Varicose veins are a widespread disease characterized by poor circulation in the lower extremities. You should consult a doctor if your legs quickly get tired and hurt, they feel heaviness, burning, and throbbing. Externally, varicose veins at the initial stage appear in the form of spider veins. If the disease is not treated, swelling, venous nodes, skin defects form, and trophic ulcers may appear.
An effective means of treating and preventing varicose veins is wearing special compression hosiery: golf, stockings or tights. Elastic underwear evenly distributes pressure on the legs, restores blood circulation, supporting blood vessels. In this case, the disease develops more slowly, reducing the risk of blockage of the vein by a blood clot.
The use of medications can reduce swelling, relieve cramps and pain. However, the use of drug therapy does not lead to complete recovery, so it is used only as part of complex treatment.
Conservative methods often include sclerotherapy. A special preparation is injected into the damaged vessel, gluing it from the inside. Used to treat veins that are not too large. It is performed under local anesthesia. After the procedure, it is recommended to wear compression garments.
The main types include:
The patient is given spinal anesthesia. This is not general anesthesia - the patient is conscious and breathing independently. The surgeon makes incisions in the skin and soft tissue through which the damaged vein is removed. After 2-3 hours, leg mobility and the ability to walk are restored. On the same day or 1-2 days after surgery, the patient is discharged home.
In some cases, when the dilated vessel is of small diameter, and surgery is not possible, phlebectomy is performed under local anesthesia.
View before surgery.
Varicose veins (tributaries of the great saphenous vein)
View after removal of veins from a puncture in combination with laser coagulation (obliteration).
Laser vein obliteration is currently considered one of the most effective methods for treating varicose veins of the lower extremities. Until recently, it was possible to get rid of varicose veins with the help of a painful and traumatic intervention performed under general or spinal (epidural) anesthesia. Features of treatment methods
Varicose veins – victims of this disease, according to statistics, are 25-30% of the female population and 15-20% of men. If left untreated, this progressive disease can cause severe complications. Also, insufficient treatment can even lead to disability. Among the most common consequences of the disease are thrombophlebitis and trophic ulcers. Features of treatment methods
An alternative to traditional methods of treatment for varicose veins is EVLT - endovasal laser coagulation. You can also find another name - endovenous obliteration, ablation. With this minimally invasive method, it is possible to eliminate blood reflux in the veins using the thermal energy of laser radiation. Features of treatment methods
Varicose veins – this disease in recent years has taken a leading place among patients in the middle age category. But increasingly, the disease also affects the younger generation. Perhaps the reasons lie in inactivity - sedentary work, resting near the TV, etc. In addition, the diet is often dominated by food that cannot be called healthy. Features of treatment methods
Sclerotherapy is a minimally invasive treatment method used for varicose veins and the treatment of telangiectasias. There is an opinion among phlebologists that this particular method can be used in most patients, even in advanced cases. Features of treatment methods
Phlebectomy – this operation is today the “gold standard” of phlebology; a huge knowledge base has been accumulated on surgical intervention. The use of modern high-tech equipment has brought the operation to a new level - techniques that seemed fantastic just recently are now quite commonplace. Features of treatment methods
Despite the fact that modern methods of treating varicose veins are extremely diverse, minimally invasive techniques that are so popular today have a number of limitations. Features of treatment methods
Phlebectomy is an operation that involves removing varicose veins in order to normalize blood flow. It should be noted that if the doctor recommends such an intervention, then you should not delay it, as this will help avoid all sorts of complications in the future. Features of treatment methods
Thrombosis of the veins of the lower extremities is characterized by the formation of blood clots that interfere with normal blood flow. Disorders in the lower extremities are more common. Blood clots can form in both superficial and deep veins - this is a more serious condition that requires emergency care. Thrombosis
As is known, the outflow of blood from the lower extremities occurs through the system of internal and superficial veins. About 90% of the total blood volume flows through the vessels located in the depths. Thrombophlebitis
Laser vein obliteration is currently considered one of the most effective methods for treating varicose veins of the lower extremities. Still n.
