Varicose veins of the lower extremities Varicose veins are a pathology characterized by the formation of nodules. This is one of the most common diseases. Despite the fact that the treatment of varicose veins is actively developing in our time, the increase in the number of people with this disease is alarming.
The increase in visits to clinics with this pathology is due to the fact that many people are malnourished (passion for fast food with fast carbohydrates and low amounts of plant fiber), hormonal problems in the background of thyroid dysfunction. , adrenal glands against the background of unfavorable environmental conditions.
And very oftenVaricose veins occur during pregnancy, for those who are forced to stand on their own two feet due to the nature of their profession (risk group - hairdressers, salesmen).
In women, varicose veins can develop against the background of unusual power loads for them when playing sports: for example, lifting weights.
It is better not to delay the fight against varicose veins. One of the most advanced methods of treatment is laser treatment of blood vessels.
Laser treatment of blood vessels. What is this?
Laser vein therapy is a minimally invasive treatment. Dilated veins are effective in combating trophic ulcers in the legs.
Modern surgeons, as a rule, under the laser treatment of blood vesselsendovenous (endovasal) laser coagulation or obliteration (EVLK, EVLO), ablation. In medical practice, coagulation, obliteration, ablation are one and the same. With the help of special equipment, blood flow in the perforated (ie connecting superficial and deep veins) and superficial veins is eliminated, and then blood is physically pumped into the veins due to thermal energy.
If we use the terms, the word "obliteration" means closure, "ablation" - destruction, "clotting" - clotting. I meanThese are different parts of the complex that combine the processes that take place in the diseased vessels during treatment.
However, in practice, when a surgeon works with a laser, the procedure is often called "coagulation", and the terms "obliteration" and "ablation" are often used in the radiofrequency treatment of blood vessels. In this case, equipment with a radio frequency generator is used instead of a laser. However, there is no clear "obligation" for each of these terms in relation to laser or radio frequency equipment. For this reason, patients who plan laser vein treatment at different clinics may come across different names for surgery.
- Endovenous laser coagulation (EVLK).
- Endovasal laser ablation (EVLA).
- Endovenous laser thermal ablation.
- Laser thermal ablation.
The mechanism of laser removal of blood vessels
The laser works from the inside of the lumen of the vein. The essence of the procedure is to create a fully controlled wall combustion. It is "brewed", "sealed", and then begins resorption, ie. the process of removing the vessels is gentle.
EVLT can be used in single or complex operationsin combination with sclerotherapy or miniflebectomy.
In the first case, part of the vessels is "precisely closed, part is glued with a special preparation, and in the second, in addition to sealing, part of the vessels is immediately removed with a fork and succeeds.
Laser removal of blood vessels helps to save the patient from venous stasis, trophic disorders and edema.
The mechanism of laser use is based on the fact that the surrounding tissues are practically not heated by a purposeful and effective effect on the venous wall.
This provides patients with the following benefits:
- The operation can be performed in an outpatient setting, does not require hospitalization (except in cases where the pathology is highly developed and requires additional microflebectomy), is easy to perform without incisions, does not require surgery. sew stitches.
- You can quickly return to your normal lifestyle.
- There are a few contraindications (we'll talk about them below).
Which vessels can be removed with a laser?
Unfortunately, not all veins can be removed with a laser. Conservative surgery (scalpel) is used in the advanced stages and with some anatomical features.
Which vessels can be operated with a laser?
It is important to pay attention to the characteristics of the course of the vessel.The laser only removes vessels with a linear course. If the vein is anatomically highly flexible, it is difficult to predict how the laser beam will pass, and it will not be possible to provide the main condition for the successful implementation of the procedure - to control the artificial burn area.
As for the type of veins that respond well to laser treatment, thenThese include:
- Large sapen vein.
- Small sapen vein.
- Additional saphenous veins located at least 5 mm deep from the skin surface;
- Incompetently perforated vessels (ie, vessels with an obviously impaired venous flow, often the veins of the foot).
Indications and contraindications for EVLT
The only sign for EVLK is varicose veins. Also, EVLT is the only method that can be used for surgical treatment of open trophic ulcers.
What is characteristic of stage 1-4 varicose veins?
- Varicose veins.
- Venous malformations (arteriovenous malformations). Pathological fistulas between fistulas, veins and arteries. They can be invisible and can only be detected by microscopic examination. Combine direct venous and lymphatic problems. Causes severe pain.
