phlebeurism

31 January 2024

A team of qualified cardiovascular surgeons/phlebologists at the medical clinic diagnose and treat all types of varicose veins at any stage of the disease, as well as associated pathologies. Our asset, of which we are proud, is treatment according to Israeli protocols, which show maximum effectiveness in clinical practice.

Varicose veins: The trigger for the development of varicose veins is considered to be a disturbance in the normal functioning of venous valves with the appearance of reverse flow (reflux) of blood.

As a general rule, valves that are subject to maximum mechanical stress are the first to be affected. In this case, the pathological discharge of blood occurs through the mouth of the great and small saphenous veins, sometimes through the large perforating veins. Excessive blood volume arising in the superficial veins gradually leads to excessive stretching of the venous wall. It increases the total volume of blood contained in the superficial venous bed of the lower extremities. This increased blood volume continues to drain into the deep system through the perforator veins, overstretching them. As a result, dilation and valve insufficiency occurs in the perforating veins.

Symptoms and signs of the disease

Signs of illness are not necessarily associated with pain. On the contrary, most patients state that at the beginning of the disease they are more concerned about aesthetic problems than pain.

The clinical picture depends on the location of the pathological process, as well as the stage of the disease.

Varicose veins of the lower extremities manifest themselves as follows:

Heaviness in the legs, feeling of fullness in the legs.
The appearance of cramps in the calf muscles, spasms in the feet and fingers.
Feeling tired after walking for a long time.
Ankle swelling at night.
Venous relief pattern on the skin, spider veins, spider veins.
Signs accompanying the disease are cellulite, itchy legs, dry ankles and calves, thinning and sagging skin, long-healing ulcers, uneven pigmentation - from dark spots to colorless areas, pronounced nodular formations with a color varying from blue to dark violet or burgundy. , trophic ulcers.

Progressive venous disease is accompanied by a deterioration in general well-being:

Unstable blood pressure, hypertension, hypotension.
A feeling of chronic fatigue, apathy develops.
Arrhythmia, tachycardia.
Difficulty breathing, frequent diseases of the respiratory system.

The obvious symptoms of varicose veins of the lower extremities in women may appear more intensely before menstruation and decrease afterward.

Symptoms of venous pathology in the upper extremities are characterized by numbness of the hands, spastic states of the fingers, a feeling of goosebumps, tingling and coldness.

Varicose veins of the esophagus are manifested by belching, burning sensation, pain behind the breastbone, inflammation in the esophagus and stomach, difficulty swallowing and signs of reflux esophagitis, anemia.

Diagnosis of the disease.

Effective treatment of varicose veins cannot be carried out without a preliminary comprehensive diagnosis. The diagnosis is clarified by clinical picture and data analysis after hardware studies.
The following methods are most often used for diagnosis:

duplex or triplex ultrasound angioscanning;
contrast phlebography;
MRI with venography;
contrast angiography.

To determine the presence of reflux in the affected veins and evaluate blood flow, several test manipulations are performed:

Inspection of veins with compression in different segments.
Valsalva maneuver or stress test.
Paraná test with imbalance to evaluate veins in the calf area.
Variable intensity walking test.

Additional methods to clarify the diagnosis:

Plethysmography to determine venous reflux, obstruction.
CT, MRI for visualization of tissues and structures in the affected area.
Infrared thermography to evaluate the temperature balance in the affected area of the body.
Intravascular ultrasound uses a catheter to visualize the vascular walls from the inside.

The results of any diagnostic study performed are evaluated comprehensively. Any diagnosis is helpful in determining additional treatment tactics.
Clinical laboratory tests of blood and urine complement the picture of the disease and may indicate concomitant pathologies.

How are varicose veins treated?

If alarming symptoms of varicose veins appear, a doctor should be consulted to diagnose and start treatment in a timely manner. In regional medical institutions, this problem is treated by general surgeons, in clinics - by phlebologists and angiosurgeons.

The multidisciplinary medical clinic has a well-equipped phlebology department, staffed by a team of surgeons with extensive practical experience. The center offers a high level of service and quality of treatment, which is reflected in the excellent clinical results of which we are proud.

Varicose veins of the lower extremities and other types of pathology can be treated in the early stages of development. As the process progresses, it becomes increasingly ineffective and, in part, retains only a symptomatic meaning.

Therapeutic effects cannot completely eliminate the disease, but whenever it is possible to delay the destruction of blood vessels and the development of complications, this should be done by all available means.

Conservative treatment

At the beginning of varicose vein treatment, medications are limited to venotonic agents.
To reduce the risk of thrombosis and occlusion, injections of anticoagulants and low molecular weight heparin-phragmin are used.
New oral anticoagulants.
For inflammatory phenomena in blood vessels and surrounding tissues, the use of external non-steroidal anti-inflammatory drugs with diclofenac and indomethacin is indicated.

How to additionally treat varicose veins?

