Varicose veins of the lower extremities is a pathology that is characterized by varicose veins, the formation of nodes. This is one of the very common diseases. Despite the fact that methods of treating varicose veins are actively developing in our time, the growth 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 have malnutrition (passion for fast food with fast carbohydrates and a small amount of vegetable fiber), there are problems with hormones against the background of malfunctioning of the thyroid gland, adrenal glands against the background of unfavorable environmental conditions.
Also very oftenvaricose veins occur during pregnancy, for persons who are forced to constantly stand due to the specifics of their profession (risk group - hairdressers, sellers).
In women, varicose veins can develop against the background of power loads unusual for them when playing sports: for example, lifting a barbell.
It is better not to delay the fight against varicose veins. And one of the most progressive methods of treatment is laser treatment of veins with a laser.
Treatment of veins with a laser. What it is?
Laser vein treatment is a minimally invasive treatment method. It is effective for combating dilated veins, trophic ulcers on the legs.
Under the treatment of veins with a laser, modern surgeons, as a rule, meanendovenous (endovasal) laser coagulation or obliteration (EVLK, EVLO), ablation. At its core, coagulation, obliteration, ablation in medical practice are one and the same. With the help of special equipment, blood reflux in perforating (that is, connecting superficial and deep blood vessels) and superficial veins is eliminated, and then, physically, due to thermal energy, blood is discharged in the veins.
If we turn to the terms, the word "obliteration" means closure, "ablation" - destruction, "coagulation" - coagulation. I. ethese are different parts of the complex, which combines the processes that occur with diseased veins during treatment.
But in practice, it turned out like this: when a surgeon works with a laser, the procedure is often called "coagulation", and the terms "obliteration", "ablation" are often used in radiofrequency treatment of veins. In this case, instead of a laser, equipment with a radio frequency generator is used. But there is no clear "binding" to a laser or radio frequency equipment for each of these terms. Therefore, patients planning laser vein treatment in different clinics may encounter different names for the procedure.
- Endovenous laser coagulation (EVLK).
- Endovasal laser ablation (EVLA).
- Endovenous laser thermal ablation.
- Thermal ablation with a laser.
Mechanism of laser vein removal
The laser works from the inside through the lumen of the vein. The essence of the procedure is to create a fully controlled wall burn. It is "brewed", "sealed", and then resorption begins, i. e. the process of removing the veins is gentle.
EVLT can be used alone or in complex operationsin combination with sclerotherapy or miniphlebectomy.
In the first case, part of the veins "is precisely sealed, part is glued together with a special preparation, in the second, in addition to sealing, part of the veins is immediately brought out with a hook and succeeds.
Laser removal of veins helps to save the patient from venous stasis, trophic disorders, and edema.
The mechanism of using the laser is based on the fact that with a targeted and effective impact on the venous wall, the surrounding tissues practically do not heat up.
This provides patients with the following benefits:
- The operation can be performed on an outpatient basis, hospital stay is not necessary (except in cases where the pathology is highly developed, and additionally it is necessary to resort to microphlebectomy), it is easy to do without incisions, surgical intervention does not require suturing.
- You can quickly return to your normal lifestyle.
- There are quite a few contraindications (we will talk about them below).
What veins can be removed with a laser?
Unfortunately, not all veins can be removed with a laser. At advanced stages and with some anatomical features, conservative surgery (with a scalpel) is used.
But which veins can be operated on with a laser?
It is important to pay attention to the features of the course of the vein.Laser removes only veins with a linear course. If anatomically the vessel has a high tortuosity, 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 - taking control of the artificial burn area.
As for the type of veins that respond well to laser treatment, thenThese include:
- Great saphenous vein.
- Small saphenous vein.
- Additional saphenous veins located at a depth of at least 5 mm from the skin surface;
- Incompetent perforating veins (i. e. veins with pronounced impaired venous outflow, most often the veins of the leg).
Indications and contraindications for EVLT
The only indication for EVLT is varicose veins. Also, the only method that can be used for the surgical treatment of an open trophic ulcer is EVLT.
What is typical for stage 1-4 varicose veins?
- Varicose veins.
- Venous malformations (arteriovenous malformations). Fistulas, pathological fistulas between veins and arteries. They may be invisible to the eye and detected only by microscopic examination. Combine directly venous and lymphatic problems. Cause intense pain.
