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What to do with varicose veins?

There has been a huge leap in treatment of varicose veins in the past decade. Today, patients do not need to undergo major surgery under general anesthesia and stay in hospital after that. There are new ways to solve the problem of varicose veins. Modern ambulatory or same-day surgery is a safe solution for those who have varicose or spider veins. At the Republican Center of Medical Rehabilitation and Balneotherapy we annually treat over 1500 patients who have the problems with their veins. According to Chief Physician Sergey Korytko, up to 700 of the patients undergo sclerotherapy for spider veins, while in 150-300 patients veins are treated by sealing them from the inside. There is no need to stay in hospital. Thus, the patients may return to work the next day after the surgery. Our reporter talked to the surgeons and learnt more about varicose vein disease. One in two people on our planet suffers from the disease. Up to 70% of 60-year old people have problems with their veins. Varicose veins are not just a question of beauty. It is a serious disorder, which has a negative impact on a person’s health and can even lead to death.

 

WHAT ARE THE CAUSES OF VARICOSE VEIN DISEASE?

 

 

 

Yan Kernozhitsky, vascular surgeon at the 10th Minsk Clinical Hospital, considers that weak vein walls is the main cause of varicose vein disease.

 

Unlike an artery, a vein has a thinner layer of a wall. A vein becomes less toned with age. Vessels of the body never stop working. Arteries transport blood enriched with oxygen from the heart to the legs. Veins carry blood back to the heart with the help of valves. Healthy valves ensure a proper one-way flow of blood. If something disturbs normal functioning of the system, a vein becomes larger in diameter, and a valve fails to properly perform its functions. Blood goes from deep veins to saphenous veins making them enlarge.

Another cause of the disease is heredity. According to research, if one of the parents has varicose vein disease, there is a fifty percent chance that the parent will pass the disease to a child. If both parents have varicose veins, 9 of 10 children will face the problem in future.

Gender is also a vital factor of varicose veins. Women suffer from the disease more often than men. During pregnancy, a woman’s body produces sex hormones, which help her to prepare for childbirth. Unfortunately, these hormones make connective tissue, including vein walls, weaker. According to statistics, first manifestations of varicose vein disease appear in 70-80% of women during the first trimester of pregnancy. 20-25% of women encounter the problem during the next three month. Only in 1-5% of cases varicose veins develop in the last trimester of pregnancy.

There is a strong link between the disease and occupation. Among those, who suffer from it are hairdressers, salespersons, waiters, surgeons, chefs. They have to stand on their feet for a long time every working day. Varicose vein disease also attacks those who have sedentary jobs, i.e. programmers, cashiers, drivers, office workers. In the first case, veins are under long-term static loads. In the last case, veins behind knees are constricted. Hard physical labour, weight lifting, long travel in an uncomfortable positing may disturb a normal blood flow. A combination of these factors with the existing problems with veins may result in thrombosis.

 

NEW METHODS OF TREATMENT

 

 

Aleksandr Baeshko, Professor of the Department of Surgical Emergency and Applied Anatomy at Belarusian State Medical University, MD, considers that radiofrequency ablation and laser ablation of saphenous veins are the most effective methods of treatment for varicose veins. The methods use the energy of electromagnetic radiation. A damaged vein is not removed, but put out of the blood circulation. Both of the methods apply high temperature (120 С during radiofrequency ablation and 700 C during laser ablation) and both of them provide the same result: burn and destruction of a vessel wall. Healthy vessels start to perform the functions of the sealed vein. If to make an ultrasound examination 1 or 2 years after surgery, it will show that vein has disappeared. The thermal method is the most popular and the most effective method of treatment for varicose veins. It is a non-suture minimally invasive technique. No preparation is required. A patient may even have a breakfast in the morning on the day of surgery. The success rate is 99 of 100.

A phlebologist prescribes the procedure to patients and carries out ultrasound examinations. The surgery is performed under the guidance of ultrasound and under local anesthesia. The goal of the surgery is to stop blood reflux at the site of its appearance (where a saphenous vein meets with a deep vein). A surgeon uses a needle to make a tiny hole in a vein and introduces an electrode (in case of radiofrequency ablation) or a light guide (in case of laser ablation) through it. Pain is managed with the help of lidocain. The surgeon makes an injection of an anesthetic into the fatty tissue, which surrounds the vein. Lidocain also protects the surrounding tissues from high temperatures. Sealing itself is performed by the surgeon’s assistant – a robot. After pressing the START button, the surgeon only monitors the procedure. The procedure usually takes from 5 to 10 minutes. However, if there are visible varicose or enlarged veins on a patient’s hip or lower leg, the surgeon will make tiny holes (2-3 mm) and remove the damaged veins with the help of a special hook. The technique is called ambulatory phlebectomy. After the surgery, a patient should put on compression stockings.

What is next? Usually no pain medications are prescribed. Patients may return to physical activities a week after surgery. They have to wear compression stockings for 7-14 days (stockings may be put off at night).

One more method of treatment is sclerotherapy. Sclerotherapy is the injection of foam (a mixture of a liquid solution of a polyhydric alcohol and oxygen at a ratio of 1:4) into a damaged vein under the guidance of ultrasound.

Foam pushes blood out of the vessel. Bubbles sticks to the walls of the treated vein and cause irreversible changes thereto. The procedure usually takes about 20 minutes. There are no special post-procedure requirements.

 

WHAT ARE THE RISKS OF THE DISEASE?

 

 

Andrey Popchenko, Associate Professor of the Military Field Department at Belarusian State Medical University, PhD in Medicine says that if not treated in time, varicose vein disease can lead to thrombosis, bleeding and ulcers. Thrombosis is a life-threatening condition. Occurring in varicose veins, clots may be transported by blood to a deep vein, then to the heart and, consequently, to the pulmonary artery. To timely detect the disease is the only way to prevent the above complications. If an ultrasound examination shows a life-threatening clot, a patient should be immediately operated on for it. A surgeon will seal the upper part of the vein, where the clot is, or just ligate it. Sometimes, drug therapy is effective enough to solve the problem.

 

Another threat is a rupture of a varicose vein. Bleeding, especially at night, may lead to death. If a rupture occurs, a patient shall put on a pressure dressing (or just put pressure on a bleeding site), lift the leg up and call the ambulance.

Untreated varicose veins change the colour of the skin of the legs. Stagnant blood makes it blue purple. Any injury to the skin will then result in a trophic ulcer. Today there are no effective medications for trophic ulcers.

The first signs of varicose vein disease are pain in legs, heavy legs, ankle cramps, swollen ankles, filling of fullness and itchiness in ankles and foot. The disease manifests itself especially in spring and at the end of the day. The signs usually disappear after rest, in the morning.

Visible symptoms of varicose vein disease:

  • spider veins, swollen veins, pain along damaged veins;
  • red and pigmented skin around the damaged veins, dermatitis, eczema;
  • trophic ulcer.

To prevent serious complications of the disease, it is important to control the state of your veins, i.e. to undergo an ultrasound examination, if you have any of the above-mentions signs. After considering the results of the ultrasound examination, your doctor may also prescribe further tests, for instance, MRI or X-ray tomography.