therefore, accelerated the patient’s recovery in the postoperative period.
In my daily practice, I use the latest laser generator from the German company Biolitec and reliable disposable radial light guides Radial Fiber . Radial 2 ring radial light guides on the Russian market, it has become possible to remove varicose veins of absolutely any diameter. And ultra-thin radial light guides Radial Slim allow you to seal perforating veins and tributaries of any diameter and any tortuosity.
An important point when removing main varicose veins with a laser is the sterility of the procedure. Until now, in some phlebological centers in Moscow, “disposable” light guides are sterilized. This significantly reduces the cost of the procedure, which is good for the clinic. But I don’t think you would agree that during your operation surgeons use an instrument intended for single use only, which has been sterilized several times before. Therefore, be sure to ask that the light guide be taken out from a disposable bag with special markings in front of you. Each new package has an identification number (barcode), which must be pasted into your medical history and operating log.
Safety and effectiveness of laser interventions is guaranteed only if all international standards for this procedure are observed.
Another significant factor in the popularity of laser treatment for varicose veins has been the improvement of the skills of phlebologist surgeons themselves. The doctor’s experience is not only the number of laser procedures performed, but also the correctness of their implementation, as well as an individual approach to each patient. It is no secret that each patient is individual, and in my practice I have not encountered a single patient with the same form of varicose veins. Therefore, it is important where the doctor studied laser technologies, where he learned the intricacies and intricacies of endovascular vein surgery.
The next issue I would like to focus on is the recurrence of varicose veins. Treatment and redoing of previously unsuccessful vein operations is the most difficult, time-consuming and thankless process for a phlebologist surgeon. But at the same time, this is the most interesting and memorable job for the rest of my life. After all, after unsuccessful and sometimes simply terrible operations on the veins, previously performed in ordinary surgical hospitals by ordinary surgeons, patients suffered a relapse (return of the disease) within a few months. After such interventions, the architectonics (original structure) of the vessels of the lower extremities completely changed. And the scars that remained after operations... And in order to convince the patient to go under the knife again, doctors had to make incredible efforts. Poor patients consulted several clinics and different doctors to understand what, and most importantly who, could help them. The fear of stepping on “the same rake” and getting the same result nullified all the explanations and beliefs of the surgeons.
With the advent of innovative laser technologies in the arsenal of phlebologists, the treatment of relapses has become much easier. There is no longer any need to make incisions in the projection of scar tissue. Now the entire procedure for endovenous laser coagulation in case of relapses comes down to laser sealing of the remaining varicose vein from a small puncture under ultrasound control. The result is the very next day, when swelling, pain, cramps, as well as the varicose veins themselves disappear.
Biolitec radial light guides in Moscow, laser treatment of varicose veins has become absolutely painless, and in the hands of an experienced phlebologist, safe and almost instantaneous. A phlebologist surgeon who is fluent in endovenous methods, together with the German company Biolitec , always means reliability, quality and the ability to eliminate varicose veins of any diameter without incisions or scars.
The advantages of laser intervention are:
The most frequently asked questions about the endovasal laser coagulation (EVLC) procedure:
It is necessary to consult at another clinic. Most likely, the center you contacted uses end fibers. This is an outdated technique that is no longer used in leading phlebological centers in Russia and Europe. Laser coagulation of varicose veins using modern radial light guides from Biolitec allows veins of absolutely any diameter to be sealed without incisions.
Another reason for refusing EVLT is that some phlebology clinics do not use laser coagulation at all. Misleading patients that “endovascular techniques are no longer suitable for you, but only surgery is necessary” - phlebectomy (classical removal of veins under spinal anesthesia).
If you are not confident in the correctness of your choice, consult another phlebologist and listen to his opinion. By comparing two different opinions, you can make the right decision for yourself. Sometimes I advise my patients this way if my arguments do not convince them.
There are few contraindications for EVLT. They are divided into two groups: absolute (when performing a laser is impossible in principle) and relative (when the doctor decides whether the operation can be performed or not).
