About 1,000 operations and procedures for the treatment of varicose veins and its complications are performed annually at the Phlebology Center "SM-Clinic". New technologies are being applied, open vein surgeries are a thing of the past.
We learned more about the technologies for treating varicose veins from the specialist of the center, phlebologist, surgeon Murat Zanibekov .
Please tell us what is varicose veins and why does it occur?
Varicose veins are the expansion and tortuosity of the saphenous veins of the legs due to valvular failure.The cause of this disease is hereditary dysplasia of the connective tissue, which consists of such basic proteins as collagen and elastin.The imbalance and ratio of these proteins leads to weakness and extensibility of the connective tissue. This condition is called "dysplasia". In addition to varicose veins, it can cause a number of other diseases, such as hernias, hemorrhoids, flat feet, osteochondrosis, prolapse of organs, and others. As a result of exposure to risk factors and the presence of dysplasia, the valves of the saphenous veins are damaged - blood is thrown from the deep veins into the superficial ones, which leads to the accumulation of blood in their lumen. In turn, excess blood in the saphenous veins of the legs leads to an increase in pressure in them, they expand, the so-called "serpentine tortuosity" appears. All possible complications of varicose veins are associated, first of all, with this stagnation of blood in the subcutaneous veins.
You said the phrase "risk factors"...
Despite the fact that hereditary predisposition is of great importance for the development of varicose veins, acquired risk factors are no less significant. I would say this: hereditary predisposition is “realized” precisely through such acquired risk factors as smoking, overweight, a sedentary lifestyle, prolonged static and thermal stress, as well as hormonal changes in the body. Therefore, while treating and preventing varicose veins at our Center, we attach great importance to the elimination of these risk factors. Wherein, varicose veins in itself already means that there is a non-working area with blood stasis, and this is fraught with the risk of developing complications of varicose veins such as thrombosis, trophic leg ulcers, bleeding from dilated varicose veins. So the best measure for the prevention of vein thrombosis is the timely treatment of varicose veins (elimination of the part of the vein where there is accumulation and stagnation of blood).
What does the diagnosis of varicose veins include?
Diagnosis of varicose veins is not difficult. In the vast majority of cases, a simple examination of the patient is enough to make a diagnosis. However, an accurate picture of the disease can be established with the help of ultrasound examination of the veins. Thanks to ultrasound of the venous system, we evaluate such important parameters as the viability of the venous valves, blood flow from deep to superficial veins, the diameter and patency of the veins, the presence or absence of blood clots in the lumen of the vein. Ultrasound of the veins of the legs is a modern method for diagnosing varicose veins and thrombosis of the veins of the lower extremities.
What treatment options for varicose veins do you use at the Center ?
The choice of treatment method for varicose veins depends on the stage of the disease, which is determined at the appointment by a phlebologist, as well as on the results of ultrasound. Conservative treatment of varicose veins includes wearing compression stockings - special stockings or golfs, performing physiotherapy exercises ("venous gymnastics"), as well as the use of drug therapy - drugs that affect venous tone.
We prescribe venotonic drugs only in the presence of so-called "venous" symptoms - pain in the calves, heaviness in the legs, fatigue and swelling of the legs, which increase in the evening and in the warm season. We provide conservative treatment for most patients. However, when, according to ultrasound, saphenous vein valvular insufficiency and blood reflux are detected, conservative treatment alone becomes insufficient. Since there is a mechanical cause of stagnation of blood in a vein, this cause should also be eliminated in a “mechanical” way.
Do you mean vein removal surgery?
Indeed, for many centuries, the only way to get rid of varicose veins was to remove them through large incisions. The classic operation to remove the veins - phlebectomy, which has been improved many times and has come down to our times, consists in crossing, tying and removing the non-working section of the saphenous vein. The disadvantages of open surgery are the need for hospitalization of the patient and general or spinal anesthesia, skin incisions, suturing, the general trauma of surgical intervention and the duration of postoperative rehabilitation, not to mention the aesthetic result, which does not fit into the expectations of patients and modern requirements of aesthetic phlebology. . That's why we completely excluded from our practice open interventions in the treatment of varicose veins.
What are the modern ways to eliminate varicose veins?
The last two decades in world phlebology have been marked by the emergence of truly revolutionary methods that have radically changed approaches to the treatment of varicose veins. The fundamental difference between these new methods and open surgery is that the dilated vein is not removed, but closed from the inside under ultrasound control in such a way that reflux and accumulation of blood in it are eliminated.
We practice two thermal methods - laser and radio frequency vein obliteration. The mechanism of action of these procedures is based on the effect of heat on the walls of the vein from the inside, due to which the lumen of the vein is closed and varicose veins are eliminated. Unlike open interventions, thermal methods are less traumatic, do not require hospitalization of the patient, are performed under local anesthesia and ultrasound control from the beginning to the end of the procedure, there is no need to make incisions and stitches.
Thermal methods began to be considered as the best treatment options for varicose veins. However, they cannot be perceived as the pinnacle of modern phlebology.
The search for even more painless and aesthetic ways to treat varicose veins has led to the emergence of non-thermal methods. First of all, this is the adhesive technology VenaSeal (VenaSeal, USA), which we introduced at our Center in 2019. Over the past three years, our center has become one of the leaders in Russia in terms of the number of adhesive obliterations performed. The advantages of adhesive technology are as follows: the procedure is performed without anesthesia at all, through a single puncture, and the painlessness and versatility of the technique are absolutely incomparable with other treatment methods.
The main feature of adhesive treatment is that after the procedure there is no need to wear compression stockings, and no postoperative rehabilitation is required. The patient leaves the operating room and returns to his usual physical activity without restrictions.
Is it possible to protect the legs from varicose veins, to prevent its development?
The main attention should be paid to lifestyle: forget about physical inactivity, inactivity. The best prevention of varicose veins is active walking, active sports, swimming, cycling. At the same time, static loads on the legs in the form of prolonged standing and sitting should be avoided. In a word, the well-known saying that “movement is life” is more than relevant and fits the explanation of the prevention of varicose veins of the legs.
Now there is a lot of information that blood clots form in the vessels after a coronavirus infection. What advice would you give to patients recovering from COVID-19?
The COVID-19 pandemic continues to threaten the lives and health of millions of people, and against this background, the prevention of thrombosis has become even more pressing than before. In view of this, if you have been ill with a new coronavirus infection, and you have previously been diagnosed with varicose veins of the lower extremities or have had cases of thrombosis in your family history, you need to consult a phlebologist to avoid a real risk of thrombotic complications.
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