Varicose veins treatment. How to cure varicose veins on the legs.

The initial stage of varicose veins is the stage of compensation, in which venous insufficiency is not yet expressed, but symptoms have formed - heaviness in the legs, fatigue; At the initial stage, spider veins and edema are often observed.

In this article, we will look at the reasons for the formation of varicose veins, obvious symptoms and manifestations, and learn about diagnostic and treatment methods.

The stage of initial varicose veins does not appear in diagnoses - this is a name adapted to everyday understanding for mildly expressed venous pathology of the lower extremities (1, English). For a long time, varicose veins were divided into stages, but in 1994 the international classification of chronic venous diseases CEAP was developed and introduced into clinical practice. There is no division of varicose veins into stages; for systematization, classes of increasing severity are used. And the initial stages of the disease correspond to clinical classes C1 and C2, and with the addition of edema, class C3 can be established. In May 2020, the classification was updated, classes C1-C3 remained unchanged (2, English).

Watch the video!

Phlebologists at the center talk about what the initial form of varicose veins is. Find out what the disease is confused with, methods of diagnosis, treatment and prevention.

With initial varicose veins, changes in veins can be of 2 types (3, English):

• Damage to medium-sized vessels that belong to the superficial network. Pathology of the great and small saphenous vein and their tributaries. This is the “classic” type of varicose veins. It is this that leads to physical discomfort in patients due to developing venous stagnation and is prone to further progression.
• Damage to small intradermal vessels is the so-called initial varicose veins. Telangiectasias (spider veins) or a network of reticular varicose veins appear on the skin, which is not accompanied by stagnation of venous blood in the peripheral parts of the lower extremities.

Varicose veins at the initial stage are prognostically more favorable, since they do not lead to clinically significant hemodynamic disturbances in the lower extremities. However, its presence does not exclude the possibility of damage to superficial veins of a larger caliber that lie already under the skin.

Often there is a combination of 2 types of varicose veins; in this case, when making a diagnosis, they focus on more severe manifestations. For example, if there are only spider veins (or reticular varicose veins), they speak of class C1 according to the international classification CEAP. And if against their background signs of damage to the saphenous veins appear, we are talking about class C2, that is, classic varicose veins.

The current classification CEAP, C1 is given in the presence of reticular veins, telangiectasia, that is, initial varicose veins.

How are the veins in the legs arranged?

The legs have two groups of venous vessels: superficial and deep or deep. The first are located in the subcutaneous tissue, that is, on the surface of the leg. The latter are located deeper, in the thickness of the muscles, next to the arteries and tendons. The deep and superficial vessels are connected by perforating or perforating veins. Their wall consists of collagen and elastin fibers, with weak and few smooth muscles. The venous wall has a three-layer structure:

• At the top is the adventitia, which is composed of loose connective fibers, smooth muscle cells elongated along the walls, surrounded by small capillaries and nerves responsible for the trophism of the vessel.
• In the middle is the media, consisting of circular smooth muscle fibers.
• The intima is located on the inside. The basis of the intima is the endothelium; between its cells there are longitudinal fibers of smooth muscles. The inner shell is folded, the thickenings are opposite each other and resemble swallows' nests or patch pockets. They are called valves and are responsible for the correct direction of blood flow.

Venous valves direct blood from the peripheral parts to the heart, as well as from the superficial to the deep veins. They prevent reverse outflow and increase venous pressure. In addition to the valves, smooth muscles, tendons and muscles of the leg take part in maintaining normal tone. When any of the layers (usually the median and internal layers) are damaged, the veins lose their tone and expand, and varicose veins occur.

• There are several superficial veins:

1. The great saphenous vein is located on the inside of the leg; its walls are equipped with several valves; blood from the anterior femoral surface is collected into this vein through a series of smaller vessels.
2. The small saphenous vein is located on the outside of the leg, equipped with valves, and collects blood from the veins on the front and back of the leg.

Communication between the large and small veins occurs through connecting vessels.

• The deep veins are the posterior and anterior tibial veins, the popliteal vein, and the femoral vein. Varicose veins develop in them at advanced stages, when the disease is not treated for a long time.

Symptoms and manifestations of varicose veins at the initial stage

The symptoms of initial varicose veins depend on the diameter of the affected vessels and their significance for the general venous outflow.

The “cosmetic” type of the disease is characterized by the presence of only external defects in the form of spider veins (telangiectasia) or a superficial fine mesh. There cannot be any other complaints, since the affected vessels have a very small diameter and are responsible for draining blood only from certain areas of the skin.

With the classic version of varicose veins, the symptoms are more obvious, although physical discomfort in the early stages of the disease is not permanent. The quality of life does not deteriorate significantly, and no serious complications arise. In this form, varicose veins can exist for quite a long time, decompensating and progressing with the addition of additional risk factors.

Severe symptoms of varicose veins

Symptoms of varicose veins affecting the saphenous veins of the legs include (8, English):

• Increased venous pattern in the lower extremities. There is a change in the course of visible superficial vessels and their bulging. But with obesity, this symptom is often masked by overdeveloped subcutaneous tissue. Obvious nodular deformation of blood vessels usually develops in later stages of the disease.
• The appearance of heaviness, a feeling of fullness and fatigue in the legs are signs of decompensation of venous insufficiency. They are usually accompanied by a tendency to slight swelling (pasty) of the legs. Such complaints may appear towards the end of the working day, especially if professional activities involve prolonged standing or sitting. In the early stages of varicose veins, discomfort and swelling disappear soon after taking a horizontal position with legs elevated. Facilitates the condition and performance of a set of exercises to engage the muscle pump of the legs.
• Increased fatigue of the leg muscles, and in some patients a tendency to cramps. This is explained by the beginning of metabolic changes in tissues, which are caused by microcirculation disorders against the background of phlebostasis.