According to statistics, the most frequent Internet queries regarding diseases are related to treatment. It’s the same with varicose veins: people ask search engines how to deal with varicose veins, whether it can be treated at home, etc. Many people are especially interested in methods of treating varicose veins without surgery, because no one wants to go under the surgeon’s knife (or laser). Unfortunately, it is not always possible to avoid intervention. But let’s be optimistic and consider all the popular and effective methods of getting rid of the currently popular disease.
Modern methods of treating varicose veins in the legs are classified into three large groups:
Treatments for varicose veins in the legs that can be used at home without medical supervision include:
All this can be done by every person who wants to get rid of varicose veins or at least stop its progression. Varicose veins are not only unsightly swollen veins, but also periodic pain, swelling and the risk of complications. Therefore, you need to use all possible methods of protection against varicose veins.
When choosing traditional methods of treating varicose veins of the lower extremities, a person expects a quick recovery without negative consequences. But this is far from true. Traditional medicine is by no means a panacea, and this must be remembered. For what? So that there is no temptation to abandon traditional methods of treating varicose veins. The best option: combine conservative therapy and the use of traditional recipes.
You can find recipes for preparing various decoctions and tinctures for varicose veins, compresses and rubs on the Internet on forums and in health magazines. You should not choose methods that pose health risks (it is not recommended to drink vinegar or use therapeutic fasting).
Treatment with unconventional methods has been practiced for a very long time, when basic surgical operations did not yet exist. Some are skeptical about them, while others try them on themselves and achieve results. According to reviews from forums, the best methods of alternative medicine are cleansing according to Semenova and treatment with leeches.
Treatment of varicose veins using the method of Semenova Nadezhda Alekseevna, Candidate of Biological Sciences, found both support and criticism. She suggested treatment with blood purification, because... contamination of the bloodstream, in her opinion, is the main cause of the disease.
The recipe for the healing drink is as follows: 2 tbsp. Mix valerian roots with 200 g of dill seeds, add 200 ml of honey and 2 liters of boiling water. Mix everything thoroughly and leave in a thermos for a day. Take the cleansing infusion for 2 weeks 3 times a day (2 tablespoons before meals). At the same time, all other principles of anti-varicose therapy (compression, massage, ointments) are preserved.
Alternative methods also include bloodletting. It is most advisable to do this with the help of leeches, because leeches not only suck out the blood, but also simultaneously inject a special substance into it. Hirudin is a natural anticoagulant that prevents blood clotting and additionally supplies it with useful enzymes.
Surgical methods of combating varicose veins are used in extreme cases when other types of therapy are useless. The feasibility and necessity of performing an operation to remove the affected vein is determined by the doctor.
Methods of surgical treatment of varicose veins were first used at the end of the 19th century. The patient was given spinal anesthesia, after which the leg was dissected from the thigh to the lower leg to make it convenient to operate on the affected vessel. The recovery was very difficult, many people remained disabled after such operations.
Gradually, new methods of getting rid of varicose veins began to be used. An American surgeon named Babcock in 1908 tried phlebectomy - pulling out a diseased vein with a rigid metal probe.
The operation consisted of several stages:
This technology is still used today, only in a slightly improved form.
More modern methods of treating varicose veins involve preserving the problematic vessel inside the leg, but depriving it of function. Sclerotherapy refers to the gluing of vein walls. Those. the hollow vessel through which blood used to flow turns into a thin cord that does not in any way interfere with a person’s life.
Sclerotherapy today is carried out in two ways.
Before laser technology appeared, this was the most effective method of treating varicose veins, which made it possible to do without surgery as such. Gluing the vein is carried out by injecting a special solution into it - sclerosant. It is injected through the venous lumen through a thin needle. The patient feels almost nothing, and the procedure is bloodless.
If the introduction of sclerosant is popularly called vein gluing, then the effect of a laser is sealing. The laser method of treating varicose veins today is considered the most effective because it has almost no contraindications. And the rehabilitation period boils down to the fact that the person immediately after the procedure puts on compression stockings and actively moves for an hour.
