Phlebeurysm

31 January 2024

A team of qualified cardiovascular surgeons/phlebologists at the medical clinic diagnoses and treats all types of varicose veins at any stage of the disease, as well as associated pathologies. Our asset, which we are proud of, is treatment according to Israeli protocols, which show maximum effectiveness in clinical practice.

Varicose veins – the trigger for the development of varicose veins is considered to be a disruption of the normal functioning of the venous valves with the occurrence of reverse flow (reflux) of blood.

As a rule, the valves that are subject to maximum mechanical stress are the first to be affected. In this case, pathological discharge of blood occurs through the mouth of the great and small saphenous veins, sometimes through large perforating veins. Excessive blood volume arising in the superficial veins gradually leads to overstretching of the venous wall. The total volume of blood contained in the superficial venous bed of the lower extremities increases. This increased blood volume continues to drain into the deep system through the perforating veins, overstretching them. As a result, dilatation and valvular insufficiency occur in the perforating veins.

Symptoms and signs of the disease

Signs of illness are not necessarily associated with pain. On the contrary, most patients claim that at the beginning of the disease they are more concerned about aesthetic problems than pain.

The clinical picture depends on the localization of the pathological process, as well as on the stage of the disease.

Varicose veins of the lower extremities manifest themselves as follows:

Heaviness in the legs, feeling of fullness in the legs.
The appearance of cramps in the calf muscles, spasms of the feet and fingers.
Feeling tired after walking for a long time.
Swelling of the ankle in the evening.
Venous relief pattern on the skin, spider veins, spider veins.
Signs accompanying the disease are cellulite, itching of the legs, dry ankles and calves, thinning and sagging skin, long-healing ulcers, uneven pigmentation - from dark spots to colorless areas, pronounced nodular formations with a color from bluish to dark purple or burgundy, trophic ulcers.

Progressive venous disease is accompanied by a deterioration in general health:

Unstable blood pressure, hypertension, hypotension.
Feeling of chronic fatigue, apathy develops.
Arrhythmia, tachycardia.
Shortness of breath, frequent diseases of the respiratory system.

Obvious symptoms of varicose veins of the lower extremities in women may appear stronger before menstruation and decrease after it.

Symptoms of venous pathology in the upper extremities are characterized by numbness of the hands, spastic conditions of the fingers, sensations of goosebumps, tingling, and coldness.

Varicose veins of the esophagus are manifested by belching, a burning sensation, pain behind the sternum, inflammation in the esophagus and stomach, difficulty swallowing and signs of reflux esophagitis, anemia.

Diagnosis of the disease

Effective treatment of varicose veins cannot be performed without preliminary comprehensive diagnostics. The diagnosis is clarified by the clinical picture and data analysis after hardware studies.
The following methods are most often used for diagnosis:

duplex or triplex ultrasound angioscanning;
phlebography with contrast;
MRI with venography;
contrast angiography.

To determine the presence of reflux in the affected veins and evaluate blood flow, several test manipulations are performed:

Inspection of veins with compression on different segments.
Valsalva maneuver, or straining test.
Parana test with imbalance to evaluate veins in the calf areas.
Walking test of varying intensity.

Additional methods to clarify the diagnosis:

Plethysmography to determine venous reflux, obstruction.
CT, MRI for visualization of tissues and structures in the affected area.
Infrared thermography to assess the temperature balance in the affected area of the body.
Intravascular ultrasound uses a catheter to visualize the vascular walls from the inside.

The results of any diagnostic studies performed are assessed comprehensively. Any diagnosis is of great help in determining further treatment tactics.
Clinical laboratory tests of blood and urine complement the picture of the disease and can indicate concomitant pathologies.

How are varicose veins treated?

If alarming symptoms of varicose veins appear, you should consult a doctor to get diagnosed and begin treatment in a timely manner. In regional medical institutions, this issue is dealt with by general surgeons, in clinics - by phlebologists and angiosurgeons.

The multidisciplinary medical clinic has a well-equipped phlebology department, staffed by a team of surgeons with extensive practical experience. The center offers a high level of service and quality of treatment, which is reflected in the excellent clinical results of which we are proud.

Varicose veins of the lower extremities and other types of pathology can be treated in the first stages of development. As the process progresses, it turns out to be increasingly ineffective, partly retaining only symptomatic significance.

Therapeutic effects cannot completely eliminate the disease, but as long as it is possible to delay the destruction of blood vessels and the development of complications, this must be done by all available means.

Conservative treatment

At the beginning of the treatment of varicose veins, drugs are limited to venotonic agents.
To reduce the risk of thrombosis and occlusion, injections of anticoagulants and low molecular weight heparin-fragmin are used.
New oral anticoagulants.
For inflammatory phenomena in blood vessels and surrounding tissues, the use of non-steroidal anti-inflammatory external drugs with diclofenac and indomethacin is indicated.

How to treat varicose veins additionally?