Unfortunately, there are contraindications to the treatment of laser veins:
- Ischemic manifestations in the legsagainst the background of obliterative diseases of peripheral arteries (chronic ischemia) and acute ischemia of the lower extremities. Most often in patients with atherosclerosis. In this case, laser removal of blood vessels may be ineffective. This is due to the fact that the need for compression after treatment will not be avoided, and on the background of ischemia - these are serious risks for the development of the latter.
- Lactation. Risks are associated with increased hormone production in women during breastfeeding. Experts recommend waiting until breastfeeding is stopped and only then resorting to laser treatment.
- Oncological diseases.
- Any pathology in the acute stage. The doctor determines how critical a particular inflammation is, taking into account the disease and the individual characteristics of the patient.
- blockage of blood vesselsBlood clot.
- Impossibility to maintain real estate and asset imagethe patient's life after surgery.
- Inflammatory process in the field of upcoming surgeryinterventions (except for chronic trophic ulcers). Inflammation can lead to the spread of infection during surgery and then sepsis.
Stages of endovenous laser coagulation
Stage 1. Medical examination, consultation
It is important that they are performed not only by a surgeon, but alsoSpecialist in vascular surgery, phlebologist. Phlebologist fully understands the features of the anatomy of the lower extremities, the physiology of venous flow, the pathogenesis of venous transformation of vessels, the characteristics of the position of the valves at different stages of varicose veins.
Phlebologists purposefully deal with methods of combating pathological reflux in blood vessels. These doctors are the most competent in making decisions about the treatment of vascular defects.Phlebologists are not just "general" surgeonsThey will also give you the most comprehensive advice on recovery.
Stage 2. Diagnostics. Analyzes and functional examination
What is included in the preoperative examination?
- Functional tests. They are of several types: to determine the failure of perforating veins, valve insufficiency, analysis of the condition, the openness of deep veins.
- Blood test. Hematological examination, general and biochemical blood tests (detailed) are important. The doctor pays special attention to the following aspects: according to the results of the analysis, whether the patient has latent inflammatory processes, what is the level of glucose (this is especially important for varicose veins with trophic ulcers, increased sugar causes their infection), D-dimer level (this indicatordirectly related to the assessment), APTT - thromboplastin time (although we are talking about minimally invasive intervention, when manipulating blood vessels, this indicator is important for the surgeon). As before other vascular interventions, Rh factor and blood group are determined, HIV is tested, tests are performed for RW (syphilis), HBs (hepatitis B), HCV (hepatitis C).
- General urinalysis. It is important to exclude hidden pathologies that may adversely affect the overall outcome.
- Electrocardiogram. Ultrasound of the heart, if necessary. Unfortunately, if a person has problems with blood vessels in the legs, the heart often fails. All this is part of the cardiovascular system. Therefore, it is extremely important for the doctor to assess the condition of the heart.
- For women - examined by a gynecologist. In some cases, varicose veins of the perineum, vulva and varicose veins develop against the background of pelvic venous syndrome.
- Ultrasound of blood vessels and arteries(with duplex) The results are one of the main studies used in treatment. The structure, diameter and speed of blood vessels and arteries are important for the doctor. Both the treatment regimen and the rehabilitation scheme depend on the ultrasound image. This is a complete description of the vessels and arteries that help to form a set of competent measures to prevent the risks of a particular patient.
Because varicose veins are a common disease, ultrasound diagnosis of the abdomen and pelvic organs is often prescribed as an adjunct.
Step 3. Preparation the day before and during the operation
- Depilation of the legs the day before.
- The patient can eat the day before the operationlight breakfast. If a person takes any medication, then, as a rule, it is not canceled. However, it is important to discuss this aspect with your doctor. Especially if the side effects of the drug are bleeding.
- Take it to the clinic with youcompression stockings.
- Vascular sign. A special surgical marker is used to mark the vein. Contains gentian dye & dries quicklyMost markers used in surgery have bactericidal properties. A complete projection of the vessel is drawn. Marking is performed under ultrasound control. The result of perforation reset depends on how professionally the marking is done. The professionalism of branding also affects aesthetics. The main focus is not only medical, but also cosmetic results. It is important to carry out manipulations in the area of localization of severely defective, pathologically affected vessels.