Unfortunately, there are contraindications for laser vein treatment:
- Ischemic manifestations in the legsagainst the background of obliterating diseases of peripheral arteries (chronic ischemia) and acute ischemia of the lower extremities. Most often in patients with atherosclerosis. Removal of veins with a laser in this case may be ineffective. This is due to the fact that after treatment, the need for compression will not be avoided, and it is against the background of ischemia - these are serious risks for the progression of the latter.
- Lactation. The risks are associated with the fact that women during breastfeeding have an increased production of hormones. Experts recommend waiting until the time when breastfeeding is stopped and only then resorting to laser treatment.
- Oncological diseases.
- Any pathology in the acute stage. How much a specific exacerbation is critical in a particular case, the doctor determines taking into account the disease and the individual characteristics of the patient.
- blockage of the arteriesblood clots.
- Real estate and the impossibility of maintaining an active imagepatient's life after surgery.
- Inflammatory process in the area of the upcoming surgicalinterventions (with the exception of chronic trophic ulcers). Inflammation can lead to the spread of infection during surgery and then to sepsis.
Stages of endovenous laser coagulation
Stage 1. Examination by a doctor, consultation
It is important that they are carried out not just by a surgeon, buta qualified specialist in vascular surgery, phlebologist. The phlebologist has the most complete understanding of the features of the anatomy of the lower extremities, the physiology of the venous outflow, the pathogenesis of venous transformation of the veins, the specifics of the condition of the valves at various stages of varicose veins.
Phlebologists are purposefully trained in methods of dealing with pathological refluxes in the veins. These physicians are most competent in making decisions related to the care of vascular malformations.Phlebologists, not just "general" surgeonsThey will also give you the most complete recommendations regarding recovery.
Stage 2. Diagnostics. Analyzes and functional examination
What does the preoperative examination include?
- Functional trials. They are of several types: to determine the failure of perforating veins, valvular insufficiency, analysis of the condition, patency of deep veins.
- Blood test. Hematological examination, general and biochemical blood tests (detailed) are important. The doctor pays particular attention to the following aspects: does the patient have latent inflammatory processes according to the results of the analysis, what level of glucose, (this is especially important for varicose veins with trophic ulcers, since increasedsugar provokes the progression of their infection), the level of D-dimer (this indicator is directly related to the assessment of the risk of blood clots), APTT - thromboplastin time (despite the fact that we are talking about a minimally invasive intervention, when manipulating veins, this indicator is important for the surgeon). As before other surgical interventions on the veins, the Rh factor and blood type are determined, an HIV test is done, tests for RW (syphilis), HBs (hepatitis B), HCV (hepatitis C).
- General urine analysis. It is important to exclude hidden pathologies that may adversely affect the overall result.
- Electrocardiogram. If necessary, ultrasound of the heart. Alas, if a person has problems with the veins in the legs, often the heart is out of order. It's all part of the cardiovascular system. Therefore, the assessment of the state of the heart is extremely important for the doctor.
- For women - examination by a gynecologist. In some cases, varicose veins of the perineum, vulva, and varicose veins develop against the background of the syndrome of venous plethora of the pelvic organs.
- Ultrasound of veins and arteries(with duplex) One of the basic studies, the results of which are used in the treatment. For a doctor, the structure of veins, arteries, diameter, and blood circulation speed are important. Both the treatment regimen and the rehabilitation scheme depend on the ultrasound picture. It is a complete picture of the vessels and arteries that helps to form a competent set of measures to prevent the risks of a particular patient.
Since those suffering from varicose veins often have concomitant diseases, ultrasound diagnostics of the abdominal cavity and pelvic organs are often additionally prescribed.
Stage 3. Preparation the day before and on the day of surgery
- Depilation of legs the day before.
- On the day before the operation, the patient can eatlight breakfast. If a person takes any medications, then they, as a rule, are not canceled. But this aspect is important to coordinate with the doctor. Especially if the side effects of the drug are bleeding.
- Take with you to the cliniccompression stockings.
- Vein marking. A special surgical marker is used to mark the vein. It contains gentian dye, dries quickly. Most markers that are used in surgery have bactericidal properties. A complete projection of the vein is drawn. Marking is carried out under the control of ultrasound. The result of perforating reset depends on how professionally the marking is done. Also, the professionalism of marking affects the aesthetics. The focus is not only medical, but also cosmetic results. It is important that the manipulations are carried out strictly in the area of localization of defective, pathologically affected vessels.
- Tumescent anesthesia. A cold, long-acting local anesthetic solution is used. An anesthetic "coupling" is formed near the vein.
