Varicose veins:treatment, causes, surgery

Update: October 2018

Varicose veins, the symptoms of which are detected in
every fourth inhabitant of the planet is not just a cosmetic
a defect that appears as a blue tree net on the shins,
thighs or rear of feet, heavy legs, pains with static
exertion or prolonged walking, jerking of muscles
shins, but also high risks of thrombosis in the system of the lower hollow
veins.

Thrombotic complications lead to trophic leg ulcers,
acute disorders of blood flow with blue limbs and the risk of their
dying Breaking away from the vascular wall, blood clots from the legs are often
begin a journey that ends in the heart (leading to
heart attack) or cerebral vessels (causing a stroke). Exactly
This circumstance, and not at all a spoiled look
attractive legs requires the earliest possible attention to treatment
(and better to prevention) varicose veins.

Since the disease, having appeared, is not static, but
gradually progressing, capturing all new segments of the outer or
internal venous network of the legs, the treatment should start with
descriptions of prophylaxis. Exactly разумные профилактические мероприятия
will allow at least a little to slow down the process that has developed on the background
hereditary failure of the valve apparatus of the lower veins
limbs.

Prevention of varicose veins

The veins of the lower extremities have very weak walls, almost
lacking muscle elements that could push blood
by reducing. Therefore, special veins are provided in the veins.
valves that prevent backflow of blood and its stagnation in the veins.
In some people, these valves are hereditarily untenable or
become so with age:

  • heavy exertion
  • increases in abdominal pressure
  • constipation
  • frequent pregnancies.

Сначала процесс затрагивает наружные veins. And then amazed
collector veins and deep venous network. Varicose veins of the extremities
develops over several (sometimes tens of) years and
speed varies with lifestyle, intensity
physical loads and vascular wall strength.

  • Therefore, the first task of prevention is to minimize
    increase intra-abdominal pressure (fight constipation, avoid
    overloading).
  • The second task is to create conditions for passive venous outflow
    blood from the legs. This must be done at the end of the day or several times.
    in a day. To this end, the legs are laid from foot to hip on
    surface at an angle of 45 degrees to the horizontal. Lie in such
    position should be at least half an hour. Persons for whom varicose
    varicose veins in the legs – an accomplished medical fact
    It is recommended to sleep with raised legs as often as possible.
  • It is recommended not to use tight shoes, socks for varicose veins.
    with a tight elastic band – that is, do not create additional obstacles
    for blood circulation in the legs (see also what to do if swelling
    legs).
  • It is also necessary not to sit on the leg and with a long
    sitting position, lean your legs on a support and give them a horizontal
    (or slightly higher) position. This posture can sometimes be seen in
    gangster movies about cool mafiosi sitting in a chair,
    throw his legs on the table.
  • Of course, in the office, if you are not the owner of the company, you will have to
    come up with something less challenging. You can, for example, put
    under the desk a cardboard box and put your feet on it or
    use a high plastic wastebasket for the same purpose
    with flat top lid. Any questions about the unusual way
    sitting at your desk should be honest to answer in order to avoid
    ridicule and not passing for eccentric. It should be remembered that none of
    giggling employees will not actively participate in your
    treatment. Therefore, it is necessary to adequately perceive the opinions of others and
    Do not neglect the prevention of disease.
  • If you are at home, try to take as much as possible.
    horizontal position and position with a few pillows
    legs above the head. This is to improve the conditions for
    venous outflow (see treatment of varicose veins at home).

Conservative treatment

The program of non-surgical treatment included a diet,
compression and drug therapy.

Diet

Dietary activities are mandatory, as being overweight is
one of the risk factors for the development of varicose veins. Power should be
kalorazhu compensated (consumed energy should not
exceed energy needs that correlate with character
loads or lack thereof). In addition, the menu will have
eliminate spicy seasonings, pepper, marinades, excess salt,
smoked meat, reduce the use of fried. Alcohol also
It is recommended not to use.