The severity of symptoms may vary. In some patients, varicose veins in the initial stage debut with visible changes in the superficial veins. In others, signs of venous insufficiency initially appear, which is a sign of already existing valve pathology and serves as an indicator of a less favorable course of varicose veins.

For what reasons does varicose veins appear, and who is at risk of getting sick?

It is difficult to say why people get varicose veins at the moment. Only a number of risk factors have been identified, due to which the valves weaken and the elasticity and tone of the walls of the superficial and perforating veins decrease.

Here are the factors that lead to the development of the disease:

• Heredity. The structure of the walls of blood vessels is determined genetically; with some changes in the genes, they weaken and the valves do not close well. As a result, with the slightest increase in pressure in the veins, a reverse outflow of blood occurs, the vessels overflow and expand.
• Hormonal changes in the body in women. This situation is typical for pregnant women or for the second half of the cycle, when the amount of progesterone increases and the level of estrogen decreases. As a result, blood rheology changes (coagulability increases), vascular tone decreases, elastin and collagen fibers are destroyed, and the risk of blood clots increases.
• Obesity. People who are overweight move little, which slows down blood flow throughout the body. Excess subcutaneous fat on the abdomen leads to increased pressure in the abdominal cavity and compression of the main veins. This leads to stagnation of blood in the vessels of the legs, and further to varicose veins.
• Diabetes. Sugar, the level of which increases in this disease, damages the vascular endothelium, which increases the risk of blood clots.
• Alcoholism. When drinking large doses of alcohol, dehydration occurs, the blood thickens, clots form, clogging small blood vessels and causing congestion.
• Static occupational loads, such as lifting heavy loads, standing or sitting work. In such a situation, muscle tone drops, blood moves worse from the lower extremities to the heart, stagnation occurs, and the veins in the legs dilate because of this.
• Congenital pathologies of blood clotting. Hypercoagulation, in which too many factors are produced that are responsible for the formation of clots in the blood, provokes thrombosis and impedes the movement of blood through the vessels.
• Wrong diet. A diet deficient in a number of vitamins (C, E, PP) and plant fiber leads to disturbances in the structure of the endothelium and other structural elements of the vascular walls.
• Tight underwear. When wearing tight underwear, some of the veins are pinched, which causes obstructed blood flow from the lower half of the body.
• Frequent constipation. People suffering from this problem have to constantly push, this increases the pressure inside the abdomen, as a result, the outflow of blood becomes difficult.
• High heel. Overstraining the calf muscles and insufficient contraction causes blood to stagnate in the veins.
• Hot climate. In summer, during the heat, the body becomes dehydrated. If you do not compensate for the problem by drinking a sufficient volume of fluid, the risk of blood clots in the vessels will increase.
• Pathologies of the heart and kidneys. These may be congenital or acquired heart defects, renal failure.
• Exceeding doses of medications that affect coagulation. In this case, the blood vessels may become clogged with blood clots.
• Operation. The risk of thrombosis in this case increases due to blood loss and compression of veins during the intervention.

Anti-varicose medications

Drugs prescribed for pathology are divided into several groups according to their mechanism of action:

• Antiplatelet agents . They are believed to reduce the risk of blood clots, but convincing scientific evidence is only available for their preventive effect on the formation of atherosclerotic plaques in the arteries. Aspirin (acetylsalicylic acid), Thrombo ACC, Cardiomagnyl.
• Venotonics . Strengthens the venous wall, reduces swelling. This is the most commonly used group of drugs. Phlebodia 600, Detralex, Venarus, Troxevasin.
• Anticoagulants . Heparin-based drugs thin the blood and are used to prevent and treat blood clots. They come in the form of tablets, injections and ointments. Xarelto, Clexane, Fraxiparine, Lyoton gel, Heparin ointment, Trombless.
• Angioprotectors and microcirculation correctors . Improves blood circulation, microcirculation and vascular condition. Troxerutin, Curantil, Detragel.

When complications occur in the form of trophic ulcers, healing agents such as Oflomelid, Solcoseryl and dressings for various purposes are used. Treatment of ulcers depends on the stage of the process, the extent of the tissue defect and other factors. In each situation, the treatment course is prescribed individually.

How can varicose veins be complicated?

• Thrombosis due to blood stagnation.
• Vascular thromboembolism as a result of blood clot detachment.
• Thrombophlebitis or inflammation of the venous wall.
• PE (pulmonary embolism). In this case, blood flow in the pulmonary circulation is sharply disrupted, which leads to death. Small blood clots can lodge in the small pulmonary arteries and cause a heart attack or pulmonary edema.
• Trophic ulcers, eczema on the skin of the legs due to tissue malnutrition. With poor blood circulation, little oxygen and nutrients enter the tissues, which impairs regeneration or causes massive cell necrosis.
• Edema syndrome. As a result of impaired blood outflow and stagnation, fluid leaks through the walls of blood vessels into the intercellular space. The swelling is soft in consistency, elastic, and most often appears near the affected vein, regardless of the time of day.
• Dermatitis. The inflammatory process in the skin develops due to impaired blood flow and tissue nutrition.
• Hyperpigmentation, cyanosis of the affected areas of the skin.
• Consolidation of subcutaneous fat due to swelling and hemorrhage.