In parallel with therapeutic treatment, the patient is recommended to perform certain exercises that strengthen the muscular corset of the lower extremities and have a general strengthening effect. For example, the best exercises in a lying position are the "bicycle", alternately pulling your toes towards you and stretching them, as in ballet.

You should be careful with water and thermal procedures, because hot baths and showers, beach holidays in the sun with sunbathing can worsen the situation. The vessels need to be strengthened, this is facilitated by hardening with a contrast shower, when warm and cold water is alternately poured onto the legs.
For pain, inflammation, and heaviness in the legs, daily cool foot baths with decoctions of oak bark, chamomile, calendula, birch leaves, St. John's wort, white acacia flowers, and horse chestnut are recommended.
It is useful to rub freshly squeezed juice from aloe leaves into the skin; it softens the skin and prevents inflammation.
It’s worth changing your habits and quitting smoking. The diet should be dominated by vitamin-rich foods with plenty of fiber, fresh vegetables, citrus fruits, and seafood.
You need to adjust your drinking regime by drinking enough water daily (1. 5 to 2 liters). At the same time, you should reduce the consumption of coffee, strong tea, chocolate, and alcohol.

If the veins in the legs are enlarged, the doctor may recommend periodic or constant wearing of compression stockings.

Attention! In any case, you should listen to the recommendations of your doctor and strictly follow them. Self-medication is unacceptable!

Causes of the disease

Family history of occurrence allows us to conclude that varicose veins are genetically determined and can be transmitted hereditarily.

In many clinical cases, it is impossible to determine the exact cause of the disease. The researchers concluded that the culprit is a combination of several internal and external factors.

Causes of varicose veins:

congenital defect of the valve system;
physical inactivity, lack of activity;
pregnancy;
working conditions with prolonged stress on the legs, long periods of standing, in a static position;
treatment with certain hormonal drugs;
uncomfortable shoes, high heels;
obesity;
tight underwear, clothes that tighten the hips, knees (for example, very tight jeans, shapewear);
regular lifting of weights;
systemic pathology of the kidneys, heart and blood vessels;
diabetes;
regular bowel problems, frequent diarrhea or constipation.

Varicose veins of the lower extremities (varicose veins)- dilatation of the superficial veins of the lower extremities, accompanied by valve incompetence and impaired blood flow. The term "varicose veins" comes from the Latin. varix - "swelling".

As a result, the veins stop working correctly, the entire circulatory system is disrupted, complicated by congestion, disruption of trophism in the tissues, and blockage of blood vessels with blood clots.

Many complications are life-threatening, therefore, if the onset of varicose veins is suspected, diagnosis and treatment must be carried out immediately and professionally.

Types of disease

The blood flow in the vessels changes, slows down, and blood clots can form in uneven walls. Changes in the functionality of blood vessels cause blood stagnation, venous insufficiency, and persistent disturbances of capillary circulation in the periphery.

According to WHO, varicose veins occur in 45% of women and 20% of men.

According to the generally accepted international classification CEAP, varicose veins are divided into six classes-stages of the disease, based on the fact that C0 is the complete absence of subjective, visual and clinical signs.

C1 – the initial stage, manifested by a capillary network and spider veins on the skin.
C2 – visible thickening of the veins under the skin, venous pattern in the lower extremities in the form of blue threads.
C3 – swelling of the legs appears as a result of prolonged standing on the feet or a state of rest (night sleep).
C4 – the surface of the skin changes, unevenly pigmented areas appear, venous eczema, accompanied by itching and ulcers, lipodermatosclerosis.
C5 – venous ulcers on the surface of the skin that heal after some time.
C6 – non-healing venous trophic ulcers.

The classification of varicose veins of the lower extremities distinguishes between pathology on superficial and/or deep vessels, perforating communicating veins.

By origin, venous deformation can be:

congenital, manifesting itself in infants;
acquired;
secondary, arising against the background of other pathologies, injuries;
idiopathic, with an unknown cause.

The full classification of varicose veins of the lower extremities and organs also includes complications - reverse blood flow, reflux, and/or occlusion, blockage of the lumen.
Varicose veins of the lower extremities are not the only manifestation of varicose veins, although the most common. There are also varicose veins of the esophagus, sublingual veins, retina, scrotum (varicose veins in men), stomach, cavernous bodies of the rectum (hemorrhoids), pelvic veins, female genital organs - vulva, labia, uterus.

Surgical treatment of varicose veins

RFO (radiofrequency obliteration of saphenous veins)is a modern method of treating varicose veins. Treatment involves applying radiofrequency radiation to the inner wall of the vein. Using the thermal effect, the vein is "welded", disconnected from the general blood flow, and after a few months is replaced by connective tissue.

Advantages

The procedure is carried out without general anesthesia; local anesthesia is sufficient;
Maximum safety for patient health
RFA does not require special preparation;
During the manipulation, the patient does not feel pain or discomfort;
Radiofrequency ablation of the veins of the lower extremities is highly effective;
Low likelihood of complications, almost all patients tolerate this procedure well;
Radiofrequency ablation can be combined with mini-phlebectomy of tributaries or sclerotherapy;
After radiofrequency ablation there are no scars or marks left;
Literally a couple of days after the procedure, the patient will be able to return to their normal lifestyle.

