Who is predisposed to varicose veins?
There is a myth that sedentary work and high heels contribute to the expansion of veins. This is not true. But there are other obvious factors (congenital and acquired) that can affect the health of our legs:
- Smoking,
- obesity,
- lack of physical activity,
- pregnancy and the postpartum period,
- oral contraception.
“In women, varicose veins are much more common than in men. Age does not matter. If there are risk factors, then after childbirth they make themselves felt more often, ”says doctor Vyacheslav Simonov.
In addition to oedema and an ugly "pattern", varicose veins provoke discomfort in the legs, pain and cramps.
How are veins examined?
First of all, independently pay attention to the veins of your legs. If there are blue “asterisks”, bulging veins, swelling and an unpleasant sensation of heaviness - you need to consult a doctor.
Phlebologists use the special CEAP classification (clinical manifestations (C), etiology (E), anatomical localization (A) and pathogenesis (P)) - the abbreviation in which the first letter is the most important, to determine the degree of varicose veins and make a diagnosis. If the patient sees the C0 level on the results of the examination, it means they do not have varicose veins, if it is C6 - then it already means trophic ulcers. The degree of neglect of this problem and other conditions can be determined by the numbers that fit into this range. The treatment begins when the patient voices the first complaints.
Why do varicose veins form?
The cause of venous insufficiency is the valves in the veins that manage poorly with their function. Blood flows through the veins back to the heart. Under pressure, it rises from one section of the vein to another, restrained from flowing the wrong way by valves in the vessels. If the valves are weak, the venous outflow is disturbed: under the influence of gravity, the blood returns from where it came from, where it stagnates. As a result, the veins in these places expand, and varicose veins can be seen on our legs.
How are veins tested?
To establish a diagnosis, only two components are necessary - a doctor’s examination with the duplex dopplerography, on which both deep and superficial veins are visible, along with the perforating vessels (these are the veins that connect the deep veins to the superficial veins).
The procedure of dopplerography is painless. Doppler ultrasonography of the lower extremities can determine the patency of deep veins and the state of the valvular apparatus of the superficial veins. It can also examine the veins for the possible presence of thrombosis. The procedure, as a rule, lasts about 20-30 minutes. Results are available immediately.
Treatment: conservative or surgical?
The conservative treatment includes a drug therapy and compression stockings. “In not all cases it is immediately necessary to resort to surgery. If the patient only has the C1 or C2 degree of the disease, I can see on the duplex that there are already problems, but the patient has voiced no complaints yet, we can try medication and wear the compression stockings,” explains Dr Vyacheslav Simonov.
Drug treatment includes oral vasotonic drugs that stimulate the walls of the veins. Medication is taken in courses and must be combined with compression stockings that act to improve the blood circulation. The compression stockings create pressure on the veins and helps push the blood up, thereby the vein does not expand, which means that venous insufficiency does not form.
“If the patient sees that “asterisks” have begun to form on the legs, this indicates the beginning of the development of venous insufficiency. Whether it will progress to the second or third degree is unknown. But this is a signal that you need to see a doctor who can recommend treatment and compression methods,” the specialist notes.
Vyacheslav Simonov does not recommend self-medication and picking compression stockings on their own, because they are different and for different purposes. They differ in the pressure exerted on the patient's legs. By the way, compression stockings that cannot be distinguished from ordinary socks are now produced. Different colours, textures, but the effect is the same: they stimulate the blood circulation. “Compression stockings are prescribed in case of a deep vein thrombosis and after the sclerotherapy surgery,” adds Dr Simonov.
Sclerotherapy - “gluing” the small “asterisks”
An excessively developed capillary network sometimes resembles an ugly cobweb on the legs. To remove it, sclerotherapy is used. A special sclerosant medicine is injected into a vein, which “sticks together” the small wreaths and 1-3 mm subcutaneous capillaries. The "asterisks" become invisible. To perform the procedure, thin needles or microcatheters are used, which are also called “butterflies” due to visual similarity.
The procedure is done on an outpatient basis, it takes around 15-30 minutes. The vessels are not sclerotized blindly: for perfect accuracy the vein is highlighted with a special apparatus - “View Viewer”.
Can such veins appear elsewhere? “The sclerotherapy procedure will be effective if the patient wears compression stockings after the operation. During the first three days - without taking off, then only during the day. Side effects are possible - hyperpigmentation, which resolves itself after 1-3 months, or an allergic reaction,” the doctor continues.
If a surgery is needed: the method of radiofrequency ablation of blood vessels
Lipex clinic uses a method of radiofrequency ablation of blood vessels for the treatment of veins. Laser operations are very popular in Latvia. But the laser heats the vessels to 600-800 degrees, while the radio frequency apparatus - only to 100-120 degrees. Lower temperatures mean less risk of tissue damage and hyperpigmentation.
“We burn the veins anyway, but at a lower temperature. The results are no worse. The surgery is helped by a special probe, which is inserted into a vein. The probe has notches that allow you to automatically work on the veins in stages. We manage to go through each section. If the patient has many lateral branches, miniflebectomy is also performed,” the doctor explains.
How will blood outflow occur if some veins are removed?
There are deep veins that take on this function.
“The veins are operated on to maintain health and to remove venous insufficiency. If we remove the varicose veins, the complaints disappear – there is no swelling, pain or discomfort. If you do not treat varicose veins, trophic ulcers develop, which are difficult to treat and it takes a long time to do so,” explains Dr Simonov.
A while ago, after the surgery on the veins, the patients had scars. Now all the manipulations are carried out through two small incisions, which are not visible after healing.
“If the vein has many lateral branches, we remove them also. This manipulation is called miniflebectomy. In order to carry it out, small punctures of 1-2 mm are made on the skin. A special crochet needle is used to pull the wreaths out. There are no scars,” adds Dr Simonov.
After ablation, if necessary, additional sclerotherapy for reticular asterisks is carried out.
Thromboembolism or what else can a doctor see during the dopplerography?
During dopplerography of the vessels of the lower extremities, the doctor can detect thrombosis timely. Deep vein thrombosis on the legs is dangerous because it can cause sudden pulmonary thromboembolism - an acute blockage of a blood vessel by a thrombus, which can detach and enter the blood circulation.
Symptoms of deep vein thrombosis: the leg becomes red, very painful and very swollen. These symptoms need to be distinguished from symptoms of superficial vein inflammation (thrombophlebitis) which also causes redness and blockage of the superficial vein. But such a vein can be seen with the naked eye and even palpated.
A duplex helps to establish the correct diagnosis. If a blood clot is noticed in a timely manner, the treatment with medication and compression stockings can begin. “And at the same time, every 2-3 months I will definitely control on doppler how the treatment is going, what is the percentage of recanalization, that is, how much the thrombus has resolved,” the doctor summarizes.
Preserve the beauty and health of your legs! Begin treatment today to be ready for the summer!!!
You can sign up for a consultation with Dr Vyacheslav Simonov by calling (+371) 67333322 or (+371) 67579208