Scientifically, the method is called EVLC (EVLO) - endovasal laser coagulation (obliteration). Through a thin puncture, a light guide is inserted into the vessel, at the end of which a laser beam is turned on. It seals the walls of the affected vein, simultaneously disinfecting it. All this time, the leg is scanned by an ultrasound machine, so the doctor can control his actions by looking at the monitor.
The answer to this question depends on how advanced the disease is. If a person turns to a phlebologist on time, then the methods will be painless and inexpensive. If varicose veins progress so much that the veins become very swollen and the legs swell so much that it is difficult to wear shoes, only surgery will help. This will be more expensive (especially in the case of laser therapy), but still after the procedure you will have to continue prevention for a long time.
Treatment of varicose veins, thanks to technological progress, has become completely painless, highly effective and does not require incisions or hospitalization.
The Innovative Vascular Center uses all modern methods of treating varicose veins, which can be found on this page.
Endovascular laser coagulation (EVLC) for varicose veins is an alternative to surgical treatment, not inferior to surgery in terms of effectiveness. The meaning of EVLT is to introduce a thin fiber into the lumen of a varicose vein and “evaporate” it with a laser beam. The main advantage is that it is not painful, radical, cosmetic and outpatient. Our phlebologists perform up to 1000 EVLT procedures per year.
EVLT is carried out to eliminate vertical and horizontal discharge along varicose trunks. Currently, laser coagulation can be used for any diameter of varicose veins. The advantage of laser vein treatment is that the treatment is less traumatic, has excellent cosmetic results, and allows you to go home straight away. The intervention is performed under local anesthesia. Our clinic has extensive experience in using laser methods in the treatment of varicose veins. Can be used alone or in combination with sclerotherapy and miniphlebectomy.
The second most popular method is thermal (thermal) obliteration of varicose veins. Based on the effect of microwaves on the venous wall. The results are similar to EVLT. Treatment of varicose veins with RFO has a number of advantages associated with the absence of any pain after the procedure and a reduced need for compression therapy. Therefore, the method can be used in the warm season.
The method of sclerosing therapy is the injection of a certain drug into varicose veins, which causes them to “stick together.” For primary varicose veins, it gives excellent therapeutic and cosmetic results. Innovative sclerotherapy technology (Foam-Form) allows you to “seal” even large veins with varicose veins, and not just spider veins. Phlebologists at our clinic use ultrasound-guided sclerotherapy. Thanks to sclerotherapy (Foam-Form), the number of operations for varicose veins has decreased by 3 times.
In its “pure” form it is used for the treatment of varicose veins without vertical discharge along the trunk of the great or small saphenous vein, or with a small diameter of the trunks (catheter sclerotherapy). In addition, foam sclerotherapy successfully complements laser and microsurgical treatment options, increasing the cosmeticity and radicality of the operation. Targeted sclerotherapy is very effective in the treatment of varicose trophic ulcers, especially in older people. Sclerotherapy is an outpatient procedure that does not disrupt the patient’s usual lifestyle. In the presence of very large varicose veins, it is better to use miniphlebectomy, although sclerotherapy is also possible.
Large incisions to remove varicose veins go away along with the surgeons who made them. The modern method of choosing surgical treatment for large varicose veins is miniphlebectomy. Varicose veins are removed through skin punctures under local anesthesia. In this case, invisible scars of 1-2 mm in size remain, which are practically invisible after 3-6 months. The intervention is carried out on an outpatient basis or with hospitalization for one day. The patient can walk on the first day after surgery and work after 3 days.
This is a surgical treatment of varicose veins using micro-incisions. In recent years, approaches to the surgical treatment of varicose veins have also changed; there is a constant search for new methods that, while maintaining the radicalism inherent in the very concept of surgery, would allow achieving high cosmetic results. Miniphlebectomy is performed when the diameter of the saphenous veins is large, if other treatment methods are not suitable. To perform this operation, punctures and special instruments are used, which make traces of the intervention completely invisible after just a few months. Large incisions and post-operative pain are a thing of the past. In our clinic, this operation requires hospitalization for only one day. Phlebectomy is complemented by laser treatment methods and sclerotherapy. Surgical procedures are performed only where radical treatment is impossible without them.