How to diagnose varicose veins

• Using functional tests (application of a tourniquet), the condition of the valves is studied. They are named after the authors - Troyanov-Trendelenburg, Pratt, Sheinis, Delbe-Perthes, etc.. For the Troyanov-Trendelenburg test, you need to lay the patient horizontally, then offer to raise the leg 450. In this position, the doctor strokes the limb from the foot upward to empty the superficial veins. The next step is to apply a tourniquet to the upper half of the thigh, after which the patient rises from the couch. Healthy veins in the legs should fill up after 15 seconds.
• Duplex ultrasound scanning of veins (ultrasound angioscanning) provides the most information and allows you to visualize the vessels and blood flow through them.
• Dopplerography is a method for assessing blood circulation through vessels.
• Phlebography or X-ray examination using contrast, which helps to study the internal structure of the vessel.
• Phleboscintigraphy is a technique using radioactive substances with further study on a special device for their distribution.

To study the superficial veins, they are examined and palpated. The first three methods are used as additional examinations. The last two methods are necessary to study the condition of the deep or deep veins.

Treatment of varicose veins

Conservative treatment options

• Drug therapy does not cure varicose veins, but with the help of drugs, valve function, vascular trophism, blood circulation are partially improved, and the risk of thrombosis is reduced.
  For this purpose, venotonics are used (Detralex, Troxivazin, Lyoton gel, etc.). They can be prescribed for any type of varicose veins. Ointments with nonsteroidal anti-inflammatory drugs (Indomethacin, Diclofenac, etc.) are indicated for thrombophlebitis. Also in this situation, anticoagulants are used (Heparin, Clexane, Fraxiparine, etc.), which effectively resolve blood clots. Treatment should be selected by a doctor, after a thorough diagnosis and taking into account the characteristics of the patient.
• Herbal medicine and additional techniques are of auxiliary value. It is advised to wear compression stockings, do gymnastics, skiing, cycling, and swimming. The “bicycle” exercise in a supine position, flexion and extension of the feet, gives good results; it improves the outflow of blood from the extremities. You can do the exercises if there are no complications. It is also recommended to take a contrast shower in the morning (water your leg first with warm water, then gradually reduce the temperature to cold). Cool baths with decoctions of oak bark, horse chestnut, chamomile, St. John's wort, rubbing the skin with tincture of white acacia flowers, Kalanchoe leaves, and apple cider vinegar help. Leeches help get rid of thrombophlebitis.
• Mode. You need to get out of bed slowly, 5-10 minutes. Your legs should be raised 10-15⁰ at night; to do this, place a cushion under your heels. You need to walk calmly, it is undesirable to cross your legs when sitting, and do not overwork. All patients are advised to wear compression stockings.
• You need to eat right, include coarse fiber and foods rich in vitamins in your menu. Citrus fruits, tomatoes, rose hips, black currants, nuts, legumes, liver, onions, eggs, and seafood will be useful. It is important not to drink alcohol, not to smoke, and to drink enough water during the day. For persistent constipation, it is recommended to drink a laxative.

Surgery

Phlebectomy or complete removal of veins

The indication for such a radical operation is varicose veins, which involve a large number of veins. At the same time, there are complications - trophic ulcers that are difficult to treat, thrombophlebitis, persistent swelling in the legs, general symptoms (fatigue, dizziness, fainting).

The operation is contraindicated in case of ischemic heart disease, severe infections, in very old patients, in the second half of pregnancy, in case of local inflammation of the legs (erysipelas, pustular rashes, eczema). Only surgery can radically rid the patient of varicose veins and restore the function of the valves. If the situation is too severe, untreated and neglected, this method of treatment remains the only one. The disadvantages of the intervention are the need to give anesthesia and keep the patient in the hospital for several days under observation, postoperative trauma with scars.

Laser therapy (endovascular microthermocoagulation)

Laser treatment of varicose veins is used if the pathology is combined with diseases of the cardiovascular system (CHI, hypertension), changes in peripheral vessels (phlebitis, thrombophlebitis), diseases of the respiratory system (asthma, chronic bronchitis, pleurisy), gastrointestinal pathologies (cholecystitis, ulcers, peritonitis ), nervous system (FM injuries, meningitis, encephalitis and their consequences), genitourinary system (inflammation of the kidneys, prostate, pathology of the uterus with appendages), with skin diseases (furunculosis, dermatitis, psoriasis, etc.).

Contraindications to the use of laser are oncology, decompensated pathology of the kidneys, liver, heart, cerebral sclerosis, pregnancy.

The main advantages of laser therapy are its effectiveness in eliminating dilation of superficial veins, speed (duration of manipulation is 15-20 minutes), no need to go to the hospital, and low trauma. Among the disadvantages, it is worth highlighting the poor accessibility of the technique; not all clinics have the appropriate equipment. Treatment is expensive and is of little use for severely affected and deep veins. If the laser is used incorrectly, you can get a thermal burn, and sometimes depigmentation occurs at the sites of exposure.