In parallel with therapeutic treatment, the patient is recommended to perform certain exercises that strengthen the muscular corset of the lower extremities and have a general strengthening effect. For example, the best exercises in a lying position are the "bicycle", alternately pulling your toes towards you and straightening them, as in ballet.

You need to be careful with water and thermal procedures, because hot baths and showers, beach holidays in the sun and sunbathing can worsen the situation. The vessels should be strengthened, this is facilitated by hardening with a contrast shower, when warm and cold water is alternately poured onto the legs.
For pain, inflammation and heaviness in the legs, daily cold foot baths with decoctions of oak bark, chamomile, calendula, birch leaves, St. John's wort, white acacia flowers and horse chestnut are recommended.
It is useful to rub the freshly squeezed juice of aloe leaves into the skin, as it softens the skin and prevents inflammation.
It is worth changing your habits and quitting smoking. The diet should be dominated by foods rich in vitamins and high in fiber, fresh vegetables, citrus fruits and seafood.
You should adjust your drinking regimen by drinking enough water per day (1. 5 to 2 liters). At the same time, it is advisable to reduce the consumption of coffee, strong tea, chocolate and alcohol.

If the veins in your legs are enlarged, your doctor may recommend periodic or constant use of compression stockings.

Attention! In any case, you should listen to your doctor's recommendations and strictly follow them. Self-medication is unacceptable!

Causes of the disease

The family history of appearance allows us to conclude that varicose veins are genetically determined and can be transmitted hereditarily.

In many clinical cases it is impossible to determine the exact cause of the disease. The researchers concluded that a combination of several internal and external factors is to blame.

Causes of varicose veins:

congenital defect of the valve system;
physical inactivity, lack of activity;
the pregnancy;
working conditions with prolonged tension in the legs, long periods of standing, in a static position;
treatment with certain hormonal medications;
uncomfortable shoes, high heels;
obesity;
tight underwear, clothing that squeezes the hips and knees (for example, very tight jeans, girdles);
regular weight lifting;
systemic pathology of the kidneys, heart and blood vessels;
diabetes;
regular intestinal problems, frequent diarrhea or constipation.

Varicose veins of the lower extremities (varicose veins)- dilation of the superficial veins of the lower extremities, accompanied by valvular insufficiency and impaired blood flow. The term "varicose veins" comes from Latin. varicose veins - "swelling".

As a result, the veins stop functioning properly, the entire circulatory system is disturbed, which is complicated by stagnation, impaired trophism in tissues and blockage of blood vessels with blood clots.

Many complications are life-threatening, so if varicose veins are suspected, diagnosis and treatment must be carried out immediately and professionally.

types of disease

Blood flow in the vessels changes, slows down, and blood clots can form in the irregular walls. Changes in the functionality of blood vessels cause blood stagnation, venous insufficiency and persistent disturbances in capillary circulation in the periphery.

According to the WHO, varicose veins occur in 45% of women and 20% of men.

According to the generally accepted international CEAP classification, varicose veins are divided into six classes-stages of the disease, based on the fact that C0 is the complete absence of subjective, visual and clinical signs.

C1 – the initial stage, which is manifested by a capillary network and spider veins on the skin.
C2 – visible thickening of the veins under the skin, venous pattern on the lower extremities in the form of blue threads.
C3 - swelling of the legs appears as a result of prolonged standing or a state of rest (night sleep).
C4 - the surface of the skin changes, unevenly pigmented areas appear, venous eczema, accompanied by itching and ulcers, lipodermatosclerosis.
C5: venous ulcers on the surface of the skin that heal after a while.
C6 – non-healing venous trophic ulcers.

The classification of varicose veins of the lower extremities distinguishes between pathology in superficial and/or deep vessels, perforating communicating veins.

By origin, venous deformation can be:

congenital, manifesting in babies;
acquired;
secondary, arising against the background of other pathologies, injuries;
idiopathic, of unknown cause.

The complete classification of varicose veins of the extremities and lower organs also includes complications: reverse blood flow, reflux and/or occlusion, lumen blockage.
Varicose veins of the lower extremities are not the only manifestation of varicose veins, although they are the most common. There are also varicose veins of the esophagus, sublingual veins, retina, scrotum (varicose veins in men), stomach, cavernous bodies of the rectum (hemorrhoids), pelvic veins, female genital organs: vulva, labia, uterus.

Surgical treatment of varicose veins.

RFO (radiofrequency saphenous vein obliteration)It is a modern method of treating varicose veins. The treatment involves applying radiofrequency radiation to the inner wall of the vein. Using the thermal effect, the vein is "welded", disconnected from the general blood flow and after a few months it is replaced by connective tissue.

Advantages

The procedure is performed without general anesthesia, local anesthesia is sufficient;
Maximum safety for the patient's health
The RFA requires no special preparation;
During the manipulation, the patient does not feel pain or discomfort;
Radiofrequency ablation of lower extremity veins is very effective;
Low probability of complications, almost all patients tolerate this procedure well;
Radiofrequency ablation can be combined with mini-tributary phlebectomy or sclerotherapy;
After radiofrequency ablation there are no scars or marks;
Literally a couple of days after the procedure, the patient will be able to return to his normal lifestyle.

