Treatment of varicose veins with laser coagulation. There is truth at my feet

Varicose veins, or varicose veins, in everyday life are often referred to as "tired legs disease. " But in reality, the causative factors are much more complicated. And the disease itself is not just a harmless cosmetic defect. Varicose veins in the lower legs cause chronic venous insufficiency - a condition, the end result of which may be the occurrence of trophic venous ulcers.

Of course, in a large number of cases, we face varicose veins of moderate severity, which are now treated effectively and practically without recurrence treatment. But first things first.

Why are varicose veins dangerous?

How common varicose vein disease is, it is difficult to say: many patients consider it a cosmetic defect and do not go to the doctor. According to Western scientists, at least a quarter of the population in the United States and Europe suffers from the disease. In our country, pathology has been recorded in more than 30 million people. At the same time, according to some studies, no more than 18% know about their disease, and no more than 8% receive treatment.

Varicose veins on the lower part of the legs are a disease in which the structure of the venous wall changes. Vessels become longer, convoluted, in areas of wall thinning, the lumen expands, forming knots.

Statistics
Varicose veins are a disease with a hereditary predisposition. The probability of its occurrence in those whose family has no one suffering from venous pathology is not more than 20%. If one of the parents is ill, the risk increases: for men - up to 25%, for women - up to 62%. If there is disease in both parents, the probability of varicose veins in heredity is 90%.

With varicose veins, the ratio of the two major structural proteins of the venous wall is disturbed:collagenandelastin. . . If collagen forms stiffness, then elastin, as the name implies, is responsible for elasticity - the ability of the venous wall to return to its normal state. In patients with varicose veins, the amount of this protein in the venous wall is reduced. Collagen itself also changes: instead of the type III collagen that occurs, which is responsible for elasticity, the content of type I collagen - stiff, retains residual deformation, increases. In addition, the number of smooth muscle cells that regulate the vessel lumen also changes, and the ability to interact between them is impaired. These pathological changes are hereditary. Then the game is playedexternal factors:

  • long -term static load - the need to stand or sit without moving;
  • overweight;
  • pregnancy and childbirth.

Some experts point to chronic constipation, tight clothing that increases intra-abdominal pressure, and high heels that interfere with the normal function of the muscle pumps in the legs as predisposing factors.

Individually or in combination, these factors increase the pressure in the venous system in the lower leg. The altered venous wall stops "holding" pressure, the lumen of the vein expands. As a result of the expansion of the venous lumen, the valve, which provides blood flow in only one direction, stops functioning. Arisereflux- reverse flow. The pressure in the affected vein increases even more, and the vicious circle closes.

Increased venous pressure, combined with changes in wall structure over time, triggersinflammatory response- initially only on the surface of the valve and the inner wall of the vessel. Gradually, inflammatory proteins and blood cells begin to "permeate" through the damaged venous wall into the surrounding tissue. There they are crushed, releasing the active ingredient -mediators of inflammation. . . They damage the surrounding cells and attractlymphocyteswhose function is to remove damaged tissue. As a result, edema, induration (induration) of the skin of the feet, and hyperpigmentation develop. This process can cause trophic venous ulcers. Prolonged inflammation of the venous wall also increases blood clotting. In combination with venous congestion, this leads to the fact that blood clots begin to form in varicose veins. Arisethrombophlebitis- another dangerous complication of varicose veins.

Manifestations of varicose veins are divided into objective and subjective.Subjective symptoms- this is a patient complaint about:

  • weight in the legs;
  • rapid fatigue;
  • paresthesia - an unpleasant sensation of "goose bumps", changes in sensitivity;
  • burning sensation in the muscles;
  • leg pain, its special feature is that the intensity decreases after walking;
  • swelling in the evening;
  • restless legs syndrome - a condition in which discomfort in your legs prevents you from sleeping;
  • night cramps in the lower legs.

The combination of these symptoms and their severity is individual and is not always related to changes in the venous wall and surrounding tissues.

The combination of subjective complaints and objective changes in the tissues of the lower extremities forms the basis of the modern classification of varicose veins and chronic venous insufficiency:

  • C0- there are complaints, but there is no change in appearance, vein lesions can be detected only by special examination and tests;
  • C1- "spiders" appear (scientific name - telangiectasias) or a network of intradermal dilated veins (reticular varicose veins) becomes visible;
  • C2- the diameter of the saphenous vein widens more than 3 mm, the jugular vein appears;
  • C3- the affected leg becomes swollen;
  • C4- changes appear in the surrounding tissues: the skin becomes darker (hyperpigmentation), eczema develops, the maintenance of subcutaneous tissue;
  • C5- the degree of ulcer that heals;
  • C6- open ulcer stage.
stage of development of varicose veins in the legs

Starting from the fourth stage, the trophic skin changes described can no longer be completely eliminated. Even varicose veins healed at this stage will not cause full reabsorption of hyperpigmentation or induration. In addition, keep in mind about the relatively dangerous complications -thromboembolism. . .