- Swollen anesthesia. A cold local anesthetic solution is used. An anesthetic "compound" forms near the vein.
- Insertion of a light guide into a vessel.
- EVLO directly. The doctor turns on the equipment and turns on the light guide. The laser beam is activated and the light guide travels along the vein.
- Creating compression. After the procedure, a compression bandage is applied (special rollers are tightened in the vein, compression stockings are put on the foot).
If only laser removal is performed, all manipulations take about 40 minutes.
If laser treatment is combined with miniflebectomy, the duration of treatment is increased: some short sections of blood vessels are removed through a thin puncture. The combination of laser treatment with microflebectomy is an excellent opportunity to achieve remarkable aesthetic results with very large varicose veins.
If it is important to complete laser treatment with sclerotherapy, a special drug is injected into a number of veins. This combination of surgical techniques is relevant for teleinjections (open dilation of small vessels), reticular varicose veins ("vascular network").
Stage 4. Restorative
The main thing at this stage is to wear compression stockings to prevent relapses.
It is important to be aware of potential complications before planning laser treatment.
It's cosmetic and more global.
- Pain. Some patients do not have pain immediately after the procedure, but after 5-6 dayspain on day 5-6 after medical manipulations. As a rule, this happens when patients ignore the rules of physical activity and immediately switch to an active lifestyle or against the background of other pathologies.
- Seals."Alloy" can occur in the arm area of the vessel. Fillers are not aesthetic and cause psychological discomfort, but if you immediately control the seals,After a month and a half, the problem is easy to solve. To do this, doctors adjust the compression scheme in this area. Seals are dissolved with properly selected compression stockings.
- Pigmentation.Occurs during vascular resorption. The problem does not occur in all patients, but only if the vein is located close to the skin. In this case, no special treatment is required.After a while, the skin often regains its natural shade.. If this does not happen, the pigmentation is removed by cosmetic methods. Patients with seals along the "alloy vein" may have fairly large areas of pigmentation. In this case, they can become "provocateurs" of hyperpigmentation.
- Decreased leg mobility.The emergence of the "wire feeling". There is no pain, but when the leg is extended, it appears that a rope, a rope is tied to it, and it prevents normal movements in the usual "mode".After a few weeks of laser coagulation, the discomfort disappearsalone.
- Edema. More often - on the ankle, lower leg. The problem, as in seals, is effectively solved by correcting the pattern of wearing compression stockings and changing them.
- Subcutaneous bleeding (hematomas).If you use absorbent gels, you can forget about bruises for a few weeks.
- Inflammatory processes in tissues.In severe cases, medication may be required. But more often the problem is solved by changing the pattern of wearing compression stockings.
- Phlebitis of the arms.There is a lot of tension in the legs. The skin is very red (usually in stripes). The skin temperature rises locally. phlebitis -rare complications of minimally invasive procedures, but if it manifests itself, ultrasound dopplerography, angioscanning, blood tests are recommended. Based on these results, the doctor decides what medications (anti-inflammatory, blood thinners) will be prescribed to the patient, whether physiotherapy is needed, and whether the compression garment will be replaced with a tighter or looser one. Everything is defined in the complex, but also very individually.
Prevention of complications
Patients are advised to wear compression stockings. As a rule, two pairs of knitwear provide the best effect. The most intense - immediately after the procedure and knitted - with less pressure to maintain the effect of treatment.
When choosing compression stockings, it is important to consider not only brand awareness, but also two conditions:
Compression stockings must comply with the RAL standard. In this case, the products are carefully analyzed and evaluated according to the level of compression and pressure distribution.
Estimation of optimal compression level should only be performed by a physician. Choosing compression stockings independently and determining this or that level of compression is a big mistake that is fraught with pain and tightness. In self-assessment, the patient often relies on subjective feelings (some socks are tighter, others less tight). However, only a physician can objectively assess which anatomical incision and which compression is optimal for a particular patient.
If the work is dynamic or static, but you only need to work on your feet,It is important to avoid high loads after coagulation, change the position of the feet frequently during the day.
Adjustments are made for fitness and sports. The best sport is swimming and walking. Alternate gait on the heel and toes is helpful.
However, stretching is the first thing that can be most damaging after the procedure. It is also worth avoiding jumping and running - especially with acceleration, exercises with dumbbells.