Absolute contraindications to laser obliteration are: pregnancy and breastfeeding, acute myocardial infarction and acute stroke, thrombophilia, and the presence of severe concomitant pathology in the patient. Relative are: chronic arterial ischemia of the lower extremities, the presence of inflammatory foci on the skin in the intervention area, the impossibility of early activation immediately after the intervention.
No. Preoperative preparation includes standard collection of tests. There is no need to come to the procedure on an empty stomach, as it is performed under local anesthesia. On the contrary, I suggest that my patients drink a cup of coffee or tea before the intervention. There is no need to shave your leg (unless, of course, you suffer from increased hair growth). And it is very important to purchase special compression hosiery in advance. Hospital compression class II stockings will be able to be fitted for you in specialized orthopedic salons, since it is necessary to take measurements of your legs.
After the laser procedure, patients leave the clinic on their own within 15-20 minutes. They are recommended to take a quiet walk for one hour. There are no pain symptoms at all, so there is no need to observe the patient for a longer period of time. The next day, if you wish, you can go to work, which many patients do.
There are some restrictions regarding sports activities. I don't recommend putting any weight on your legs for 3-4 weeks. Play football, skate, ski and lift weights. But walking 3-4 kilometers a day improves blood circulation in the lower extremities and has a positive effect on the entire recovery period.
The price for laser treatment of varicose veins in Moscow, in leading phlebological centers, is almost the same. The cost can be reduced only through the use of cheap consumables, inexpensive laser equipment and the repeated use of outdated end-mounted optical fibers (as a rule, Russian-made). In the clinic where I work, the most modern laser device from the German company Biolitec and only disposable radial light guides are used to treat varicose veins. Therefore, the price for laser treatment of varicose veins cannot be cheap.
How much do you rate your health, your strength and experiences? The main thing is your desire to be healthy. Of all the treatment methods for varicose veins that exist today, I will select for you exactly the one that will require the least cost, both mental and physical and material.
The widespread prevalence of varicose veins has given rise to a lot of speculation on this problem. We are promised painless and quick relief from varicose veins once and for all. In this article: modern methods of treating varicose veins, advertising promises and facts, a test for predisposition to the disease.
When faced with varicose veins, you should understand
that the main danger lies in its complications . They are caused by dilated superficial veins, which have lost their original functions and pose a threat to life.
Stretched veins will no longer return to normal and will not disappear with the help of tablets, ointments, herbs, much less spells and other unconventional methods of treatment.
A complete cure for varicose veins is possible only by eliminating varicose veins and venous discharges. Some alternative medicine methods can only provide disease prevention, pain relief, and slow the progression of varicose veins.
Welcome to the site dedicated to the phenomenon of sleep and quality of life. I hope the information is useful.
Modern medicine and vascular surgery are today the only panacea and have effective cosmetic and surgical treatment methods. But first things first.
By taking internal medications you can get rid of varicose veins forever
Fact. The modern pharmaceutical market offers a large selection of venotonic drugs. The most popular: detralex, troxevasin, phlebodia, venoruton, antistax. They all have similar substances (plant flavonoids), and many have low effectiveness and side effects. Venotonics will not relieve you of varicose veins, but it is quite possible to relieve heaviness, swelling and night cramps.
Creams and gels will cure varicose veins
Fact. Sellers and manufacturers promise high effectiveness in advertisements, but you must understand that gels and creams do not get rid of varicose veins. Rubbing them in promotes venous outflow, acts as a light massage and has a soothing effect on the skin at the initial stage of the disease.
When varicose veins are advanced, some creams and ointments can cause dermatitis and allergies, which aggravates the problem. For thrombophlebitis, the use of heparin agents (Lioton, hepatrombin, thrombophob, etc.) is prescribed, which thin the blood and help relieve inflammation.
Thanks to active advertising, gels and creams with leeches are very popular. According to doctors, these shamanic products (for example, “Sophia with leeches”) have nothing to do with leeches or medicine. A waste of money and time, self-hypnosis takes place.
Fact. Leech saliva is rich in hirudin, which thins the blood. It is this fact that serves as the main point why ignorant people resort to leeches for varicose veins, confusing it with thrombophlebitis.
Blood thinning will not have any effect on varicose veins, which are caused by an increase in the venous lumen and valve insufficiency. “Leech therapists” are silent about the danger that such treatment poses.