How's it going

The intervention is performed under ultrasound control. Before starting the procedure, local anesthesia is administered so that the patient does not feel pain or discomfort during the treatment.
Let's see how RFA is done step by step:

Before the operation, the lower extremities are carefully treated with antiseptic agents. The doctor then uses a marker to mark the vein prone to varicose veins. The doctor then inserts a radiofrequency catheter into the vein and treats the desired area with radiofrequency waves.
At the end of the procedure, the catheter is removed, the doctor applies a bandage and helps the patient put on compression garments.
The procedure lasts 30 to 50 minutes. To stop the flow of blood through a weakened vessel, it is necessary to destroy it. The body itself will then redirect the blood through healthy veins. As a result, after ablation, the walls of the veins stick together and form scar tissue inside (it is safe and not noticeable), and varicose veins disappear.

Rehabilitation

Immediately after the operation, the patient should walk (about 30 minutes) to avoid stagnation of blood and lymph. After radiofrequency ablation of the veins of the lower extremities, it is necessary to carefully follow the doctors' recommendations:

During the week, it is prohibited to increase physical activity and lift heavy objects;
It is necessary to walk more, be in the same position as little as possible (except for sleep);
For 3-4 weeks you should stop taking a hot bath, you can only shower;
You should stop visiting the bathhouse for at least a month;
It is necessary to drink as much tap water as possible, on average about 2. 5 liters, while it is necessary to minimize the amount of salt consumed;
A week after the operation, it is necessary to start physiotherapy, which the doctor will tell you about;
After radiofrequency ablation of the veins in the lower extremities, the doctor may prescribe some medications.

Following these rules will help you avoid complications and prevent further development of varicose veins.

A week after the operation, a new examination is necessary (ultrasound examination of the veins of the lower extremities). You can get more detailed information about lower extremity vein radiofrequency ablation during an in-person consultation with a specialist.

Laser coagulation of veins.

Endovasal (endovenous) laser coagulation (obliteration) of varicose veins (EVLK, EVLO) is a modern method designed to eliminate blood reflux in superficial and perforating veins using the thermal energy of laser radiation. EVLO allows you to do without incisions and does not require hospitalization of the patient in a hospital. The international term is EVLA (endovenous laser ablation).

Main stages

Venous puncture. Performed under ultrasound guidance.
Light guide positioning. The light guide is a thin optical fiber. Laser radiation is delivered to its end. The light guide is inserted into the diseased vein. Its end is installed in the place where the varicose vein empties into healthy deep veins, that is, in the anastomosis.
Tumescent anesthesia. A "cushion" of anesthetic is created around the vein to better press the vein against the light guide and prevent damage to the surrounding tissue.
Laser venous coagulation. Laser radiation is supplied to the working part of the light guide.
At the same time, the light guide is slowly removed from the vein. In this way, the laser heats the vein evenly to a temperature of 85 °C. A heated vein, like any protein, contracts when heated. The lumen of the vein disappears and the blood stops.

Rehabilitation

Immediately after the operation, the patient should walk (about 40 minutes) to avoid stagnation of blood and lymph. After EVLO of the veins of the lower extremities, it is necessary to follow the recommendations of doctors:

During the week, it is prohibited to increase physical activity and lift heavy objects;
It is necessary to walk more, be in the same position as little as possible (except for sleep);
For 3-4 weeks you should stop taking a hot bath, you can only shower;
You should stop visiting the bathhouse for at least a month;
It is necessary to drink as much tap water as possible, on average about 2. 5 liters, while it is necessary to minimize the amount of salt consumed;
A week after the operation, it is necessary to start physiotherapy, which the doctor will tell you about;
The doctor may prescribe some medications after the operation.

Sclerotherapyis a method of non-surgical (minimally invasive) removal of varicose veins and spider veins of the lower extremities.

Benefits of venous sclerotherapy:

absolute outpatient care, which requires no additional preparation,
execution speed,
without the need for anesthesia,
absence of complications typical of surgical treatment methods, such as nerve damage,
the absence of "thermally induced phlebitis", characteristic of coagulation methods, accompanied by persistent pain along the coagulated vein.

Thus, today sclerotherapy of varicose veins is an effective and safe method, which in some cases can be used as an alternative to other types of surgical interventions.

The sclerotherapy method is based on obliteration of the vein by introducing a chemical substance into its lumen, which "washes" the inner layer (endothelium) with the subsequent development of endofibrosis. The degree of endothelial damage depends on the concentration and volume of the drug administered.

The modern medical center uses advanced technologies for the treatment of varicose veins, ensuring maximum effectiveness of all treatment measures. The use of modern equipment by experienced professionals will give you relief from varicose veins in the shortest possible time, without complications and without the need for long-term rehabilitation.

Treatment in a modern clinic means health and a significant improvement in quality of life.