The menu should contain a sufficient amount of vegetables and
fruits rich in vitamin C, fiber-rich meals, bread
wholemeal, seafood. It is shown frequently (at least 4 times a
day) split meals. As for the fashionable few years ago
The tendency to limit oneself in any animal fats is worth it.
to forget. Of course, exorbitant numbers of triglycerides and cholesterol –
this is not the case. But in reasonable quantities, cholesterol helps to patch up.
vascular wall, reducing the risks of secondary thrombotic complications
and sudden rupture of veins.

Smoking Cessation

Smoking is the most harmful habit of varicose veins. If you choose
between drinking moderate amounts of alcohol and smoking, then
the first is still possible with sin in half to endure. But the second – will have
categorically exclude. Not only resins clog up the vessels, but
carbon dioxide spasms them, increasing the risks of blood clots and
secondary complications (heart attacks, strokes, pulmonary thromboembolism
arteries). Especially worth being careful to those who have varicose veins.
(or predisposed to it), takes hormonal drugs (in
including oral contraceptives) and still manages to smoke.

Compression underwear (stockings, stockings, tights)

This is a good option for the prevention and treatment of early stages.
varicose veins, as they have different parameters of pressure on soft tissues,
options for models and colors. Wear underwear is necessary
in the morning without getting out of bed until the venous system has yet
filled with blood. For this method, there is one but –
exorbitant price tags on the territory of the Russian Federation, limiting the acquisition
anti-varicose knitwear by the masses. how
as a rule, the laundry is not started by those to whom it can
help at the stage of pre-disease, and those with severe varicose veins,
often complicated by thrombotic processes that have already been shown
surgical treatment, and compression hosiery as a secondary
prophylaxis.

Varicose veins: treatment with drugs

Medications are not a panacea. Completely stop or
they cannot cure varicose veins.

Venotonic – ointments and gels

Venotonics can protect the walls of the veins, stimulate the venous
outflow and somewhat improve microcirculation. By these means
reduce the severity of pain and swelling under the condition of the course
reception. Courses are shown twice a year with a duration of at least
2 months.

The most useless (but also safe) can be read ointments or
gels They do not penetrate beyond the skin and any
standing action on the vessels can not have. They are recommended on
early stages of the disease when it is not known why
swelling and heaviness in the legs can go away: from drugs or
simple postural drainage and end of physical exertion.
Often the trick of the manufacturer comes down to the recommendation to use
local remedy with tablets.

  • Troxevasin – ointment based on derivatives of flavanoid rutin.
    Improved drainage is achieved by taking pills (see
    direct anticoagulants).
  • Venitan – in the ointment, which is recommended topically twice a day,
    Contains horse chestnut extract.
  • Antistaks – the active principle of the gel or spray Antistaks is
    extract of grape leaves. The manufacturer promises the effect of
    treatment not earlier than after 6 weeks of use. There are
    Antistax capsules taken on an empty stomach in an amount of two
    pieces

Venotonics tablets

For preformed venotonics resorted to in cases of varicose veins
deep veins.

  • Saponin derivatives are prepared on the basis of horse chestnut,
    which contains plant bioflavonoid escin. A drug
    Escuzane is sold in drops or drops.
  • The most effective drugs: Detralex and Phlebodia 600 in
    its basis bear diosmin. It is a powerful venotonic.
    Детралекс принимается по таблетке дважды in a day. Phlebodia 600 – by
    tablet in the morning. The course of treatment from 2 months to six months.
  • Ruthosides were the first venotonics. They improve
    microcirculation and have anti-inflammatory effect. – To
    natural ruthosides include Venoruton in soluble tablets and
    in capsules. – To полусинтетическим: Венолан, Троксевазин,
    Troxerutin. Combined rutozids are Ginkor forte. In him
    Troxerutin and ginkgo biloba extract are combined. A drug принимают
    2 capsules in the morning and evening for a month. With
    the need for a course is extended.

