Varicose veins: treatment

Today, varicose veins are recognized as one of the most common vascular diseases. Treatment of this unpleasant and insidious disease is carried out using several methods.

Several decades ago, only surgical intervention could relieve a patient from such a malaise as varicose veins. Treatment with modern methods is painless and less dangerous to human health.

Surgical treatment of varicose veins is not always possible. There are a number of contraindications, in which even the most complex stages of varicose veins have to be treated conservatively.

Contraindications include congenital features, such as heart defects, the patient's personal refusal to undergo surgery for various reasons: from fear to religious motives. In this case, doctors have to look for another way out of the situation - to use therapeutic treatment methods.

Therapeutic treatment is suitable not only for those patients who have any contraindications, but also for those who:

• The disease is in the early stages of development.
• Deep vein valve insufficiency.
• Minor dilation of veins.

Conservative treatment of varicose veins should solve the main problem - to slow down the process that has begun and the further development of the disease. Therefore, patients are prescribed:

• Applying elastic bandages to the area of the affected vein or to the entire affected limb. Women should use special elastic nylon tights or stockings.
• Provide your legs with an elevated position for better blood flow several times a day, the last time before going to bed. Place a bolster under your feet while you sleep. If you have a sedentary job, place a small base, chair, or box under your feet.
• A set of flexion and extension exercises for the knee and ankle joints. These exercises allow for more intensive pumping of venous blood due to muscle action.
• Sclerotherapy – in cases where small blood vessels are subject to expansion.
• Wear shoes with low, hard soles. Shoes should be as comfortable as possible.

In case of varicose veins, it is PROHIBITED to wear tight clothing that compresses the thigh or shin in a circular manner, hindering the already weak venous outflow.

Treatment of varicose veins with elastic bandages

Compression provided by elastic bandages, as well as special stockings, tights, knee pads and other toilet articles, promotes accelerated blood flow in the deep veins. Due to elastic compression, microcirculation improves, excess blood leaves the subcutaneous veins, edema does not form, and tissue metabolic processes are normalized.

The proper effect of an elastic bandage can only be achieved by applying it to the foot correctly. The bandage is applied in the morning, before getting out of bed. The bandage should be applied in the direction from the toes to the thigh, while necessarily covering the heel and ankle joint. The layers of the bandage are applied so that the next one overlaps the previous one by half, or, in other words, overlapping.

There are a great many bandages on sale. You need to choose the right one for yourself, not only in quality, but also with the right degree of compression. Of course, it is better if the bandage is made of certified knitwear, intended specifically for medical purposes. The compression degree of the bandage can be from 1 to 4. The difference between them is in the pressure that the bandage exerts on the surface of the leg, the minimum is 20 mm Hg - this is the 1st degree and the maximum is 60 mm Hg - respectively - the 4th degree of compression.

Ointments for varicose veins

Ointments are also an excellent external remedy included in the treatment of varicose veins. The ointment is prepared on the basis of some melted animal fat - badger, pork, etc. and vegetable oil.

To prepare the remedy, you need to take 3 tablespoons of powder from medicinal plants: celandine and sweet clover, mint and eucalyptus leaves, dandelion and snakeweed roots, clover flowers, calendula and chamomile. The herbs for making the powder should be taken in equal proportions.

Pour half a glass of hot water into the mixture and, putting it on the stove, bring it to a boil, then simmer for about 5 minutes. Mix the hot broth with vegetable oil and animal fat (75 g each), cool and put in the refrigerator for storage.

Treatment of varicose veins with homemade ointments

Blanks for ointments may contain different components. Here are some examples of collections. The numbers indicate individual collections, each of which will subsequently be mixed with a specific ointment base, which will be discussed below.

