Phlebeurism

31 January 2024

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

Varicose veins – the trigger for the development of varicose veins is considered a disturbance in the normal functioning of venous valves with the occurrence of reverse flow (reflux) of blood.

As a rule, valves subject to maximum mechanical stress are the first to be affected. In this case, pathological discharge of blood occurs through the mouth of the great and small saphenous veins, sometimes through the large perforating veins. The excessive volume of blood arising in the superficial veins gradually leads to excessive stretching of the venous wall. The total volume of blood contained in the superficial venous bed of the lower extremities increases. This increased blood volume continues to drain into the deep system through the perforating veins, stretching them excessively. As a result, valve dilation and insufficiency occur 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 localization 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 cellulitis, itchy legs, dry ankles and calves, thin and sagging skin, long-healing ulcers, uneven pigmentation - from dark spots to colorless areas, pronounced nodular formations with a color from bluish to dark purple or burgundy, trophic ulcers.

Progressive venous disease is accompanied by a deterioration in general health:

Unstable blood pressure, hypertension, hypotension.
Feeling of chronic fatigue, apathy develops.
Arrhythmia, tachycardia.
Shortness of breath, frequent diseases of the respiratory system.

The obvious symptoms of varicose veins of the lower extremities in women may appear stronger before menstruation and lessen after it.

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

Esophageal varicose veins are manifested by belching, burning sensation, pain behind the sternum, 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 comprehensive preliminary diagnosis. The diagnosis is clarified by the clinical picture and data analysis after hardware studies.
The following methods are most often used for diagnosis:

duplex or triplex ultrasonographic angioscanning;
contrast phlebography;
magnetic resonance imaging with venography;
contrast angiography.

To determine the presence of reflux in the affected veins and assess 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 region.
Variable intensity walking test.

Additional methods to clarify the diagnosis:

Plethysmography to determine venous reflux, obstruction.
Computed tomography, magnetic resonance imaging to visualize tissues and structures in the affected area.
Infrared thermography to assess 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 studies performed are comprehensively evaluated. Any diagnosis is of great help in determining new 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, you should consult a doctor to be diagnosed and begin treatment in a timely manner. In regional medical institutions, this issue is dealt with 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 proves to be increasingly ineffective, partially retaining only a symptomatic meaning.

Therapeutic effects cannot completely eliminate the disease, but as long as it is possible to slow down the destruction of blood vessels and the development of complications, this must 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-fragmine are used.
New oral anticoagulants.
For inflammatory phenomena in blood vessels and adjacent 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 the lying position are the "bicycle", alternately pulling your toes towards you and stretching them, like in ballet.

You should be careful with water and thermal procedures, as hot baths and showers, beach holidays in the sun with sunbathing can worsen the situation. The vessels need to be strengthened, this is facilitated by hardening with a contrast shower, when hot and cold water is alternately poured onto the legs.
For pain, inflammation and heaviness in the legs, daily 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 freshly squeezed juice from aloe leaves into the skin, as it softens the skin and prevents inflammation.
It's worth changing your habits and stopping smoking. The diet should be dominated by foods rich in vitamins and with a lot of fiber, fresh vegetables, citrus fruits and seafood.
You need to adjust your drinking regime by drinking plenty of water daily (1. 5 to 2 liters). At the same time, you should reduce the consumption of coffee, strong tea, chocolate and alcohol.

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

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

Causes of the disease

The family history of occurrence 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 the culprit is a combination of several internal and external factors.

Causes of varicose veins:

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

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

As a result, the veins stop working properly, the entire circulatory system is disturbed, complicated by congestion, disruption of trophism in tissues and blockage of blood vessels with blood clots.

Many complications are fatal, therefore, if varicose veins are suspected, diagnosis and treatment must be carried out immediately and professionally.

Types of disease

The blood flow in the vessels changes, becomes slower and blood clots can form in irregular walls. Changes in the functionality of blood vessels cause blood stagnation, venous insufficiency and persistent disorders of 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 classification CEAP, 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 – initial stage, manifested by capillary network and spider veins on the skin.
C2 – visible thickening of the veins under the skin, venous pattern in 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, areas of irregular pigmentation appear, venous eczema, accompanied by itching and ulcers, lipodermatosclerosis.
C5 – venous ulcers on the surface of the skin that heal after some time.
C6 – venous trophic ulcers that do not heal.

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 infants;
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, blockage of the lumen.
Varicose veins in 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. 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.

Benefits

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

How are you

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

Before the operation, the lower limbs are thoroughly treated with antiseptics. The doctor then uses a marker to mark the varicose-prone vein. Then, the doctor 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 the compression garment.
The procedure lasts 30 to 50 minutes. To stop the flow of blood through a weakened vessel, it must be destroyed. Then the body itself will redirect blood through healthy veins. As a result, after ablation, the walls of the veins come together and scar tissue forms inside (it is safe and imperceptible), and the varicose veins disappear.

Rehabilitation

Immediately after the operation, the patient must 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, increased physical activity and weight lifting are prohibited;
You need to walk more, stay in the same position as little as possible (except when sleeping);
For 3-4 weeks you need to stop taking hot showers, you can only take a shower;
You must stop going to the bathhouse for at least a month;
It is necessary to drink as much ordinary water as possible, on average about 2. 5 liters, at the same time it is necessary to minimize the amount of salt consumed;
A week after the operation, you need to start physiotherapy, which will be informed by the doctor;
It is possible that after radiofrequency ablation of the veins in the lower extremities, the doctor will prescribe some medications.

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

A week after the operation, it is necessary to re-examine (ultrasound examination of the veins of the lower limbs). You can get more detailed information about radiofrequency ablation of lower extremity veins 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 backflow in superficial and perforating veins using the thermal energy of laser radiation. EVLO allows for no incisions and does not require the patient to be hospitalized. The international term is EVLA (endovenous laser ablation).

Main steps

Venous puncture. Performed under ultrasound guidance.
Light guide positioning. The light guide is a thin optical fiber. Laser radiation is delivered to your end. The light guide is inserted into the diseased vein. Its end is installed at the point where the varicose vein enters the healthy deep veins, that is, at the anastomosis.
Tumescent anesthesia. An anesthetic "cushion" is created around the vein to better press it 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 withdrawn from the vein. Thus, the vein is uniformly heated by the laser to a temperature of 85 °C. A heated vein, like any protein, contracts when heated. The lumen of the vein disappears, the blood flow through it stops.

Rehabilitation

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

During the week, increased physical activity and weight lifting are prohibited;
You need to walk more, stay in the same position as little as possible (except when sleeping);
For 3-4 weeks you need to stop taking hot showers, you can only take a shower;
You must stop going to the bathhouse for at least a month;
It is necessary to drink as much ordinary water as possible, on average about 2. 5 liters, at the same time it is necessary to minimize the amount of salt consumed;
A week after the operation, you need to start physiotherapy, which will be informed by the doctor;
The doctor may prescribe some medications after the operation.

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

Benefits of venous sclerotherapy:

absolute outpatient care, without the need for additional preparation,
execution speed,
no 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 dull pain along the clotted vein.

Thus, today vein sclerotherapy for 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 obliterating 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 free you 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 the quality of life.