Radiofrequency coagulation (ablation)

The operation is indicated for extensive lesions of the saphenous veins, trophic ulcers resulting from long-term and untreated varicose veins.

Radiofrequency coagulation is contraindicated in acute thrombophlebitis, limited mobility of the patient, pregnancy, and mental disorders.

The main advantages of the method are its painlessness, absence of injury, and the need for hospital stay. Patients can return to normal activities the very next day.

The disadvantage is the high cost of the intervention.

Sclerotherapy

Indicated for varicose veins of small and large superficial veins (on large vessels it is carried out under the control of duplex Doppler ultrasound) in the initial stage and without complications. Pregnant and nursing mothers, allergies to drugs, deep vein thrombosis, infectious and inflammatory skin lesions on the legs are not treated with this method. The main advantages are low price, quick recovery, no need for hospitalization. The procedure leaves no marks and does not cause injury.

The disadvantage is the risk of the sclerosing drug entering a deep vein, reduced effectiveness upon contact with blood, and the ability to use only in the initial stages.

Possible complications

Deformed veins and the sclerotic valves located in them are not able to recover to their original level under the influence of drug therapy. The changes are irreversible and prone to progression, especially when provoking factors persist and new adverse effects are added.

In the initial stages of the disease, developing venous insufficiency can decompensate - this does not indicate getting rid of varicose veins, but a temporary slowdown in the pathological process. Subsequently, adjacent sections of the vein and other vessels are involved in phlebosclerosis. The greatest clinical significance is the damage to the communicating veins, which provide communication between the superficial venous network of the legs and the deep one. They penetrate (perforate) the fascia located on top of the muscles, therefore they are also called perforators.

Most communicating vessels also have valves, which normally prevent the non-physiological discharge of blood from deep veins to superficial ones, therefore varicose changes in perforators are accompanied by the development of horizontal reflux. This shutdown of the natural mechanism for regulating pressure in the superficial venous system leads to serious consequences:

What happens if varicose veins are not treated?

Turning off the natural mechanism for regulating pressure in the superficial venous system leads to serious consequences (11, German):

• worsening phlebosclerosis and accelerating the process of varicose veins against the background of significantly increased venous hypertension;
• increased phlebostasis, which increases the likelihood of developing intravascular thrombosis;
• disruption of the walls of the capillary network, which is accompanied by an increase in their permeability to plasma and protein molecules, accumulation of metabolic products in tissues and the development of chronic hypoxia.

The addition of horizontal reflux is a factor contributing to persistent decompensation of chronic venous insufficiency. Trophic disorders arise and increase in the skin and soft tissues, swelling and physical discomfort experienced by the patient increase, and the risk of developing thrombophlebitis increases. Varicose veins become complicated, advanced, with a significant area of ​​damage to the veins. And the treatment will no longer give as quick and tangible results as at the early stage.

Is it possible to cure varicose veins at home?

At home, it is allowed to use auxiliary methods for treating varicose veins, which alleviate symptoms. They use ointments from pharmacies or self-prepared ones, baths and lotions based on herbs, compresses, drink decoctions and infusions to improve blood flow and relieve swelling. Below are some recipes.

Chestnut tincture

Take about 200 g of ripened and peeled chestnuts. Pass through a meat grinder or grind with a blender. Fill everything with a liter of vodka, put it in a dark corner and leave for a couple of weeks. To make the product smell good, add a couple of drops of peppermint oil. In the evening, lubricate the legs with the tincture to get rid of heaviness and itching, strengthen blood vessels, and prevent their fragility. It is also recommended to make a compress from the tincture. If there is no chestnut, it is replaced with nutmeg, the recipe remains the same. Tincture with musk nuts can not only be used to rub sore feet; it is recommended to drink 20 drops a day. After the bottle is finished, a new tincture is made. But there should be a pause of 2 weeks between taking the next portion.

Calendula-based ointment

An infusion is made from calendula flowers - pour a tablespoon of boiling water, put on fire, cook for a couple of minutes, leave for 3 hours in a thermos. Strain the infusion and add it to some kind of fat; lanolin, Vaseline, badger fat are suitable. For the smell, it is recommended to add a drop of aromatic oil (rose, bergamot, citrus, sage, lavender, etc.) Rub the ointment in the morning and evening, with gentle movements from the bottom of the leg to the knee, until completely absorbed. Thyme, hop cones, and nettle are also added to the calendula infusion.

Chamomile oil

Medicinal chamomile flowers are placed in a half-liter glass jar of a dark shade so that the container is filled to the top. Pour in half a liter of any type of vegetable oil, for example, from olives, corn, hemp. Leave for a month, shaking or stirring from time to time. After this, the oil infusion is filtered. For scent, add a couple drops of tea tree, mint, lavender, and grapefruit aroma oil. Apply chamomile oil to the foot early in the morning and late in the evening, while simultaneously doing a light massage. You can also make night compresses from the infusion.