In each case, take the raw materials in equal proportions:

1. Eucalyptus, lilac, lemon balm, celandine, sweet clover, chamomile, calendula, clover, fir needles, flax seeds, dandelion roots, snakeweed (rhizome).
2. Sage, primrose, lady's mantle, bogbean, Iceland moss, St. John's wort, meadowsweet, horsetail, wormwood, rose petals, white willow bark, horse chestnut flowers.
3. Thyme, chamomile, horehound, hyssop, sweet clover, thistle, raspberry, walnut, wild strawberry (leaves), oat straw, red clover flowers.
4. Woodruff, celandine, succession, lilac (leaves), plantain, coltsfoot, white willow bark, mullein (flowers), clover, fir, alder (fruits).
5. Chicory (roots), chamomile (flowers), calendula, Iceland moss, meadowsweet, St. John's wort, coltsfoot, lady's mantle, black nightshade shoots.

Ointment bases and ointment preparation options

Each of the above collections can be prepared according to the options below:

1. 20 grams of herbal mixture per 100 ml of water. Boil over low heat for 5 minutes, stirring constantly. Cool slightly. Add 75 ml of lard and any vegetable oil. Stir. Keep in the refrigerator.
2. 30 grams of herbal mixture, 100 grams of lard and any vegetable oil. Mix. Keep in a water bath for 10 minutes, stirring constantly. Stir in 50 grams of flaxseed. Keep the finished ointment in the refrigerator.
3. 20 grams of herbal mixture, 50 grams of flaxseed, 500 ml of water, 150 ml of vegetable oil. Heat everything in a water bath for 15 minutes. The finished ointment is stored in the refrigerator.

Method of application of ointments

Apply a thick layer to the affected veins. Cover as a compress. Wrap with a bandage on top. Change the bandage 3 times a day.

Sclerotherapy

This method became possible only in 1988. Until that time, the only possible method of treating varicose veins was considered to be enucleation or removal of part of the diseased vein.

Before moving on to the description of the sclerotherapy method, we should dwell a little on the mechanism of development of the varicose vein process itself.

Each large blood vessel contains special valves inside that allow blood to flow only in the right direction. If a reverse flow occurs, the valves close the lumen of the vessel and the blood is forced to move forward again.

In the lower limbs there are superficial and deep veins. Blood moves in the superficial veins in the directions from outside to inside and from bottom to top, while in the deep veins it moves only from bottom to top.

When the valves fail to perform their duties for some reason, the backflow of blood from the deep veins enters the flow of the superficial veins, causing the latter to overflow. The constant overflow of the superficial veins leads to their expansion. As a result of this process, chronic venous insufficiency develops.

What does the sclerotherapy method involve?

The essence of this treatment method is to exclude the vein affected by varicose veins from the general blood flow by introducing a special substance - a sclerosant. After the procedure, varicose "stars", "nets", "spiders" and veins gradually disappear. "Stars" and other varicose "decorations" require about a month and a half to disappear, veins - about 3-4 months.

Using a special ultrasound scanning device, a study of the veins of the lower extremities is carried out, identifying places where the reverse flow of venous blood occurs. In the professional language of doctors, the reverse flow of fluid is called reflux.

Having found and marked the reflux sites with markers, a surgical intervention is planned. It is performed under local anesthesia. At the points marked with markers during the examination, punctures or small skin incisions are made and the vessels are bandaged. In this way, normal venous blood flow is restored.

After the operation is completed, an elastic bandage is applied to the leg. The patient is allowed to get up an hour after the operation, and after 24 hours he is discharged home for dispensary observation.

In the postoperative period, for approximately two months, compression hosiery should be worn. At the end of the second month of the recovery period, a control examination of the operated area is carried out. Subsequently, preventive examination should be carried out twice a year.

As medical practice shows, dilated veins, after sclerotherapy, return to normal within two months. Chronic venous insufficiency also undergoes changes, being eliminated completely or partially.

Indications for sclerotherapy

Treatment of varicose veins by sclerotherapy should be based on indications. These include:

• Adhesion or obliteration of individual sections of enlarged veins at the initial stage, provided that the specific Troyanov-Trendelenburg test is negative.
• Obliteration of small veins that remain after removal of large veins of the thigh or lower leg.

Sclerotherapy is also indicated in cases where combined treatment is required.

Contraindications to sclerotherapy include pronounced varicose veins, more than 1 centimeter, thrombophlebitis, pustular diseases, and obliterating processes.