This disease affects about forty percent of the adult population of the planet. Varicose veins cause a whole range of associated symptoms and cosmetic defects in the appearance of the skin. Modern methods of treating varicose veins of the lower extremities in many cases make it possible to avoid surgical intervention. Varicose veins affect approximately forty percent of the adult population at some point in life. It is most common around the age of 55, but in some of the population the disease appears as early as puberty. Women are most susceptible to the disease during hormonal changes and after pregnancy.
Patients, as a rule, present with a complex of problems associated with varicose veins. Although some patients are more concerned about the symptoms of the disease, others are concerned about the cosmetic defects that the appearance of dilated veins creates.
Swelling around the ankles, itching of the skin turning into varicose eczema, tired legs, cramps, darkening of the skin, “woody” appearance of the skin, varicose ulcers indicate the progression of the disease.
In the past, surgery was the only effective treatment for varicose veins. But the operation and its consequences cause fear and reluctance in many people to undergo such procedures, so many patients prefer to live with the disease, putting up with its symptoms.
Recently, modern methods of treating varicose veins have appeared that are not associated with surgery and general anesthesia, and have much less significant side effects.
In the 90s of the twentieth century, an ultrasound control method called sclerotherapy was developed. This treatment method has achieved significant results in treating the disease. Sclerotherapy allows you to treat not only visible cosmetic defects of veins, but also their developmental anomalies hidden from view. Ultrasound injections specifically heal hidden diseased areas of the venous blood flow. This approach to treatment allows you to achieve amazing results.
In 2001, a new method of treating varicose veins with laser appeared - intravenous laser ablation. The method involves intravenous administration of a special fiber laser under ultrasound guidance. It does not require the use of general anesthesia; the operation is performed under local anesthesia at the laser site. The fiber laser is directed into the affected vein, where it is turned on, causing instant cauterization and closure of the varicose vein. This technically complex, but quite simple method from a surgical point of view has made a real revolution in the treatment of the disease. Intravenous laser ablation is currently the most effective treatment for varicose veins.
Will closing varicose veins put additional pressure on other vessels in the venous circulation?
There are two venous blood flow systems in the human leg - one is located deep under the skin in the muscles, the second is subcutaneous. The deep system performs the main function of transporting blood and ensuring good venous circulation. The blood flow through the subcutaneous system is weak and the human body can easily do without these veins. Superficial veins are located in the subcutaneous fat layer and have a fairly weak vascular wall, which causes the development of the disease. The expansion of these vessels prevents normal blood flow, the blood in them stagnates and coagulates, and blood clots clog the vein valves. The blood stagnates in them, the blood flow stops, thus, even before the disease is treated, the function of transporting venous blood is taken over by the deep veins located in the muscles. When varicose veins are closed, venous blood flow is normalized.
What is the standard treatment procedure for varicose veins?
Before starting treatment, it is necessary to carefully examine the condition of your venous blood flow in order to choose the options for the procedures you need.
A diagnostic screening test, also known as an ultrasound card, must then be performed. The test creates a “road map” of your venous blood flow, which will be used in further treatment of the disease.
Next, several treatment sessions are carried out using ultrasound injections or a fiber laser.
Then you will need to follow some simple doctor’s recommendations related to the recovery period after treatment of the disease.
Is laser treatment for varicose veins painful?
Both of the above procedures are practically painless. The needles used for injections are very thin and the procedure is less painful than taking blood for analysis. Using laser technology is completely painless. During the recovery period after the intervention, inflammation may occur, causing some discomfort, which, however, is easily relieved with conventional anti-inflammatory drugs.
What should you do at home after treatment for varicose veins of the lower extremities?
After both treatments have been completed for a certain period of time, certain requirements will need to be met. For three weeks, you must wear special surgical stockings, which are compression stockings. For a month, you should not expose your legs to prolonged stress, walk for more than an hour, or sit for more than four hours. It is necessary to lead a healthy lifestyle; release from work is not required except for the time that the treatment itself will take.
Can complications occur after treatment?