- Insertion of a light guide into a vein.
- EVLO directly. The doctor turns on the equipment and activates the light guide. The laser radiation is turned on and the light guide is advanced along the vein.
- Creating compression. After the procedure, a compression bandage is applied (special rollers are fixed on the vein, compression stockings are put on the leg).
If only laser removal is performed, then all manipulations take about 40 minutes.
If laser treatment is combined with miniphlebectomy, then the treatment time increases: some short sections of the veins are removed through a thin puncture. The combination of laser treatment with microphlebectomy is an excellent opportunity to achieve remarkable aesthetic results with very large varicose veins.
If it is important to supplement laser treatment with sclerotherapy, a special drug is injected into a number of veins. This combination of surgical techniques is relevant for telangiectasias (pronounced expansion of small vessels), reticular varicose veins ("vascular network").
Stage 4. Restorative
The main thing at this stage is wearing compression stockings, prevention of relapses.
Before planning laser treatment, it is important to be familiar with the potential complications.
There are cosmetic and more global.
- Soreness. A number of patients have no pain immediately after the procedure, but after 5-6 dayspain on the 5-6th day after medical manipulations. As a rule, this happens in such cases when patients ignore the rules regarding physical activity and immediately switch to an active lifestyle, or against the background of other pathologies.
- Seals.Can be formed in the area of tributaries of the "soldered" vein. The seals are unaesthetic and cause psychological discomfort, however, if you immediately take control of the seals,in a month and a half the problem is easy to fix. To do this, doctors adjust the compression scheme in this zone. With properly selected compression stockings, the seals dissolve.
- Pigmentation.Occurs at the time of resorption of the vein. The problem does not occur in all patients, but only if the vein is located close to the skin. Special treatment in this case is not required.After some time, the skin in most cases regains its natural shade.. If this does not happen later, pigmentation is eliminated by cosmetic methods. Sufficiently extensive areas of pigmentation may occur in patients who have seals along the course of the "soldered vein". In this case, they can become "provocateurs" of hyperpigmentation.
- Decreased mobility of the legs.The emergence of the "feeling of the string". There is no pain, but when the leg is extended, it seems that a string, a rope was tied to it, and it interferes with the usual actions in the usual "mode".A few weeks after laser coagulation, the feeling of discomfort disappears.on one's own.
- Edema. More often - in the ankle, lower leg. The problem, as in the case of seals, is effectively resolved by correcting the pattern of wearing compression stockings and replacing them.
- Subcutaneous hemorrhages (hematomas).If you use absorbable gels, you can forget about bruises in a couple of weeks.
- Inflammatory processes in tissues.In severe cases, drug therapy may be required. But more often the problem is solved by changing the pattern of wearing compression stockings.
- Phlebitis of tributaries.There is a lot of tension in the legs. The skin becomes very red (usually in stripes). The skin temperature rises locally. Phlebitis -rare complication of minimally invasive procedures, but if he declared himself, ultrasound dopplerography, angioscanning, blood tests are recommended. Based on these results, the doctor decides which drugs to prescribe to the patient (anti-inflammatory, blood thinners), whether physiotherapy is required, whether to replace the compression garment with a tighter or less loose one. Everything is determined in a complex, but at the same time quite individually.
Prevention of complications
Patients are prescribed to wear compression stockings. As a rule, two pairs of knitwear provide the best effect. The tightest - immediately after the procedure, and knitwear - with less pressure, to maintain the effect of the treatment.
It is important that when choosing compression stockings, not only brand awareness is taken into account, but two conditions are also observed:
Compression stockings must comply with the RAL standard. In this case, the products are carefully analyzed and evaluated for the level of compression, pressure distribution.
Evaluation of the optimal level of compression should be carried out exclusively by a doctor. Independently choosing compression stockings and prescribing one or another level of compression is a huge mistake that is fraught with pain and tightness. In self-assessment, the patient often relies on subjective sensations (some stockings are more tight, others are less tight). But only a doctor can objectively assess which anatomical cut and compression are optimal for a particular patient.
If the work is dynamic or static, but you have to work exclusively while standing,after coagulation of the veins, it is important to avoid high loads, often change the position of the legs during the day.
Corrections are given for fitness and sports. The best type of exercise is swimming and walking. Alternate walking on heels and toes is useful.
But stretching is what in the first time after the procedure can do the most harm. It is also worth refraining from jumping, running - especially with acceleration, exercises with dumbbells.