A type of sclerotherapy is echosclerotherapy, which allows you to quickly and painlessly cure varicose veins. Treatment with this method involves the use of a duplex scanner. Thanks to this sensor, the doctor is able to treat even deeply located veins.

The next type of sclerotherapy is Foam-form. Treatment with this method involves the use of foam solutions.

Laser therapy

Laser therapy is another way to get rid of such an ailment as varicose veins. Treatment in this case is carried out using laser devices. Laser therapy allows to reduce the treatment time several times. Laser treatment lasts only 35-40 minutes, and this method does not require general anesthesia, allows to treat both legs simultaneously, minimally traumatizes tissues. Hospitalization in this case is not required.

This painless method is often used for patients suffering from chronic venous insufficiency, as well as for people with trophic ulcers in the shin area. The laser has the ability to "glue" and "cover" the walls of veins affected by varicose veins. A special optical fiber (fiber) is inserted into the lumen of the venous trunk using an angiographic catheter, advancing it to the saphenopopliteal or saphenofemoral junction - this depends on which vein is being worked on at the moment. Then, under local anesthesia, after detecting the connection with the deep veins, work is carried out with a laser. As the fiber is pulled back, pulsed radiation is supplied along it at certain intervals. As a result, the blood in the vein boils, forming steam bubbles, the venous wall is destroyed, gluing the lumen of the vessel. After this, a roller is installed in the projection of the irradiated vein, the limb is bandaged.

Intravenous laser is another method that has the ability to defeat varicose veins. Laser treatment consists of the following: a light-emitting diode is inserted into the affected vein and the vein is “glued” using laser radiation. After some time, the diseased vein completely disappears. This method is quite expensive, but often only one procedure is enough for treatment.

After some time has passed since the procedure, the patient is required to wear special underwear and periodically visit a phlebologist.

Hirudotherapy

Hirudotherapy helps in treating many diseases. Varicose veins are not spared either. Leech treatment is very effective during the initial stage of varicose veins. Usually 5-6 sessions of hirudotherapy are prescribed, after 3-4 months the series of sessions must be repeated. Leech saliva contains a special enzyme that allows the affected veins to narrow and return to their original shape.

Drug treatment of varicose veins

For some people diagnosed with varicose veins, laser, leech, and surgical treatment is contraindicated. In this situation, a medicinal method of treating the disease comes to the rescue. It is often prescribed in combination with compression therapy. Most often, doctors prescribe ointments, creams, and tablets as medicinal treatment for varicose veins.

Modern drug therapy for varicose veins should be prescribed only by a doctor and only after a full range of necessary examinations and tests.

There are a large number of tablets, creams, ointments and gels available for the treatment of varicose veins.

Let us give, as an example, the most common groups of funds:

• Venotonics – existing varicose veins: treatment with venotonics leads to increased vascular wall tone and better venous blood outflow from the lower extremities. These include: antistax, venitan, detralex.
• Antithrombotic drugs. Medicines aimed at thinning thick blood. These drugs are prescribed only by the attending physician, so we will name only one representative of this group - simple, well-known aspirin.
• Products that improve blood flow, relieve swelling and heaviness in the legs: Trental, Curantil, Dicrofenac, Lyoton, Venolaif, Trombofob.

If there are indications for improving microcirculation of blood in tissues, then special drugs are additionally prescribed for this purpose. One of such drugs is the well-known aspirin. Treatment of varicose veins is not complete without non-steroidal anti-inflammatory drugs.

The most common medications used for varicose veins are Detralex, Ginkor, Antistax, Cyclo-3, Aescusan, Giosmi, etc., which help reduce swelling and heaviness in the legs.

Varicose Vein Surgeries

In addition to folk, there is traditional treatment of varicose veins. It was with its help that doctors of the last century treated varicose veins. Treatment using surgical intervention has not lost its relevance today, but at present this method is used only in the most hopeless situations. For example, too large affected veins can only be removed by surgery. The essence of the treatment in this case is to ligate the diseased vein and remove the damaged area. Modern surgeons perform all actions so quickly and carefully that scars almost do not remain after the operation. This includes various surgical operations, for example, combined phlebectomy, consisting of several stages of treatment:

• crossectomy (lower and upper);
• stripping;
• perforating vein ligation;
• miniphlebectomy.