As with any medical intervention, side effects may occur. For example, deep vein thrombosis, but the possibility of such a pathology occurring is only one percent. The low chance of side effects is due to the fact that general anesthesia is not used during treatment, as a result, you can walk independently immediately after the operation, and as a rule, there is no postoperative pain.
Some blood remains in the sealed varicose vein and it takes three to four months for the body to completely absorb it. During this period, the surface of the vein will be somewhat hard and rough.
What is the cosmetic result?
After a few months, there are practically no visible skin defects left at the site of the varicose vein. Sometimes a brown pigmentation of the area may occur, caused by the pigment hemosiderin released into the surrounding tissue by the blood remaining in the closed vein. Pigmentation disappears within 6-12 months. This defect occurs in approximately 15 percent of patients.
How is the deterioration of varicose veins related to pregnancy?
Hormonal changes in a woman's body can weaken the walls of the veins. The volume of circulating blood increases, which increases the load on venous blood flow. The increasing weight and size of the uterus can put pressure on the vena cava, thereby increasing the load on the check valves in the venous circulation of the lower extremities.
How necessary is treatment for varicose veins?
For most people, varicose veins do not cause additional symptoms and are only interested in treating the condition for cosmetic reasons. Modern treatment methods, due to their simplicity, make it possible to treat the disease focusing only on the cosmetic effect. If there are concomitant symptoms of the disease, it is necessary to treat the underlying disease in order to prevent the development of symptoms. Very often, with a long course, trophic ulcers of the lower leg occur, which are very difficult to treat.
Are there other ways to treat varicose veins?
Symptoms of the disease can often be relieved by wearing special compression stockings. The underwear has the greatest degree of compression in the ankle area and the least in the knee area. This encourages blood to move through the venous circulation, relieving symptoms caused by stagnation.
There are no reliable studies showing that herbal remedies improve venous blood flow. The disease is of a mechanical nature, associated with the destruction of check valves and stretching of the walls of blood vessels, thus, conventional drug therapy for this disease is ineffective. Instead of normal venous blood flow, destroyed valves provoke abnormal stretching of blood vessels and stagnation of blood, with subsequent damage to surrounding tissues.
Between 10% and 20% of men and up to 67% of women suffer from varicose veins. This is a disease of the veins of the lower extremities, which is characterized by dilatation of the saphenous veins and incompetence of their valve apparatus. The return of blood to the heart is possible thanks to venous valves, which prevent blood from flowing back to the legs. If they fail to cope with their function, blood circulation is disrupted and pressure in the veins increases, causing them to expand. As a result, venous stagnation develops, the consequence of which is a violation of the full supply of oxygen to tissues, which in advanced cases leads to chronic venous insufficiency, manifested by edema, hyperpigmentation, thrombophlebitis, and trophic ulcers.
The most common complaints with venous disease of the lower extremities:
The best way to prevent varicose veins is to exercise regularly. Swimming and any water sports, walking, cycling and exercise bike, yoga and skiing are useful and desirable.
Regardless of the primary cause of varicose veins, the choice of treatment method is influenced by the stage of the disease, its severity, and examination data.
The purpose of the operation is to eliminate blood stagnation in varicose veins by removing these veins, eliminating the pathological flow of blood from deep veins to superficial ones. This involves removing the large or small saphenous veins, which contain incompetent valves, as well as their varicose tributaries.
The operation is usually performed under general anesthesia, using surgical incisions in several places. The percentage of complications is minimal. An important factor in preventing postoperative complications is the earliest possible activation of patients after surgery. After surgery, you will need to wear an elastic bandage for several weeks. The operation is highly effective and in more than 95% of cases there are no relapses of the disease for many years.
Intravenous treatment using laser technology and treatment using a radiofrequency generator are innovative, minimally invasive methods. Currently, in Israel, endovenous laser coagulation (EVLT-endovenous laser treatment) and radiofrequency ablation are modern alternatives to traditional vein operations.
After completing the laser or radio wave treatment, large varicose veins and nodes are treated using ultrasound-guided foam sclerotherapy (US-Guided Foam Sclerotherapy) or Ambulatory Phlebectomy. The procedure is performed under local anesthesia, which allows patients to be mobilized as early as possible after surgery, which is necessary to prevent postoperative complications. After half an hour of observation, the patient is discharged. Significant complications are very rare.