Compress based on wormwood

Take a package of kefir or fermented baked milk, 3 tablespoons of dried wormwood. The grass is crushed and mixed with kefir (ryazhenka). When the grass is wet, place it on cheesecloth along with a thick liquid. Then a compress is applied to the leg, covered with wax paper on top (cellophane film is not used), and everything is fixed with several layers of bandage. Keep your legs elevated and remove the compress after half an hour. It is recommended to do the procedure twice a day. Instead of wormwood, you can take hops, chamomile flowers, string, clover, oak or birch leaves, St. John's wort, horsetail, tricolor violet flowers, yarrow. Combinations of different plants give a good effect. To improve the effect of the compress after the procedure, it is recommended to lie down for a while with your legs raised up. All of the herbs listed can be infused and used to make a foot bath. The water in such a bath should be warm, the duration of the procedure is about 25 minutes. It relieves fatigue, swelling, reduces skin itching and pain.

Traditional recipes for internal use

Various herbal infusions improve blood flow in the veins well. The following herbs are used:

• Clover
• in succession
• Leaves and berries of lingonberries, viburnum, strawberries, raspberries
• Coltsfoot
• Calendula
• Japanese Sophora
• Melissa
• Schisandra
• Hawthorn

The grass is dried, then crushed and made into a mixture of different types of plants. Then take 3 tablespoons, pour a liter of boiling water, leave overnight in a thermos and drink 1/3 glass before meals.

Varicose veins are well treated with bee pollen and honey. Pollen should be consumed internally. Honey can also be eaten, but it still makes good compresses. It is recommended to add infusions of various herbs to honey.

Treatment of varicose veins in pregnant women

Carrying a baby is accompanied by a hormonal storm in the female body and overload, which often provokes varicose veins. Treatment during this period is carried out conservatively, with the help of local creams, ointments and gels. The most effective ointments have a decongestant effect and eliminate heaviness in the limbs. Asklesan, Venorutin, Lyoton give good results. Apply them in a thin layer, moving from bottom to top, with soft massage movements. The frequency of manipulations is 1-3 times a day.

Folk remedies also help. It is recommended to prepare baths with herbal decoctions (from chamomile, thyme, hop cones, calendula, wormwood, coltsfoot, oak bark, birch leaves, etc.).

You can fight swelling by applying cabbage leaves or raw grated potatoes to your feet. You need to cover the compress with waxed or regular thick paper, not cellophane, so that the skin can breathe. The procedure is done before bedtime and the lotion is left overnight.

Doctors also prescribe medications for internal use to pregnant women. There are venotonics that do not negatively affect the development of the fetus and the health of the mother. They are most often based on plant extracts. Here are some popular drugs:

• Antistax
• Venoruton
• Troxevasin
• Detralex
• Vasocket
• Phlebodia
• Aescusan

After taking the medications, venous tone increases, the walls become elastic, they don’t stretch as much, lymph flow improves, the liquid part of the blood stops leaking into the intercellular space, and swelling goes away. You cannot take these medications without a doctor's prescription.

Effective external remedies for the treatment of varicose veins

External remedies are not able to cure varicose veins completely, but they slow down the process and relieve some symptoms. In the initial stages, they can be the main treatment.

Treatment

The treatment methods used for varicose veins are divided into conservative and surgical. Typically, a treatment regimen includes both of these components.

For the treatment of varicose veins at the initial stage, drugs of various groups are widely used, with preference given to phlebotonics in tablet form and as part of ointments. Their regular use in most cases makes it possible to compensate for incipient venous insufficiency, which has a beneficial effect on the patient’s condition (English). Some medicinal plants have approximately the same effect, which explains the frequent use of herbal medicine - both in the form of decoctions and infusions for oral administration, and in the form of herbal preparations.

In addition to drug treatment, the following may be used:

• physiotherapy;
• compression jersey;
• exercise therapy;
• diet therapy - normalizing body weight will reduce the load on the vessels of the lower extremities.

All conservative methods have only a restraining and compensating effect. No drug is capable of restoring sclerotic and deformed veins and the valves located in them.

At the initial stage, an excellent effect can be obtained with sclerotherapy; varicose veins of large diameter are eliminated with a laser - both treatment technologies will relieve not only the unsightly looking vessel, but also the existing venous insufficiency. Healthy deep veins take over the drainage of venous blood. After a short period of adaptation, the blood flow system is completely compensated, phlebostasis is stopped, microcirculation is normalized.

Effective creams for the treatment of varicose veins

Creams for the treatment of varicose veins are used only at the very beginning of the development of pathology. The following products have proven effectiveness:

Traditional methods of treating varicose veins

There are many folk recipes for infusions, decoctions, lotions and compresses. A number of remedies are advised to be taken even internally. Below are several options for treating varicose veins using traditional methods.

Lilac tincture

Take a container with a volume of one and a half liters, pour flowers and lilac leaves into it. Then everything is filled with vodka or medical alcohol so that the liquid completely covers the grass (to the very edge of the container). Infuse for a week, shaking occasionally, then filter and rub the tincture on your feet every day. Rub the skin with soft massage movements, from fingers to knees.

With the help of tincture they fight inflammation, swelling, cramps, and pain in the legs.

Garlic ointment

Garlic cloves from a whole head are peeled, ground in a meat grinder or pressed through a garlic press. After this, you need to take butter (unsalted) and mix with crushed garlic in a ratio of 1:2 (2 parts butter and 1 part garlic). Apply this mixture to the affected leg, cover with wax paper, bandage it, the compress can be kept overnight.

The compress eliminates pain and burning sensation, it has antiseptic properties, softens the skin, and helps heal wounds.

Honey with garlic

You need to take a head of garlic and 250 ml of honey (preferably linden or buckwheat). Both ingredients are thoroughly mixed and left for a week. Drink a tablespoon three times a day, before meals. The product relieves swelling and fatigue, pain, and varicose veins become less noticeable.