The first option for using combined phlebectomy is crossectomy, which involves ligation and transection of the great saphenous vein and its main tributaries at the junctions with deep veins. A small incision (approximately 5-6 cm) is made in the area of the inguinal fold, which exposes the ostial section of the great saphenous vein and its tributaries. The skin and subcutaneous tissue are dissected, the trunk of the GSV is isolated up to its very mouth in the femoral vein, and the main tributaries, which are usually at least 5, are simultaneously isolated from nearby tissues and ligated. The GSV is transected and ligated in the area of the mouth, leaving no more than half a centimeter of stump. The GSV segment is excised within the wound. If necessary, other operations (such as stripping) are performed from this incision. Then the wound is sutured and the stitches are removed after about a week.

Stripping is the next stage of combined phlebectomy, which helps to cope with such an insidious disease as varicose veins. The treatment is carried out according to the following scheme: the doctor makes two small incisions, one at one end of the affected vein, the other at the other end. After exposing the vein, it is crossed in two places, and a small, thin probe is inserted into the lumen. The head of the probe is fixed with a thread at the end of the vein, that is, where the probe came out. Then the doctor pulls the probe, which comes out along with the vein.

The main advantage of stripping is that there is no need to make an incision along the entire length of the affected vein, but only two incisions - at the ends of the vein. There are almost no scars left.

The next step is ligation of perforating veins, which helps to get rid of varicose veins. The treatment involves two methods of action - suprafascial and subfascial ligation.

The suprafascial ligation is performed as follows: in the area of the mark where the affected vein is located, the doctor makes an incision approximately 2 cm long, spreads the edges of the wound with a clamp and grasps any vein in the subcutaneous fat layer with it. Then the surgeon isolates the vein at a short distance and intersects it with two clamps. Next, each end of the vein is freed from the surrounding tissues, gradually pulling each end up until the fixation of this vein with the one that goes deep into the wound becomes visible. They follow this vessel, clearing it of surrounding tissues, until the fascia is found. After this, through the window in the fascia, which serves as an exit for the initially isolated vein, they make sure that they have found what they wanted, and then apply a clamp to the perforating vein, trying to get as close to the fascia as possible, intersect the vein and tie off the stump.

The subfascial ligation consists of the following: the skin is cut together with the subcutaneous fat layer (up to the fascia itself), the edges of the wound are spread apart with the fingers of the left hand, the fascia is opened with a small incision, a raspatory or a couple of fingers are inserted under its leaflet, the fascia is cut to the required length, and then hooks are inserted under the fascial leaflets. After this, the subfascial space is examined.

The perforating veins are located under the medial leaf of the fascia. The leaf is raised and bluntly separated until the wall of the vein is found, located across the wound. The vein is circumferentially bypassed using a swab or the end of a clamp, then two clamps are applied so that both sections of the vessel have a sufficient distance between the clamps, after which each end of the vein is ligated. An overview is made in the subfascial medial space, reaching the edges of the tibia, to which the fascia is attached. All perforating veins found during revision are treated in the same way as the first vein.

After this, the hooks are removed from the wound and individual interrupted sutures are applied to the fascia under finger control. The wound is sutured in such a way as not to disrupt the skin nutrition.

Miniphlebectomy is another option for combating such a scourge as varicose veins. Miniphlebectomy treatment is an operation, the essence of which is as follows: under local anesthesia, the patient is given a paravasal injection of a special solution, then punctures up to 2 mm long are made along the lines of force (if possible). Then a hook (phlebextractor) is inserted into the puncture site, after which the vein hooked by the hook is dislocated into the wound. The vein is isolated from the surrounding tissues using special spatulas. The vein is grasped with a clamp, at the moment of its tension, the place of the next puncture is determined by the point of skin retraction. After the affected vein is isolated, it is removed along its entire length. The punctures are sealed with bandaging material.

