Varicose veins of the lower extremities has long been known to mankind. About 30% of the world population suffers from varicose veins in the legs. In 25% of patients without treatment developed severe complications (thrombophlebitis and venous ulcers). The patient it is important to understand that varicose veins – this is a complete degeneration of the venous wall and without medical intervention the disease will, unfortunately, only progress!
There are methods of conservative, surgical and not surgical treatment of varicose veins. To not operating methods belongs sclerotherapy. Today is the surgical treatment of varicose veins is one of the main. However, it is necessary to note that surgical treatment is indicated not all patients with the disease. Surgical treatments include ligation (ligation of the vein), Stripping, microphlebectomy.
Varicose veins of the lower extremities can be called "folk illness." More than 40% of women and 20% of men have signs of this disease. In 20% of cases varicose veins leads to venous ulcers, more than 25% of patients suffer thrombophlebitis varicose veins.
Hereditary – varicose veins is due to congenital weakness of the connective tissue. Such patients may also have a hernia, hemorrhoids, etc.
Overuse – prolonged static load (standing on toes) or sedentary work, lifting and carrying heavy loads, shoes with high heels, lack of exercise (inactivity) are the main contributing factors for the development of varicose veins.
Trigger of varicose veins is sudden physical exertion, pregnancy and childbirth. Under excessive load there is a rise in pressure in the veins of the lower extremities, and damage to the valve apparatus.
Chronic venous insufficiency – a typical complication of varicose veins in which the deterioration of the venous outflow causes a pathological condition called chronic venous insufficiency. The disease is slowly but continuously progressing. Swelling become permanent, there is dark coloration of skin in the ankles.
Thrombophlebitis varicose veins – in telae thrombosis venarum is the inflammation of the venous wall, with the formation in the lumen of the vein thrombus. Varicose veins thrombophlebitis occurs in 25% of patients and sometimes complicated by pulmonary embolism.
Varicose trophic ulcer is a wound that does not heal for a long time that occurs when heavy violations of the venous outflow via the deep and superficial veins. They have been reported in 1% of the total population and 20% of patients with varicose veins. Trophic ulcers appear in advanced stages of varicose veins.
Primary varicose veins – varicose disease of the lower extremities – occurs in 20-40% of the population in developed countries. For a long time, varicose veins of the legs is only a cosmetic defect, however, the progression of the disease leads to pain, swelling of feet and legs, and in advanced stages by the darkening of the skin of the legs, inflammatory changes and ulcers.
Secondary varicose veins – post-thrombotic disease. Develops after suffering a venous thrombosis or due to congenital diseases (arteriovenous fistulas, congenital venous dysplasia). Post-thrombotic disease – a serious progressive disease process in the venous system of the lower extremities. Due to valve insufficiency, which develops as a result of thrombosis, blood in the deep veins begins to move up and down, there is a secondary varicose veins and there are conditions for venous congestion, especially in the lower parts of the feet and lower legs.
Indications for sclerotherapy:
Sclerotherapy can be used as a separate method of treatment of varicose veins, as a complement to surgical methods.
Contraindications to sclerotherapy
Duration and technique of sclerotherapy
Procedure sclerotherapy lasts from 5 to 30 minutes, depending on the number of varicose veins that need to be addressed.
The procedure of sclerotherapy is the patient in a horizontal position. Before administration of the drug, the patient should raise the leg to the blood in the veins of the glass down. The purpose of this procedure is to reduce the amount of blood in the vessel to sclerosant did not dissolve in it, and acted directly on the vein wall.
During one session of sclerotherapy, the doctor can make from 5 to 10 injections. The amount of injection is determined by the severity of varicose veins and the dose of sclerosant. An average course of treatment may require 3 to 5 sessions.
The effectiveness of sclerotherapy
The advantage of sclerotherapy is much lower cost compared to surgery, no need to stay in the hospital (that is, the patient can immediately go home), as well as faster recovery period.
The effectiveness of sclerotherapy to eliminate the appearance of varicose veins reaches 85%.
Indications for surgical treatment of varicose veins
Surgical treatment of use cases where conservative treatment and lifestyle changes do not help you resolve the symptoms.
Typically, Stripping is carried out with the removal of varicose veins. Also, what method of intervention is used to prevent trophic changes in the skin in the form of ulcers.