Both methods, laser and radio waves, operate on the same principle - only the energy source differs. In both cases, the procedure is carried out under ultrasound control (Duplex) and without incisions. After the procedure, an elastic stocking is put on the leg. Most patients are able to return to work within a day or two after surgery.
Treatment with laser or radio waves produces similar or better results than surgery. In any case, the undeniable advantages of modern minimally invasive treatment methods are a quick return to normal daily life, a good cosmetic effect, the absence of scars and a significant reduction in pain and discomfort during the recovery period.
With the steam therapy technique, developed in France, varicose veins are closed using steam (water vapor is used at high pressure). The SVS (Steam Vein Sclerosis) technology refers to endothermic methods and allows the treatment of not only the main vein, but also its collaterals. The intervention technique is similar to that used in laser and radio wave ablation.
The advantages of steam therapy are the early activation of the patient after treatment, the low likelihood of an allergic reaction and the absence of the need to administer sclerosing agents, as with other endothermic procedures.
Sclerotherapy is a method of treating varicose veins by injecting a special sclerosing drug into the dilated veins. The injected medicine causes local non-infectious inflammation of the vein wall and cessation of blood flow through it. The method of sclerotherapy has been known for about a hundred years and has been significantly improved in recent years. Using the drug in the form of foam allows you to reduce its concentration, increase the surface of active action, which reduces the likelihood of complications. The procedure takes a few minutes and allows you to immediately return to normal life. After treatment, you must wear an elastic stocking.
The main indications for sclerotherapy are various forms of varicose veins, including diffuse varicose veins, relapses after previous vein surgery, dilated capillary venous networks, as well as contraindications to surgical treatment. Sclerotherapy is also used as an additional procedure for endothermic vein interventions.
An important advantage of this method is that the treatment process does not affect the patient’s lifestyle. All patients continue to actively work, relax, and play sports. This procedure significantly improves blood circulation in the legs, eliminating pathological stagnation of blood in varicose veins, pain, swelling, cramps, and increased fatigue. A course of sclerotherapy consists of several sessions, which are carried out on an outpatient basis. Treatment is carried out without anesthesia. There is no need for hospitalization; after the procedure, the patient immediately returns to normal activities.
The most modern sclerotherapy technique is echo sclerotherapy ( Ultra sound - guided foam sclerotherapy ). It is based on injections of a sclerosing drug into the affected veins under the control of ultrasound duplex scanning. Ultrasound allows you to accurately localize a vein deep under the skin and inject medicine into it, which significantly increases the effectiveness and safety of sclerotherapy. In some cases, this technique can replace surgical intervention, especially in cases of recurrent varicose veins after vein removal.
In the first weeks after therapy, the patient may feel pain in the areas of closed veins; this area is sensitive and clearly visible. Over time, these symptoms disappear. Pigmentation (a change in skin color to light brown) may appear, which lightens over several months and then disappears completely.
Disadvantages of sclerotherapy: the course of treatment requires several sessions one to two weeks apart, that is, this method takes longer than thermal methods. When treating large veins, there is a greater risk of disease relapse compared to thermal methods. Possible side effects include brown pigmentation of the skin over the closed vein and, in rare cases, superficial thrombophlebitis, which can cause pain. These phenomena do not require special treatment and resolve on their own within a few weeks (phlebitis) to several months (pigmentation).
This procedure can be performed as a primary or secondary intervention after treating venous insufficiency with surgery, laser and radio wave ablation, steam therapy or foam injections. This involves multiple injections of a sclerosing agent into the dilated capillaries. A very important point is the correct choice of the concentration of the administered drug, as well as the accuracy of its introduction into the capillary, the diameter of which is usually less than 1 mm. This treatment is carried out in several sessions, the number of which depends on the area of the dilated capillaries. After each procedure, an elastic bandage must be applied. The time of wearing the bandage may vary and is determined individually by the vascular surgeon. Complications and side effects can manifest themselves in the form of burning, pain in the injection area, changes in skin color at the injection site and signs of local inflammation. In very rare cases, inflammation of the deep veins and an allergic reaction to the injected drug may occur. Pigmentation usually disappears a few months after treatment.