Phlebosclerosis drugs

This is a way to turn off different veins from the bloodstream without surgery.
The connective tissue gradually closes the lumen of the vessels. Her height
stimulated by the coagulation of endothelial proteins and irritation
glidomuscular components of the vascular wall.

  • The simplest option is Hepatotrombin G ointment. Effect of it
    weak. As at least some acceptable option
    use solutions for injections. There are a lot of them.
  • Synthetic means: Ethoxisclerol (Germany), Trombovar
    (France), Sotradekol (United Kingdom), Decylate (Russia).
  • Iodine-containing agents: Variglobin, Wistarin. Based
    animal protein – Varicocid. A drugы используют на некрупных
    vessels to selectively close only affected
    vein sites. practitioners most often use Trombovar and
    Ethoxisclerol, as safer, not causing vascular
    thrombosis, but only burning the vascular wall at the level
    endothelium.

Phlebosclerosis therapy includes the administration of drugs or
elastic bandaging. Its simplicity preservation of aesthetic appearance
limbs, lack of influence on the general well-being of the patient and
low painfulness attracts to this technique both doctors and
patients.

But isolated sclerotherapy does not bring lasting results and
unable to stop the progression of the disease. In most
cases, it is still necessary to combine with surgical treatment.
Before therapy, it should be mandatory
ultrasound examination of the lower limbs, excluding
prolonged lesions of the subcutaneous or deep veins of the legs.

Contraindications to phlebosclerosis are: allergies
for drugs, atherosclerosis of the great vessels with the presence of ischemia,
diabetic angiopathy, obliterating endarteritis, lesions
blood coagulation, acute or recent leg thrombophlebitis,
pregnancy.

Complementary Medicines

  • A drugы, улучшающие микроциркуляцию крови: Пентоксифиллин,
    low molecular weight dextrans. These remedies reduce blood viscosity,
    stimulate the breakdown of platelets and increase elasticity
    red blood cells. All this contributes to a better blood supply to the tissues and
    oxidative processes in them.
  • Anticoagulant direct (heparins) or indirect
    (coumarin and phenindione derivatives) actions. Reduce the risk
    thrombosis. Also used are analogues of hirudin (danaparoid,
    Lepirudin) and heparinoids (Pentozan polysulfate, Dermatan,
    Sulodexide). A very popular local remedy is heparin ointment and
    gel Lioton, providing decongestant, antithrombotic and
    anti-inflammatory effect.
  • Nonsteroidal anti-inflammatory pain relieves and suppresses
    inflammatory reactions.

Variants of phlebosclerosis therapy

  • Before surgery – vein hardening can be used until
    surgery to reduce the risks of bleeding and thrombosis in
    postoperative period
  • during surgery, replacing vein removal
  • after surgery to close the remaining unopened
    veins.

The puncture method of drug administration can be used when
please, catheter – only during the operation.

Puncture method

If it is not used in an operating room, it is carried out in
specialized surgery, in compliance with all
rules of asepsis. The larger veins are closed first, and then
small ones. With этом препараты обычно вводятся сверху вниз. Vienna
being punctured in a standing patient, and before the administration of the drug
laid down. If in the field of interest gets an extended vessel or
vessels of the entire circumference of the leg, then several sessions are held
therapy. After the sclerosing procedures, the patient should be observed in
Phlebologist for three years since the last injection.

  • After the introduction of the sclerosing drug, an elastic
    bandaging the limb, which is repeated for 2 weeks.
    With этом в первую неделю повязку не снимают.
  • Within half an hour after the procedure, the patient must walk.
  • Every day the patient needs to sleep with a raised foot end, and in
    during the day avoid prolonged sitting or standing and plenty
    walk

Radiofrequency ablation of veins

Obliteration of the veins with a radiofrequency radiator is a new
Phlebology direction. This method of getting rid of varicose veins
Minimizes vessel injury, the risk of complications, pain.
The effectiveness of the method is very high. Radio frequency radiation
destroys the inner lining of the vascular wall. With этом
surrounding tissues practically do not suffer, and the lumen of the vein subsides
and disappears.