Potato juice

Raw potatoes are crushed on a grater or in a blender, and the pulp is applied to sore spots. Keep the compress for about half an hour; if desired, you can leave it on all night. To increase efficiency, drink half a glass of potato juice at the same time. The product relieves swelling and discomfort in the leg, eliminates heaviness, reduces fatigue and inflammation.

Butter with onions

A glass of olive oil and the same amount of onion peels are mixed in a glass bowl, two teaspoons of apple cider vinegar are added there. The mixture is hidden in a dark corner for 2 weeks, shaken periodically.

Before applying oil and onions to your feet, make a bath from a decoction of onion peels. Rub the limb with oil from the fingers to the knee. It is best to perform the manipulation before bedtime. Rubbing eliminates the heaviness and fatigue of the legs, although they cannot completely cure varicose veins.

Calendula-based ointment

Pour 2-3 tablespoons of dried calendula flowers with a glass of boiling water, leave until it cools down (you can use a thermos). Strain the infusion and mix with 250 g of any fatty substance (take Vaseline, lanolin, badger fat, etc.). To improve the smell, add a couple of drops of aromatic oil from mint, grapefruit, rose, lavender, and sage to the mixture. Rub the ointment on your feet until it is absorbed, apply twice a day. The infusion can be made combined; in addition to calendula, add thyme, hop cones, chamomile, and nettle.

What is the effect of wearing compression garments for varicose veins?

Compression garments cannot cure varicose veins. But wearing it slows down the disease, relieves many of the symptoms caused by it, and improves well-being.

After putting on compression hosiery, the lumen of the saphenous veins narrows, blood and lymph flow better and do not stagnate in the limbs. At the same time, swelling is relieved, convulsive contractions of the calves disappear, legs are less tired, and there is no feeling of heaviness.

The main types of compression garments prescribed for varicose veins are leggings, socks, stockings, and long tights. It is recommended to wear the products every day; you need to put them on in the morning, before getting out of bed, always in a lying position.

There are different degrees of compression of knitwear, they are chosen depending on the stage of varicose veins. Only the right underwear will have the proper therapeutic effect. It is best to be prescribed by a doctor, but stockings or tights with low compression, for prevention, are easy to purchase yourself.

Here's how different types of compression products are labeled:

• Class I – (18.4-21.1 mm Hg) – this is underwear with starting compression. It is suitable for preventing varicose veins in pregnant women, in people whose work involves significant physical exertion, or in the initial stages of the disease.
• Class II – (25.2-32.3 mmHg). Underwear with medium compression. It is used as a prophylactic against thrombophlebitis, after operations or sclerosis of veins.
• III Class (36.5-46.6 mmHg). High compression underwear. Indicated for patients with trophic ulcers on the legs, tissue nutritional disorders, in the presence of thrombosis in the deep veins, significant disturbances in the outflow of lymph and blood circulation.
• IV Class (more than 59 mmHg). Ultra-high compression underwear. Used in patients with elephantiasis and severe venous abnormalities.

Before purchasing, you need to determine exactly what compression class you need. Inquire about the labeling features of the products of your chosen company. Reputable companies always use the word “compression” to define the class and define it in mmHg. If “DEN” is written on the packaging, then this product has nothing to do with medical underwear.

How to spend the postoperative period

The postoperative period after phlebectomy on the legs lasts ten days: from the moment of the operation itself until the sutures are completely removed. At this time, the operated limb needs special attention and special care.

After the operation, the patient receives compression of the lower extremities using compression stockings. Compression is an important condition for the smooth course of the postoperative period, as it allows you to compress the saphenous veins, preventing stagnation of blood in them, and, accordingly, the formation of blood clots. Compression also accelerates the healing of small veins remaining after removal of the main venous trunk.

Places where stitches are placed should not be wet. For hygienic purposes in the postoperative period, wet wipes or gauze moistened with water are used. The sutures are regularly treated with iodine and a sterile bandage or sticker is applied to protect them from damage and contamination.

To reduce swelling of the lower extremities, it is recommended to keep them elevated - on a pillow, a fabric cushion up to 15 cm high. In case of intense pain after surgery, the doctor may prescribe painkillers, and antibiotics to prevent purulent complications.

What effect does laser treatment bring?

Endovasal laser coagulation or treatment of varicose veins with a laser is a fairly effective technique. There are different options for this method of treatment - laser monotherapy, combined therapy (complex laser treatment with the use of drug sclerotherapy, deep vein ligation). Through the impact of laser beams on the diseased organ, they try to achieve sclerosis of too large and dilated veins, thus the altered areas are removed, some vessels are narrowed and blood flow is normalized. In addition, the treatment also has a cosmetic effect: stars and dilated vessels are removed, and the limb regains its normal appearance. The mechanism of action of the laser resembles the effect of sclerosing drugs. Soldering and further resorption of the affected vessels occurs. But with laser therapy there is no need to administer medications that may have side effects. During the operation, a small puncture is made in the area of ​​the affected vein, and a laser light guide is inserted into it using a needle. Movements in the vein are monitored through an ultrasound machine. When the light guide reaches the desired location, the doctor turns on the radiation, which acts on the vein for several seconds. The walls are burned, and after some time their sclerosis occurs. The operation is performed under local anesthesia. The duration of the procedure is a little over an hour, it does not cause pain or discomfort to the patient. After just a couple of hours, the patient can get to his feet and go home on his own. Restrictions regarding work and physical activity are lifted after a week. During this period, it is recommended to lubricate problem areas (where the intervention was performed) with ointments or gels with heparin. A week after completing treatment, the person can return to their normal activities. To improve the condition of the limb and achieve optimal results, compression stockings are prescribed and must be worn constantly.