On a note
From 30 to 60% of deaths due to sudden deep vein thrombosis and subsequent thromboembolism occur against the background of varicose veins in combination with undetectable thrombophlebitis and do not heal in time.

Therefore, you should not postpone the treatment of varicose veins until later, especially against the background of the achievements of modern phlebology.

Modern methods of treating varicose veins

Methods and techniques that meet several criteria can be considered modern: minimally invasive (trauma), high efficiency, low likelihood of relapse and complications, and short recovery period.

  • Conservative therapy.Includes the use of compression socks, ointments and venotonics (oral medications). Current clinical guidelines suggest that venotonics can reducesubjectivemanifestations (complaints) in the early stages of the disease and reduce edema, but in no way affect the condition of the venous wall itself. Different types of ointments have the same effect. Compression stockings are considered a very effective treatment for varicose veins, as they can reduce the manifestations of venous insufficiency, reduce the subjective complaints of patients, and prevent the development of varicose veins. However, compression socks cannot cure varicose veins - dilated veins will not work well.
  • Traditional surgical removal.The affected large or small saphenous vein is tied at the point where it flows into the deep venous system, after which it is removed with a special metal probe. The operation was effective, but quite traumatic and required a long recovery. There are possible postoperative complications - hematoma, postoperative paresthesia and neuralgia.
  • Sclerotherapy.A special drug is injected into the varicose vein, which "glues" its walls. The procedure is low trauma and is recommended for the treatment of small -diameter veins. However, it is rarely used to remove large and small saphenous vein trunks, as it is characterized by a higher recurrence rate. In addition, unpleasant complications such as hyperpigmentation in the framework of sclerosis are possible.
  • Endovenous laser coagulation (EVLK)- a minimally invasive, safe, modern and effective type of treatment for varicose veins. It has synonymous names: endovenous laser ablation, endovasal coagulation of a vein in the lower leg, endovenous laser ablation (EVLO). But whatever the name, the laser freezing technique remains the same. The radial optical fiber light indication is inserted through a puncture into the vein. Then, with the help of a special pump, an anesthetic solution is pumped around the vein, which not only anesthetizes the procedure, but also compresses the vein, reducing its diameter and thus protecting the surrounding tissues from overheating. For the procedure, a modern vascular laser is used, which produces two waves: one of which is absorbed by the blood hemoglobin, the second - by the vascular wall. Vienna is a "brewery". All stages (light guide position, infiltration of solution around the veins, "brewing" process) are monitored in real time by ultrasound equipment. The duration of the EVLK procedure on one limb is 30-60 minutes.

Important to know!
The only effective method of treating varicose veins is by removing the veins that are unable to perform their function.

Advantages of laser removal method:

  • Minimal trauma, which allows the procedure to be performed outpatiently and under local anesthesia;
  • you can go home immediately after surgery;
  • heal quickly;
  • good cosmetic results: no marks and scars;
  • high efficiency, low relapse rate.

Since endovenous laser coagulation is currently considered one of the most advanced, low -traumatic and minimally invasive types of treatment for varicose veins, we will consider this technique in more detail.

Instructions for laser freezing

The main indication is varicose veins, regardless of the diameter of the venous trunk and the choice for its anatomical structure. It is possible to expand the range of indications EVLK due to the perfection of modern equipment - two -wave lasers, radial fibers.

Contraindications to the procedure

In most cases, they experience severe somatic conditions of the patient:

  • deep vein thrombosis (blockage, occlusion, blockage);
  • type 1 diabetes mellitus decompensation;
  • severe atherosclerosis of the arteries and ischemia of the lower extremities;
  • severe cardiovascular disease: ischemic heart disease, especially angina pectoris at rest, extensive myocardial infarction with decreased cardiac output, severe forms of cardiac arrhythmias, stroke;
  • severe blood clotting disorders, downward and upward;
  • pregnancy and lactation;
  • individual intolerance to the anesthetic used;
  • the impossibility of physical activity immediately after the procedure;
  • inability to use compression gowns.