The result of hirudotherapy can be skin pigmentation at the site of bites and prolonged bleeding from wounds. This is the best case scenario. At worst, dermatitis, lymphostasis, phlebothrombosis, and even gangrene of the limb develop.
Leech saliva contains many allergens that, in case of chronic venous stagnation, can cause inflammatory and allergic reactions that destroy the skin and aggravate varicose veins.
Phlebologists recognize such treatment as outright quackery, dangerous to the patient’s health. Hirudotherapy is especially contraindicated for trophic ulcers.
Compression knitwear eliminates the causes of varicose veins and the disease itself
Fact. The use of elastic medical compression is indicated in the initial stages of the disease before radical measures. Squeezing the veins dilated by varicose veins promotes the redistribution of blood flow from the external affected veins to the deep ones, eliminating blood stagnation in the veins.
At the same time, elastic compression does not eliminate the cause of the disease, but only simulates the situation when the veins are “sealed” or removed. Only a phlebologist can choose the correct size and recommend wearing.
Nowadays, treatment methods for varicose veins have become simpler and almost all are carried out on an outpatient basis, and if they require hospitalization, then only for one or two days. Main types of treatment: sclerotherapy, laser coagulation, radiofrequency ablation, surgery.
Experienced specialists often use several methods at once. Let's look at the most common ones, their pros and cons.
- a non-surgical method for removing diseased veins. A sclerosant, a special liquid preparation, is injected into the vessel, gluing the vein from the inside, which disappears over time. Blood stops flowing to the affected area and is redistributed through healthy veins.
Sclerotherapy was used at the beginning of the last century; nowadays the procedure has become less dangerous and traumatic. The sclerosant is injected into the diseased vein using thin needles or microcatheters. Up to 4 injections may be required per session, and the number of sessions is determined by the severity of the disease.
After injection of the drug, a compression stocking is put on the patient’s leg and he is advised to walk (up to 5 hours) to avoid thrombosis of the deep veins. Elastic compression will have to be worn during the entire treatment course and after it ends (up to 4 weeks).
Sclerotherapy improves blood flow, dilated vessels disappear, swelling, pain, cramps and increased fatigue disappear. Pigment spots that appear on top of the eliminated vein disappear over time.
Sclerotherapy includes:
Sclerotherapy guarantees long-term therapeutic and cosmetic results, and in some cases lifelong results. Only 25% of patients with advanced varicose veins cannot count on a complete cure. At the same time, the manifestation of the disease in them is significantly reduced.
Individual intolerance to sclerosants.
Taking anti-inflammatory and hormonal drugs.
Advanced cellulite in the area of affected veins.
Inflammatory and purulent diseases of the skin of the legs.
Outpatient treatment allows you to maintain your usual lifestyle.
The cosmetic effect is noticeable immediately and leaves no scars.
Minimal pain during treatment.
It is possible to eliminate several veins at the same time.
There is no guarantee of lifetime results. To achieve this, it is necessary to begin treatment by eliminating the cause of varicose veins.
Compression hosiery can be worn around the clock; it can be removed for a short time for hygiene procedures.
Laser treatment - “office surgery”
Coagulation is a laser treatment of varicose veins by closing the lumen in them. It is the latest development of German specialists and is called endovenous (intravascular) or endovasal coagulation (EVLT). Currently widely used in leading clinics in Russia and abroad.
During EVLT, damaged veins are “soldered together” (obliterated) using a high-energy laser, without incisions. For thermal laser exposure from the inside, a special fiber is inserted into the vein through a puncture, a spasm of the vein occurs, and the lumen inside it closes. The vein is excluded from the bloodstream and is subsequently replaced by connective tissue.
The degree of impact of ELVK on diseased veins is higher than that of sclerotherapy, and allows one to achieve an effect equivalent to classical vein removal.
Intravascular coagulation is recognized as the most minimally traumatic and efficient modern method of eliminating varicose veins.
The minimal time required for the operation (approximately 40 minutes) and recovery after it (up to 4 hours), local anesthesia - all these factors made it possible to call laser treatment “office surgery”. After the procedure, the patient can leave the clinic on his own and return to his workplace.