Stripping is used, usually:
If You have both small and large varicose veins may need more than one method of treatment. Typically, the Stripping of large varicose veins is complemented by sclera therapy smaller venous branches.
Most surgical methods of treatment of varicose veins in the legs occur on an outpatient basis. That is, the patient should not be constantly in the hospital and after the operation, can immediately go home.
Contraindications to treatment by methods such as ligation and Stripping
Before surgery You will need to do the following tests:
You preferably 2 weeks before surgery do not take medicines that affect blood clotting (e.g., aspirin, cough drops). Quit Smoking 2 weeks before surgery, as Smoking harms the healing process. Refrain from drinking alcohol.
If there are indications carried out such additional tests: biochemical analysis of blood, ultrasound of internal organs, consultation of experts, etc., the Patient receives the necessary medical advice, which should be done.
Expoliantes operation can be performed under local or General anesthesia. Duration and technique of operation – Stripping.
Stripping is a minimally invasive procedure which struck Vienna is removed using a small thin probe. This involves usually two small incision – one in the region of one end of the varicose vein, the second – on the other end. After Vienna is selected, it is crossed in two places, and into the lumen of the inserted probe. The head of the probe is fixed (thread) to the end of the vein (i.e. the vein, whence came the probe). Next, the surgeon removes the probe for a vein.
Typically, Stripping is performed to remove the vein from the groin to the knee fossa or knee pit to the stone.
Advantages exuere' is the fact that it is not a long opening along the vein, but just cut at the beginning and at the end of the vein. The first of the cuts will be in the groin area, where it will completely cover of underwear.
Today apply the method short exuere'. Short Stripping is distinguished by the fact that this is removing only the affected segments of the varicose vein. But Vienna is saved, normal valve remains intact. This allows to reduce the duration of surgical intervention, trauma and improve cosmetic effect.
One of the advantages of short exuere' are: a more rapid recovery period and almost complete absence of pain syndrome in the postoperative period.
Previously, doctors believed that the conduct exuere' undesirable in the sense that if the patient ever needed heart surgery (coronary artery bypass), vein in the leg used as a shunt during this operation will not. However, today there is an opinion that varicose veins may not be complete shunts for such an operation. In addition, in most cases for such an operation, the role of the shunt may play a thoracic artery, and in addition, for such purposes you can take veins from the hands.
Ligation is the ligation of varicose veins. Usually ligaturam methods are not used separately, but only as a Supplement to the other – phlebectomy, expoliantes.
microphlebectomy is a procedure in which the varicose vein is removed through a puncture in the skin. Surgery miniphlebectomy is a minimally invasive operation, requiring to carry out a minimum of anesthesia.
miniphlebectomy is carried out using a special hook, which is inserted under the skin in the area of the varicose vein through a small incision – puncture. This hook is pulled out varicose Vienna, after which she tied and crossed. Next, the same method is removal of other veins.
Also noteworthy is the fact that the removal of the veins with a method such as Stripping or ligation, leads to the formation at the site of the varicose vein bruises (hematomas). But not to worry because they disappear after 2-3 weeks after the application of special ointments. The puncture site will remain virtually invisible scars.
Among the advantages of miniphlebectomy it is worth noting the high efficiency, low invasiveness and almost complete preservation of the health of the patient, and, of course, an excellent cosmetic effect.
After operations on the veins removal recommendations will differ for each patient – all depends on the degree of varicose veins, the extent of surgery, presence of chronic diseases.
From the first hours after surgery is recommended to roll over, bend the legs, etc. and a simple lifting of the edge of the bed by 8-10 cm greatly improves venous blood flow.
The next day after the operation is performed ligation with the use of compression hosiery or elastic bandages on both legs from the toes to the groin. Allowed to go only after ligation. After removal of veins is recommended physiotherapy and massage as a prevention of thrombosis.
7-10 days after the operation it is not necessary to exercise, and visit the bath or sauna. On the 8-9 day the stitches are removed and assigned physical therapy. Elastic compression is necessary for at least 2 months after removing the stitches.
A particularly important exercise for varicose veins for elderly patients. This is the ideal prevention of postoperative complications – the slowing down of venous blood flow and postoperative thrombosis. For the prevention of clot formation also prescribed drugs.