Laser treatment is indicated in the following situations:

• Varicose veins in relatively small areas of the vein.
• The mouth of the great saphenous vein is dilated by no more than 10 mm.
• Trophic disorders in the lower leg area.

There are few contraindications for laser therapy for varicose veins. One of the main ones is a strong expansion of the veins. There is a certain diameter of the vessel at which laser treatment can bring results and will not lead to relapse of the disease.

Opportunities of the Innovative Vascular Center

• Thermal methods for treating varicose veins are endovenous laser coagulation (EVLC) and radiofrequency obliteration (RFO) of the veins of the lower extremities.

Endovenous laser coagulation is an effective treatment for varicose veins, the principle of which is based on the thermal effect of laser energy. This treatment was introduced in 2001 and is still the best method. With laser coagulation, the damaged vein is heated by a laser beam, which provides a strong effect of damaging the collagen of the venous wall, causing an inflammatory process in the vein and its overgrowth. Advanced varicose veins on the legs, which are treated with this method, regress completely and without a trace, and its main symptoms disappear: swelling, heaviness in the legs, hyperpigmentation of the skin. Varicose veins have been treated at the Innovative Vascular Center in Moscow using lasers since 2005, since the advent of this technology in Russia.

EVLT begins with the installation of a laser fiber into the lumen of a varicose vessel through a skin puncture, which is guided along the affected vein to the site of the incompetent valve. For the patient, this method is a safe, painless and reliable way to prevent further development of the disease and its complications. Complete elimination of varicose veins is observed in 98% of patients with proper use of the EVLT method. The capabilities of this method make it possible to both treat varicose veins on the legs in women and correct venous outflow in case of trophic ulcers.

Radiofrequency obliteration (RFO)

Treatment of varicose veins using the radiofrequency obliteration (RFO) method is a similar thermal method, but heating of the tissue of the venous wall occurs according to different physical principles due to radio wave energy. Radiofrequency obliteration allows you to remove varicose veins and eliminate its symptoms; such treatment in its immediate and long-term results does not differ from EVLT, but is more painstaking for a phlebologist.

Other thermal methods

When deciding how to treat varicose veins, phlebologists often used exotic methods. Varicose veins were treated with thermal effects using superheated steam and bipolar electrocoagulation. However, modern thermal methods are more effective and they allow the doctor to prevent further development of varicose veins, and the patient to be treated on an outpatient basis without disturbing his lifestyle. In the hands of a novice phlebologist, thermal ablation methods can cause unpleasant complications: decreased sensitivity, burns, seals. The effectiveness of this method in the hands of an experienced phlebologist is more than 98%, and the laser method and RFO make it possible to get rid of not only the initial form but also severely pronounced varicose veins on the legs without incisions. In the photographs from the “Treatment Results” section you can see the view before and after minimally invasive treatment.

Non-thermal methods for eliminating stem reflux

For many years, phlebologists have been thinking about how to cure varicose veins of the lower extremities without incisions and pain. The disappearance of the saphenous veins in the arms after frequent injections prompted the idea that certain substances can cause inflammation of the vein walls - thrombophlebitis and subsequent gluing of them with the disappearance of the lumen of the vein. After the advent of the Fegan method, when treatment began to be carried out based on the cause of varicose veins, the development of non-thermal scleroobliteration methods began. Since then, varicose veins on the legs, especially in women, are treated not only with a scalpel, but also with a syringe.

• Sclerotherapy

Sclerotherapy appeared in the practice of doctors at the end of the 19th century. In recent years, the method of treating varicose veins using injections of a special substance (sclerosant) has reached perfection. The main point of sclerotherapy is to inject a drug into a varicose vein, which causes inflammation and subsequent gluing of the varicose vein. Sclerotherapy does not involve eliminating the cause of venous insufficiency and is more suitable for certain forms of varicose veins or in the initial stages of the disease. Advanced varicose veins of the lower extremities are treated with more complex methods; damage to the trunk of the great or small saphenous vein does not allow one to count on a long-term effect of sclerotherapy, since a relapse is sure to occur due to reflux.

Sclerotherapy can be done if you are not allergic to tetradecyl sulfate or polidocanol. These substances are the main sclerosants. During sclerosing treatment, manifestations of thrombophlebitis may occur, especially if liquid forms of the drug are used. Sclerotherapy of perforating veins is highly effective in the treatment of venous trophic ulcers. It is possible to eliminate the manifestations of varicose veins of the lower extremities at any stage with the help of sclerotherapy, but the relapse rate is about 40% over the next 5 years.