Intravascular laser obliteration is a worthy alternative to surgery:
• Excellent cosmetic effect - there are no incisions during the operation.
• Short duration of EVLT – the procedure takes no more than an hour.
• Fast rehabilitation, which makes it possible not to stop working.
• Laser coagulation is controlled by ultrasound readings, which improves the quality of treatment and minimizes postoperative complications.
• No hematomas or bruises.
• The cost of the operation may exceed 60 thousand rubles.
• The large diameter of the vein does not allow for incisions.
• A large diameter vein may dissolve later and return.
VNUS. Radiofrequency ablation
The newest method has been developed by the international scientific community with the goal of finding the most perfect remedy for varicose veins of the legs. In North America and Europe, the method has been practiced for more than 10 years; in Russia, it was recently introduced into practice by large clinics.
VNUS is an endovasal method used to treat large main veins affected by varicose veins. A radiofrequency catheter is inserted into the puncture, “sealing” the vein using microwave action. The catheter has sensors that measure the usefulness and effectiveness of thermal effects on the venous walls.
Rapid recovery of the patient (30 minutes after surgery). After a week you can go in for sports.
Absence of pain and bruises in most cases.
Burns may occur and resolve quickly.
Concentration of attention decreases on the day of surgery (you cannot drive a car or engage in other activities that require constant concentration).
In the United States, radiofrequency ablation is used much less frequently than laser coagulation. This is explained by the high cost with almost equal results. Coagulation gives a higher percentage of complete disappearance of veins thanks to the introduction of a new generation of lasers that provide higher efficiency and the absence of hematomas.
If thrombophlebitis, eczema, trophic ulcers appear, sclerotherapy and other non-surgical procedures are too late. In this case, doctors will most likely resort to surgical methods, combining them with sclerotherapy.
Many clinics offer high-tech microsurgical methods for removing diseased veins, which are low-traumatic (they allow you to remove the entire diseased vein from one small incision), cosmetic (no scars remain), and short-term (after 40 minutes the patient can be sent home).
According to phlebologists, there is no need to be afraid of removing varicose veins . Veins overflowing with blood pose a serious threat to health and life. After their elimination, blood circulation is normalized, and excess load is removed from healthy veins.
In conclusion of the article about modern methods of treating varicose veins, I would like to offer a Test. Answering the questions will not take more than 5 minutes of your time, but will allow you to determine the symptoms of varicose veins in the legs and your risk level.
Do you have a web of veins in your legs?
How often do your feet swell?
Do your legs feel tired at the end of the day?
Are you taking hormonal contraceptives or medications, for how long?
What kind of shoes do you prefer?
Are any of your relatives (parents, grandparents) susceptible to varicose veins?
Vein Exam test results:
5-15. Your veins are fine, especially if you are not bothered by swelling or fatigue. If you have to move a little, sit or stand a lot, you are at risk. Don't overlook your veins, prevention is better than cure. Eliminate factors leading to varicose veins.
20-45. You are predisposed to the disease; apparently you have the initial stage of varicose veins. Don’t let the disease get worse, contact a phlebologist. It is necessary to exclude factors that aggravate the disease.
50-70. You are highly likely to have varicose veins. You need an urgent consultation with a phlebologist who will prescribe the necessary treatment.
If you know that you are predisposed to varicose veins or have discovered the first signs, do not delay a visit to a vascular surgeon. Don't believe advertising promises, don't waste precious time.
Sources: A.A. Baeshko “Varicose veins: what to do, how to avoid”, http://varicose.com.ua/metodi_lecheniya.html.
Elena Valve for the project Sleepy Cantata.
Article protected by copyright and related rights. Any use of the material is possible only with an active link to the site
Read the following publications:
The President of the Baltic Society of Phlebologists, a member of the Latvian Association of Surgeons, the Association of the German Society of Phlebologists, a member of the Association of the Mexican, Latvian and World Phlebological Societies, Doctor of Medical Sciences Uldis Maurins, talks about the treatment of vein diseases in Latvia .