Modern approaches to the treatment of varicose veins have undergone significant changes in recent years. The progressive development of diagnostic tools has transformed ideas about the development and course of this common disease. Despite significant achievements in increasing the effectiveness of conservative treatment and minimizing the traumatic impact of surgical treatment, up to “surgery without incisions” or “non-surgical techniques”, the treatment of varicose veins is a purely surgical task. The introduction of intraoperative duplex angioscanning into medical practice, along with the technique of intravascular interventions, made it possible to avoid poorly tolerated types of anesthesia and made it possible to provide care to patients in a one-day hospital or on an outpatient basis. It has also become possible to safely treat advanced forms of varicose veins in patients with a large number of concomitant diseases and a high risk of complications.
Currently, various surgical treatment techniques remain one of the most effective tools in the fight against varicose veins. A timely operation can not only eliminate all manifestations of varicose veins, but also prevent the development of dangerous complications of this disease. This review provides brief information about the most effective surgical techniques for treating varicose veins.
Below is a classification of the main modern methods of surgical treatment of varicose veins of the lower extremities:
Combined phlebectomy is a traditional method of treating varicose veins, which includes several surgical stages: crossectomy, intussusception stripping, microphlebectomy. The treatment option is deservedly the “gold standard” of phlebological care. “Classical” surgical technique, which has been used to treat varicose veins for more than 100 years! Of course, during the time that has passed from the first such intervention to the present day, this technique has been polished to perfection, but its meaning has remained unchanged. It involves ligating and removing diseased veins throughout the entire limb. Today, each stage of the operation combines the principles of minimal trauma (minimally invasive) and cosmetic surgery. The main skin incision is made at the level of the inguinal fold or popliteal fossa (depending on the form of the disease), where ligation of a large main vein and its tributaries is performed at the level of its confluence with the deep veins of the limb. The main trunk of the vein of the diseased limb using special probes (modified Babcock probe or PIN stripper) is removed throughout the entire area affected by varicose veins. The least traumatic technique of “internal eversion” of the venous trunk is called intussusception stripping. Then, using micro-incisions (2-3mm) or punctures that are made along the varicose veins, the stage of microphlebectomy is performed - removal of varicose tributaries. The entire procedure is carried out using special phlebological instruments and microsurgical equipment.
Due to the vast experience accumulated by the phlebological community, any modern method of treating varicose veins is primarily compared in terms of effectiveness with this type of treatment.
The end of the twentieth century was marked by the rapid development of intravascular methods for treating various diseases. Varicose veins of large main trunks of the saphenous veins have also become possible to treat using a variety of endovascular techniques. Laser treatment of varicose veins is one of the most popular low-traumatic surgical interventions in the West. The meaning of laser treatment is the intravascular closure of the lumen of diseased veins, without their direct removal from the limb. These manipulations are performed under the mandatory control of duplex scanning of the veins of the lower extremities and require special equipment for the phlebological operating room. Exposure to laser radiation with a certain wavelength leads to the fact that a vein with varicose veins becomes denser after surgery, and then “resolves” inside the limb (so-called fibrosis of the venous trunk). The effectiveness of this technique is very high and is comparable in recent large studies to “classical” surgery – combined phlebectomy. The main difference of the laser method is its low invasiveness and excellent cosmetic results. This is due to the absence of incisions (the main stages of the intervention are performed through punctures), the absence of the possibility of traumatic effects on surrounding tissues and, as a consequence, the low frequency of complications and rapid rehabilitation of patients. During laser treatment, various anesthetic options are possible, including local anesthesia. If the laser treatment method for varicose veins is followed, the patient does not need postoperative pain relief and can be active immediately after the procedure. The length of hospital stay is determined in each case individually and most often ranges from several hours to a day. This type of treatment is also distinguished by a high cosmetic result and a low relapse rate. The laser effect is produced by a special optical fiber that transmits radiation with a given wavelength. Recent scientific studies of the spectrum of laser radiation and the nature of its emission by fiber have experimentally determined the optimal combination of these characteristics in the treatment of varicose veins. Laser radiation with a length of 1470 nm, emitted by a radial optical fiber, has the best indicators of efficiency and low trauma. The intervention is often complemented by microphlebectomy or sclerotherapy of varicose tributaries of the main veins. At the end of the operation, special compression stockings (hospital stockings) are put on to provide round-the-clock compression of the operated limb. After endovenous laser coagulation of veins has been performed, mandatory duplex monitoring of the condition of the operated limb segment is necessary.