The advantage of sclerotherapy is a good immediate effect and low cost of treatment. Injections of sclerosant lead to the gluing of veins and the cessation of the pathological process - reflux of blood through the saphenous veins. The drug is usually injected in the form of foam (Foam-Form) into varicose veins. A spasm of dilated subcutaneous vessels is formed, prolonged contact of the foam form of sclerosant with the vein wall and their subsequent inflammation and gluing. This process occurs unevenly and the degree of obliteration of the vein is not the same, so 40% of patients after sclerotherapy have relapses of varicose veins. After sclerotherapy, the affected area of ​​the veins of the lower extremities closes and over time completely heals, and the blood flow in the opposite direction stops. To prevent the occurrence of skin necrosis due to the penetration of the foam form of sclerosant into the subcutaneous tissue, administration is carried out strictly under ultrasound control.

Foam sclerotherapy can be used as a stand-alone method or in combination with laser treatment to eliminate varicose veins. The number of sessions to eliminate varicose veins using sclerotherapy depends on the stage of varicose veins and the condition of the veins. The course of treatment usually consists of 2-3 procedures. The area of ​​skin over the sclerotic vessel may take on a dark shade for 2-3 months (hyperpigmentation appears). It can ruin a woman's legs for several months, so this treatment is best done in the winter months. Drug treatment and ultrasound-guided vascular punctures can speed up the process of resorption of intravascular fluid accumulations (coaguls), the risk of which is about 10%. Coaguli form when there is insufficient compression, but will certainly go away over time. Many patients know that within a month after sclerotherapy, the signs of varicose veins of the lower extremities go away for many years, which is why sclerotherapy is still one of the most popular treatment methods.

• Using special glue (VenaSeal)

Since its inception, this method has aroused great interest among phlebologists. It involves gluing the trunk of the great saphenous vein with a special cyanoacrylate glue. In the lumen of the vessel, this glue polymerizes and fills the lumen of the dilated vessel. According to the developers, this method does not require any anesthesia, and a “plug” appears in the vessel, which reliably blocks blood flow. Taking this into account, half an hour is enough for the procedure to eliminate varicose veins on the legs. Venasil is the only technology for the treatment of varicose veins that does not require wearing compression stockings.

Most women can return to normal activities immediately. Symptoms of chronic venous insufficiency are relieved shortly after the procedure. The process of active promotion of this glue to the phlebological market should begin in the near future. However, there are certain disadvantages: The presence of a foreign body in the human body. The curdled glue remains in the vessel forever and can cause chronic allergies; sometimes there is inflammation of the vessel wall or rejection of the polymer with suppuration. Acute thrombophlebitis of the glued vessel may occur.

The use of glue in the trunk of the great saphenous vein does not eliminate the need to eliminate varicose tributaries, which is why doctors will have to remove signs of subcutaneous varicose veins with sclerotherapy or miniphlebectomy. The visible effect of using glue appears only when combined with other methods of eliminating varicose veins. The patient has to pay more. The unreasonably high cost of the gluing kit makes this procedure significantly more expensive than the modern laser or radio frequency method.

In our clinic, preference is given to thermal methods. We believe that it is better to give good local anesthesia than to treat varicose veins of the saphenous veins on the legs with an expensive and untested method. Moreover, the result is the same at best. If a relapse occurs, the patient will have to undergo a complex operation to remove the sealed vessel, since other methods will no longer be applicable.

• ClariVein mechano-chemical obliteration technology

The modern method of combined treatment of reflux along the subcutaneous venous trunks adds extra weight to conventional sclerotherapy. Mechano-chemical procedures mean a combination of mechanical damage to the inner surface of the venous wall and the introduction of a sclerosing drug. A catheter is inserted into the main saphenous vein through a puncture under ultrasound guidance. After installing the catheter in the desired location, the device is connected. The rotating sharp head of the catheter makes up to 3.5 thousand revolutions per minute, causing severe damage to the inner layer of the venous wall. At the same time, a sclerosing drug is injected through the catheter, which “mixes” in the lumen of the vessel and, using the rotating part of the catheter, acts on the vascular wall, causing its inflammation and gluing.

To date, the only advantage of this technology is the absence of the need for tumescent anesthesia. Mechano-chemical obliteration should, according to its inventors, trigger a stronger obliteration effect than foam sclerotherapy, although for some reason convincing data have not yet been presented. It is clear that such varicose veins can be treated with other minimally invasive methods, so its advantages are not obvious. The introduction of such therapy in Russia will begin in 2021, but statistical data on its advantages over EVLT and sclerotherapy do not yet exist. We have to wait for further studies from Europe or the USA in order to accurately determine the place of this technology.

• Miniphlebectomy

This is a modern microsurgical aesthetic method for removing varicose veins. It involves a delicate technique of puncturing and pulling out varicose veins using special tools. This operation is not for a novice phlebologist; you need to have the skills of delicate surgery. Miniphlebectomy is an operation without the use of a scalpel and is performed under local anesthesia. The punctures are carried out in the direction of the skin lines, so after 2 months they are practically invisible.

Miniphlebectomy has replaced the classical operation for varicose veins, which involves the use of 1-3 cm incisions, as it is aesthetically flawless, painless and very effective. By assuming how varicose veins manifest, the doctor can clearly plan micro-punctures and get by with minimal intervention. The patient can go home on his own feet immediately after the operation. Miniphlebectomy can be an independent effective method of treating varicose veins, or used in combination after laser coagulation of varicose veins. Removal of varicose veins is carried out using a special technique developed by Professor Varadi. This technique has been perfectly mastered by our phlebologists and allows for the removal of varicose veins on the legs - an effective treatment regardless of its cause.