Postoperative consequences

The consequences of the operations performed may vary, because everyone’s body is different and recovers from the operation in different ways:

• the patient may be primarily bothered by painful sensations in the area where the operation was performed. The intensity of the pain syndrome may be quite pronounced after surgical interventions and less pronounced after the use of minimally invasive treatment methods;
• the presence of hematomas in the area of the removed vein is a common occurrence;
• bleeding from the wound also sometimes occurs;
• 3-4 days after the operation, a slight increase in TT (body temperature) is possible;
• occasionally, redness of the skin along the veins is observed - this may indicate the onset of an inflammatory process;
• The formation of blood clots in deep veins cannot be ruled out.

Hydrotherapy for Varicose Veins

Since ancient times, people have been famous for water treatment, scientifically known as hydrotherapy. People suffering from varicose veins benefit from:

• Pour water over your feet with a hose. The stream should not be too strong. Start with your toes and gradually move up to your knees, then lower the stream of water back down to your toes. Repeat 5-10 times. Pay special attention to your heels, calves, and popliteal fossa. After the procedure, thoroughly rub your feet with a towel.
• Massage of the ankle area before using a regular shower improves blood circulation. The massage should be done using a special massage brush with coarse bristles.
• You can relieve vascular swelling after a long working day by using a foot bath with plain water. The water temperature should be cold to stimulate vascular contraction and eliminate signs of fatigue. Cold water relieves swelling in the legs.
• Place your feet in the basin, hold them for 2 minutes and take them out of the water for a short time, then place them again. Repeat the procedure 10 times. Finally, hold your feet in the water for 5 minutes. Then rub them thoroughly with a towel.
• Using a contrast shower – alternating very cold and hot water – also helps relieve fatigue in the legs and stimulates active blood circulation.
• It is useful to visit baths and saunas. In case of varicose veins, use birch and oak brooms. However, do not overdo it with the force of the broom blow on the areas with dilated veins. The skin above them is very sensitive and a strong blow can cause bruises and internal microtraumas.
• Swimming in an ice hole is very valuable for the body. But you need to be very careful with this method of treatment. Before diving into an ice hole, you should consult a therapist or attending physician. People suffering from varicose veins are prone to thrombotic processes. A sharp dive into cold water can cause a thrombus to break off and thus provoke a serious complication, even a fatal outcome.

Preventive treatment of varicose veins

To prevent varicose veins, you don't have to buy expensive medications. Start with something simple. It's easy to make drinks at home that can be used for both therapeutic and preventive purposes for varicose veins.

Let us give some examples.

Rowanberry - currant tea

Tea made from rowan berries and blackcurrant berries is an excellent preventive measure against the development of varicose veins. To prepare this drink, take 150 grams of rowan berries and 25 grams of currants, rinse. Prepare 0.5 liters of boiling water in advance and pour it over the berries. Let it brew for 20 minutes. The drink is drunk in the same way as regular tea, preferably with the addition of a small amount of honey. The number of times this drink is taken per day is 3 times.

Chamomile flower infusion

A valuable drink for those who have a hereditary predisposition to varicose veins. Without waiting for the disease to manifest itself, take 1 glass of infusion of dried chamomile flowers every night. It is easy to prepare.

1 teaspoon of flowers per 0.5 liters of boiling water. After 15 minutes, the infusion is ready for use. Take warm, but not hot. Those with a sweet tooth can add a little honey (no more than 0.5 teaspoon per glass of infusion).

Cranberry drink

In order for the body to receive a shock dose of all useful microelements and vitamins, it is enough to drink a glass of cranberry drink once a week. The composition includes not only cranberries, so take care of all the components necessary for its preparation in advance:

• Oregano leaves – 2 g.
• Mint leaves – 3 g.
• Freshly squeezed cranberry juice – 50 g.

Pour a glass of boiling water over the herbal leaves and let it brew for 30 minutes. Strain. Mix with cranberry juice. During the intake, you can sweeten the finished drink with honey or sugar.

As many years of medical practice show, treatment of varicose veins requires urgent action at the earliest stages of the disease. Only in this case, it is possible to maximally guarantee the avoidance of complications and a positive outcome of treatment measures.

Treatment of varicose veins is the path to healthy, beautiful legs!