How it goes

The intervention is carried out under ultrasound control. Before the procedure begins, local anesthesia is administered so that the patient does not feel pain or discomfort during the treatment.
Let's look at how RFA is performed step by step:

Before the operation, the lower limbs are thoroughly treated with antiseptic agents. The doctor then uses a marker to mark the vein that is prone to varicose veins. Then the doctor inserts a radiofrequency catheter into the vein and treats the desired area with radiofrequency waves.
At the end of the procedure, the catheter is removed, the doctor applies a bandage and helps the patient put on compression garments.
The procedure lasts from 30 to 50 minutes. To stop the flow of blood through a weakened vessel, it must be destroyed. Then the body itself will redirect the blood through healthy veins. As a result, after ablation, the walls of the veins stick together and form scar tissue inside (it is safe and not noticeable), and varicose veins disappear.

Rehabilitation

Immediately after the operation, the patient must walk (about 30 minutes) to avoid stagnation of blood and lymph. After radiofrequency ablation of the veins of the lower extremities, it is necessary to carefully follow the recommendations of doctors:

During the week, increased physical activity and heavy lifting are prohibited;
It is necessary to walk more, to be in the same position as little as possible (with the exception of sleep);
For 3-4 weeks you need to stop taking a hot bath, you can only take a shower;
You must stop visiting the bathhouse for at least a month;
It is necessary to drink as much ordinary water as possible, on average about 2. 5 liters, while you need to minimize the amount of salt consumed;
A week after the operation, you need to begin physical therapy, which the doctor will tell you about;
It is possible that after radiofrequency ablation of the veins of the lower extremities, the doctor will prescribe some medications.

Following these rules will help you avoid complications and prevent the further development of varicose veins.

A week after the operation, it is necessary to re-examine (ultrasound examination of the veins of the lower extremities). You can find out more detailed information about radiofrequency ablation of the veins of the lower extremities during an in-person consultation with a specialist.

Laser coagulation of veins

Endovasal (endovenous) laser coagulation (obliteration) of varicose veins (EVLK, EVLO) is a modern method designed to eliminate blood reflux in superficial and perforating veins using thermal energy of laser radiation. EVLO allows you to do without incisions and does not require hospitalization of the patient in a hospital. The international term is EVLA (endovenous laser ablation).

Main stages

Venous puncture. Performed under ultrasound guidance.
Light guide positioning. The light guide is a thin optical fiber. Laser radiation is supplied to its end. The light guide is inserted into the diseased vein. Its end is installed at the point where the varicose vein flows into healthy deep veins, that is, at the anastomosis.
Tumescent anesthesia. A "cushion" of anesthetic is created around the vein in order to better press the vein against the light guide and avoid damage to surrounding tissue.
Laser vein coagulation. Laser radiation is supplied to the working part of the light guide.
At the same time, the light guide is slowly pulled out of the vein. Thus, the vein is uniformly heated by the laser to a temperature of 85 °C. A heated vein, like any protein, contracts when heated. The lumen of the vein disappears, blood flow through it stops.

Rehabilitation

Immediately after the operation, the patient must walk (about 40 minutes) to avoid stagnation of blood and lymph. After EVLO of the veins of the lower extremities, it is necessary to follow the recommendations of doctors:

During the week, increased physical activity and heavy lifting are prohibited;
It is necessary to walk more, to be in the same position as little as possible (with the exception of sleep);
For 3-4 weeks you need to stop taking a hot bath, you can only take a shower;
You must stop visiting the bathhouse for at least a month;
It is necessary to drink as much ordinary water as possible, on average about 2. 5 liters, while you need to minimize the amount of salt consumed;
A week after the operation, you need to begin physical therapy, which the doctor will tell you about;
The doctor may prescribe some medications after the operation.

Sclerotherapyis a method of non-surgical (minimally invasive) elimination of varicose veins and spider veins of the lower extremities.

Benefits of vein sclerotherapy:

absolute outpatient care, requiring no additional preparation,
speed of execution,
no need for anesthesia,
absence of complications typical for surgical treatment methods such as nerve damage,
the absence of "thermally induced phlebitis", characteristic of coagulation methods, accompanied by nagging pain along the coagulated vein.

Thus, today sclerotherapy of veins for varicose veins is an effective safe method, which in some cases can be used as an alternative to other types of surgical interventions.

The sclerotherapy method is based on obliteration of the vein by introducing a chemical into its lumen, which "washes away" the inner layer (endothelium) with the development of subsequent endofibrosis. The degree of endothelial damage depends on the concentration and volume of the administered drug.

The modern medical center uses advanced technologies for the treatment of varicose veins, ensuring maximum effectiveness of all treatment measures. The use of modern equipment by experienced professionals will relieve you of varicose veins in the shortest possible time, without complications and the need for long-term rehabilitation.

Treatment in a modern clinic means health and a significant improvement in the quality of life.