In a classic, traditional operation, the patient is hospitalized and undergoes anesthesia or spinal anesthesia. At least two incisions are made on the leg - one in the groin area, the second at the ankle. The entire vein is pulled out, removing both the diseased area and the healthy one. After stitches are placed, the patient remains in the hospital for a long time, observing bed rest. In places where veins have been removed, lumps and scars may remain for a long time, legs may swell, and skin sensitivity may be lost in some places. It is necessary to wear compression hosiery for a long time, and a person can begin the activities of everyday life, and especially work, only after a few weeks. It is worth mentioning that this classic method now ranks last among the popular methods of treating varicose veins. The reason for this is not only the duration and painfulness of the process, but also the fact that varicose veins appear again in about 20% of cases after three years at the site of the removed vein, because surgery severely injures the surrounding tissue.
Ten years ago, most operations to treat varicose veins were performed traditionally, but today in Latvia, laser is used in 90% of all cases.
Laser surgery takes half an hour
Laser surgery is incomparably more modern and less traumatic. This type of operation is performed without further hospitalization: half an hour after the procedure, the patient is able to leave the clinic on his own. He not only can, but even must walk to speed up the healing process. Many foreign patients combine business with pleasure and, having arrived in Riga for vein treatment, after the operation they go for a walk around the city.
This result is also facilitated by the fact that the operation is performed under local anesthesia; the patient is given only a few injections to inject the anesthetic into the tissue around the operated vein - no anesthesia or spinal anesthesia. The surgery on one leg lasts approximately 30 minutes.
Constant ultrasound monitoring during surgery is also important, as a result of which the variable venous blood flow is qualitatively interrupted, the trunk of the main vein shrinks and becomes clogged. Therefore, the possibility of relapse is much less.
No relapses and removal of side branches
In addition, the lateral branches are not removed immediately during surgery, since they often shrink on their own after the procedure and become invisible. According to statistics, this occurs in 80% of operated patients.
In rare cases, branches also need to be removed subsequently; as a rule, this is due to the aesthetic side of the issue, but then either other methods are used, or they are also removed under local anesthesia, which cannot be compared with relapses characteristic of classical operations.
During laser surgery, only punctures are performed: no incisions are made, and therefore no stitches are applied. This means that the cosmetic effect after the operation is excellent, there will be no scars or marks on the legs, which is undoubtedly very important for ladies.
After the operation, the patient does not need to receive injections; only painkillers are enough, and they are rarely needed. The patient can walk freely within an hour after the operation, and begins work in the coming days, depending on the nature and volume of expected loads.
An important advantage is that patients no longer have to wear compression stockings. This, firstly, is very convenient, because there are no limiting factors in choosing clothes, and secondly, it makes it possible to perform operations in the summer, which previously seemed impossible.
The doctor has no right to save on materials
Laser treatment of varicose veins has been used in world practice for more than 15 years. However, patients should be aware that laser methods are very different: there are many different lasers, and laser light guides also differ. Of course, it is difficult for patients to understand whether the laser is correct, what its wavelength is, whether it is new, or what kind of laser wire it contains. I advise you to choose a clinic where a large number of laser operations are performed, and there is no doubt about their quality, where the latest technologies are used. It is important to take into account the reputation of the medical clinic. I especially recommend that you beware of doctors and clinics that use laser wires repeatedly to save money. In Europe, it is legally prohibited to reuse laser wire.
Repeated insertion of a wire into a person's blood increases the risk of blood poisoning, HIV or AIDS, hepatitis and other diseases. In addition, with repeated use, the laser wire loses its properties: the ability to transmit laser energy decreases. Therefore, before deciding to have an operation, it is worth studying the proposed methods and clarifying whether this technology is registered in the country.
Tips for choosing a clinic
The patient should focus on modern technologies, choose a clinic with a good reputation and extensive experience in this area. We need to look at what methods are offered, how many operations are performed, what kind of operations they are.
There is no doubt that laser surgery is the most painless, effective and fastest way to treat varicose veins. You just need to make sure whether it is suitable in your case, and you also need to mentally prepare and learn all the nuances and features of the operation, the technologies used, so as not to encounter surprises. Having found out all the details and consulted with an experienced specialist, the dream of painless and quick relief from varicose veins can become a reality.