It is a feature that the age of the patient is not a contraindication.

How is laser vein coagulation performed?

Immediately before manipulation, you should purchase second -degree compression stockings (25–32 mm Hg). The doctor will tell you in detail what measurements are needed. Endovasal laser coagulation itself does not require special preparation.

All stages of endoven laser removal were performed under continuous ultrasound control.

  1. Before the start of the procedure, the vein is "marked": the doctor puts a mark on the skin, corresponding to the place where the blood flows back, a tributary flows into the vein.
  2. At the beginning of the manipulation, local anesthesia occurs, the vein is punctured (punctured). The sensation is no different from a regular intravenous injection. The radial light indication is inserted into the vein using a special catheter.
  3. Next, a "protective" anesthetic drug is made around the vein. Under ultrasound control, using a special pump, the doctor injects a local anesthetic into the space around the vessel. This can not only relieve pain, but also protect the surrounding tissue from excessive laser heat.
  4. The procedure itself is EVLO varicose veins. In modern optical fibers, laser radiation is supplied evenly throughout the circumference of the device, providing uniform heating of the veins from the inside. After removing the light guide, the patient undergoes ultrasound monitoring of the condition of the treated vessel, as well as the deep veins of the limb.
  5. Compression garments are placed on the patient.

Immediately after the end of the manipulation, the patient should walk, for at least 40 minutes.

Possible complications

There are a small number of them, temporary, and the possibility of complications is associated mainly with the use of outdated medical equipment and low qualifications of doctors.

  • Deep vein thrombosis -may appear in patients with an increased tendency to thrombosis. Therefore, to avoid these complications, patients are given medications that reduce blood clotting. As a rule, they are used in 4-5 days after the intervention.
  • Thrombophlebitis- most often associated with inadequate laser exposure intensity.
  • Pigmentation along the treated veinrecover within 1. 5-2 months.
  • Feeling the veins "stretch"- pass within 1. 5 months.

To prevent the occurrence of complications as much as possible, you should adhere to a few simple rules, adherence to which is necessary for a successful recovery.

Recovery

On the first day, there may be pain and soreness along the veins. To get rid of it, conventional painkillers are enough. The temperature can rise in the first few days. Enough with taking traditional methods to reduce it.

In general, for a successful recovery, 2 main conditions must be observed - wearing compression underwear and maintaining adequate physical activity.

  • Compression underwear -for the first 5 days, it is not released even during night sleep. This is necessary so that the veins are completely "glued" and healed. Furthermore, compression socks are only worn during the day. It is enough to wear compression garments for 2, 5–3 months, but if there are risk factors (inactivity, silent work, taking female sex hormones), then further prevention is necessary to wear compression shirts.
  • Physical activity- It is recommended to walk at least one hour every day. But you should stop doing intensive sports for about a month.

Throughout the month, you should avoid hot showers, showers and saunas.

Evaluation of the effectiveness of the method

Analysis of foreign and domestic publications shows that the laser coagulation efficiency of varicose veins ranges from 93 to 100%. Failure can be attributed to several groups of factors:

  • anatomical features of the operated vein;
  • violation of the technical performance of EVLK (insufficient laser power, insufficient vein compression with anesthetic solution);
  • non -compliance by the patient with the rules of the postoperative regime (usually - rejection of compression).

The immediate and long -term results of laser coagulation on veins in the lower extremities are better than radio frequency ablation and sclerotherapy, and are comparable to traditional surgical techniques. At the same time, the treatment of varicose veins with laser can be better tolerated, the recovery time is shorter, and the number of complications is less compared to classical surgery.

How much does EVLK cost?

The endovasal laser coagulation procedure requires high -tech equipment and expensive consumables (light guides), which explains its cost. The total amount will depend on the number and complexity of the procedure, the medical equipment used and the qualifications of the doctor.

So, endoven laser coagulation is a modern effective method of treating varicose veins. It gives excellent clinical results and, in fact, leaves no residue. Minimal exposure trauma allows you to return to normal life (with minor restrictions) on the day of surgery, without the need for a hospital regimen and special conditions for recovery.

How to choose a clinic

Says vascular surgeons, phlebologists:

"The results of laser coagulation on veins in the lower legs are highly dependent on the professionalism of medical staff, as well as on the technical characteristics of the equipment used. This means that the equipment used must be modern, and doctors must be qualified. Therefore, I would recommend choosing a specialized clinicthemselves in this type of specialized service, which has been in operation for several years and has a time -tested reputation. "