Radiofrequency ablation of varicose veins is one of the most common surgical techniques for treating varicose veins in the United States. The radiofrequency ablation method, as well as laser treatment, is performed using intravascular technology and is largely similar in the principles of surgical execution. Varicose veins are treated with this method with the same effectiveness, and most importantly, with a lower incidence of complications than the “open” technique. In the case of radiofrequency ablation, the affected venous trunks are also not directly removed. Using puncture technology, catheterization of the main trunk of a varicose vein is performed. A guidewire and catheter are inserted into the lumen of the vein. The position of a special catheter (radiofrequency electrode) is controlled during the operation using duplex angioscanning. The operation of the electrode leads to heating of the thermoelement at the end of the catheter, which provides a therapeutic effect on the walls of the vein. Retrograde advancement of the electrode along the trunk of the vein affected by varicose veins leads to complete closure of its lumen. Then, over a period of time, the closed vein thickens and “dissolves” directly in the patient’s body. Unlike laser coagulation, radiofrequency exposure occurs at a frequency set according to the feedback principle. The device independently calculates the amount of energy required to treat each segment of a varicose vein.
The sclerotherapy method has been widely used in phlebology for a long period of time and is very popular in some European countries. The meaning of sclerotherapy is the introduction of a special drug (sclerosant) into varicose veins, which leads to “gluing” of the walls and closing the lumen of the affected area of the vein. The foam version of the injected sclerosant consistency (foam-form sclerotherapy) has the best healing properties. Most often, sclerotherapy is used for cosmetic purposes (small in diameter and superficially located varicose veins). However, for the full treatment of the main form of varicose veins (large, deeper-lying trunks, which are often the main cause of the disease), monitoring of a duplex ultrasound scanner is necessary. Using an ultrasonic sensor, a phlebologist performs puncture and catheterization of veins suffering from varicose veins, and then, by introducing a foam sclerosant, achieves uniform distribution of the drug throughout the affected venous segment. Immediately after completion of the drug administration, for a better therapeutic result, compression stockings are applied and the patient is asked to walk for some time (about 30-40 minutes). The therapeutic effect of the manipulation is monitored using duplex scanning on repeat visits. The advantage of the method is its relatively low cost and the absence of the need for anesthesia. Serious disadvantages of echosclerotherapy are; lower effectiveness in long-term observation period compared to other methods, the need for repeated manipulations and aspiration of thrombotic masses from large venous trunks to obtain a satisfactory cosmetic result.
The main goal of treatment for varicose veins remains the elimination of pathological blood flow (the so-called venous reflux), which is achieved by complete closure of the lumen or removal of veins affected by the disease and redistribution of venous blood flow among healthy veins of the limb. In practice, this goal is most often achieved by a combination of several techniques: for main veins, their removal or thermoobliteration is used (endovasal laser coagulation or radiofrequency ablation), and for tributaries (small “branches” and nodes) – removal using microphlebectomy or sclerotherapy technology. Only a specialist who has all the modern skills in diagnosing and treating varicose veins can weigh the advantages and disadvantages of treatment methods in each specific case. The choice of a combination of treatment methods that is optimal for a particular person is strictly individual and must take into account many personal factors and additional research data.
The material for MedTown was prepared by a vascular surgeon at the T. Topper Vascular Center at the Clinical Hospital named after. L.G. Sokolova, member of the European Society of Vascular Surgeons (ESVS) and the Russian Society of Angiologists and Vascular Surgeons Alexander Sergeevich Shapovalov.