The procedure is performed on an outpatient basis under local anesthesia. For
exact execution of its manipulation is controlled by duplex
angioscanning.

After the introduction of anesthetics, a vein puncture is performed (in the upper
third of the leg in the pathology of the great saphenous vein or in the lower
third of the leg with the defeat of a small saphenous vein). Injected into the vein
disposable catheter equipped with a radiator. He is promoted to
места впадения подкожной вены в глубокую систему veins. During
phased extraction of the catheter vessel is irradiated from the inside. After
during the session, the puncture site is closed with an aseptic dressing. On foot
put on an elastic stocking. After дозированной получасовой ходьбы
the patient is allowed to go home. Non-heavy patient
by physical labor, able-bodied the day after
manipulations.

Varicose veins: surgery

The decision on the feasibility of surgical intervention takes
Phlebologist or Vascular Surgeon.

Often women with defeat of the superficial veins and decided to
surgical intervention solely due to cosmetic
of a defect, they propose to postpone the operation if a subsequent
childbearing (as during pregnancy, varicose veins tend to
progresses and the result achieved may disappear and
require re-surgical treatment).

Combined Phlebectomy

The most common way to solve a problem quickly.
varicose veins of the lower extremities is a combined phlebectomy.
The operation is performed under general anesthesia or with epidural
anesthesia. All cuts and punctures are trying to do as little as possible.
sizes. For example, to remove the great saphenous vein. performed
a half-centimeter incision in the groin area. Through it into a vein
a probe-extractor with a tip is inserted. Then the probe is removed.
and remove the vein from the middle part of the leg to the groin. Through small
протоки удаляют протоки и мелкие veins. This part of the operation
called miniflebectomy. Compression is used after surgery.
(bandage or stocking on the leg).

Endovascular electrocoagulation

It involves the removal of the saphenous veins due to exposure to
them current. The method is more dangerous than radio frequency obliteration or
classical surgery.

Cryosurgery

Cryosurgery позволяет удалять вены за счет низких температур.
With современном оборудовании и обученном специалисте метод
is safe. It is not always possible to calculate the freezing depth, not
damaging surrounding tissues or not leaving “extra”. In the Russian Federation, the method is not
is common.

Intraoperative scleroobliteration

Involves the use of catheter sclerosing
веществ в подкожные veins. Before surgery on the leg
маркируются подкожные вены и измененные vein sites. With операции
on the great saphenous vein with supralach access expose the fistula
the great saphenous and femoral veins and bandage the tributaries of the great
подкожной veins. 1 cm from the femoral vein intersects and
tied subcutaneous. Perforating veins are ligated
(supra-fascial ligation of perforating veins) from individual incisions.
A catheter is inserted into the cut-off saphenous vein, the vein is sutured, the wound
tied up. Along the drawn projection of the saphenous vein
put the roller of gauze and press it all over the legs.
At the same time as pulling out the catheter, venosclerosing is injected.
a drug.

Endoscopic dissection

Endoscopic dissection перфонрантных вен позволяет
перевязывать и исключать из кровотока veins. Binding subcutaneous and
deep leg network. endoscopic probes are used.
A variant of the method is transillumination phlebectomy.

Laser coagulation

Laser coagulation требует от врача высокой квалификации и
experience with laser equipment. Vienna sealed by laser
from the inside and expelled from the circulation.

Home Treatment for Varicose Veins

Varicose veins can be treated at home systemic
drugs (prescribed by a doctor), even with ointments and gels, even
leeches (varicose veins treatment with leeches) and cabbage leaf, apple
vinegar. Also for the home part of the program is suitable compression
linen and elastic bandaging (matched and recommended
phlebologist). For the advanced stages of the disease, all these efforts will be
vain without radical surgical treatment.

Thus, today the cardinal method of getting rid of
varicose veins can only be recognized by surgical methods, often
combined with sclerotherapy or compression techniques.

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