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Treatment of varicose veins

treatment of varicose veins by a phlebologist

Varicose veins are a very common vascular disease that has been known to people since ancient times.It is mentioned in the papyri of ancient Egypt;even a mummy was excavated with manifestations of enlarged veins on the legs.Information about pathology is found in Hippocrates, Galen and Avicenna.Modern doctors also often encounter varicose veins in patients and are looking for effective treatment methods.

The term "varicose veins" is of Latin origin, and the word "varix" is translated as "expansion".That is why the disease began to be called "Varicose veins".In this disease, the peripheral veins increase in volume, become long, tortuous, deformed and knotty.Blood stagnates in the lower parts of the leg as the valves begin to malfunction and the walls weaken.Vascular damage is most often observed in the legs, since the greatest load is on the blood vessels, you have to pump large amounts of blood and overcome the force of gravity.

Varicose veins are diagnosed in approximately 17-25% of people.Among young people, both boys and girls are equally affected.In mature and elderly women, this pathology occurs 2-3 times more often than in men of the same age.This is due to the constant hormonal changes in the female body that occur throughout life.

How are the veins on the legs arranged?

The legs have two groups of veins: superficial and deep or deep.The first are located in the subcutaneous tissue, that is, on the surface of the leg.The latter are located deeper, in the thickness of the muscles, next to the arteries and tendons.Deep and superficial vessels are connected by perforating or perforating veins.Their wall consists of collagen and elastin fibers, with weak and few smooth muscles.

The venous wall has a three-layered structure:

  • At the top is the adventitia, which consists of loose connective fibers, smooth muscle cells elongated along the walls, surrounded by small capillaries and nerves responsible for vessel trophism.
  • In the middle is a medium consisting of circular smooth muscle fibers.
  • The intima is on the inside.The basis of the intima is the endothelium;between its cells there are longitudinal smooth muscle fibers.  The inner shell is folded, the thickenings are opposite each other and resemble swallow nests or patch pockets.They are called valves and are responsible for the proper direction of blood flow.

Venous valves direct blood from the peripheral parts to the heart, as well as from superficial to deep veins.They prevent reverse outflow and increase venous pressure.In addition to the valves, smooth muscles, tendons and leg muscles participate in maintaining normal tone.When any of the layers (usually the middle and inner layers) are damaged, the veins lose tone and expand, resulting in varicose veins.

There are several superficial veins:

  1. The great saphenous vein is located on the inside of the leg;its walls are equipped with several valves;blood from the anterior femoral surface collects into this vein through a series of smaller vessels.
  2. The small saphenous vein is located on the outside of the leg, equipped with valves and collects blood from the veins on the front and back of the leg.

Communication between large and small veins takes place through connecting vessels.

The deep veins are the posterior and anterior tibial veins, the popliteal vein and the femoral vein.  Varicose veins develop in them in an advanced stage, when the disease is not treated for a long time.

For what reasons do varicose veins appear and who is at risk of getting sick?

It's hard to say why people get varicose veins at this point.Only a number of risk factors have been identified, due to which the valves weaken, and the elasticity and tone of the walls of superficial and perforating veins decreases.

Here are the factors that lead to the development of the disease:

  • Heredity.The structure of blood vessel walls is determined genetically;with some changes in the genes, they weaken and the valves do not close properly.As a result, with the slightest increase in pressure in the veins, there is a reverse outflow of blood, the vessels overflow and expand.
  • Hormonal changes in the body in women.  This situation is typical for pregnant women or for the second half of the cycle, when the amount of progesterone increases and the level of estrogen decreases.As a result, blood rheology changes (coagulability increases), vascular tone decreases, elastin and collagen fibers are destroyed, and the risk of blood clots increases.
  • obesity.People who are overweight move less, which slows blood flow throughout the body.Excess subcutaneous fatty tissue on the abdomen leads to increased pressure in the abdominal cavity and compression of the main veins.This leads to stagnation of blood in the veins of the legs, and further to varicose veins.
  • diabetes mellitus.Sugar, the level of which increases in this disease, damages the vascular endothelium, which increases the risk of blood clots.
  • Alcoholism.When consuming large doses of alcohol, dehydration, thickening of the blood, formation of clots, clogging of small blood vessels and blockages occur.
  • Static occupational loads, such as heavy lifting, standing or sitting work.In such a situation, the muscle tone decreases, the blood deteriorates from the lower extremities to the heart, stagnation occurs, and the veins on the legs expand as a result.  
  • Congenital pathologies of blood clotting.Hypercoagulation, in which too many factors are created that are responsible for the formation of blood clots, causes thrombosis and hinders the movement of blood through the vessels.
  • The wrong diet.A diet lacking a number of vitamins (C, E, PP) and plant fibers leads to disturbances in the structure of the endothelium and other structural elements of the vascular walls.
  • Tight underwear.When you wear tight underwear, some of the veins are compressed, which causes the blood flow from the lower half of the body to be obstructed.
  • Frequent constipation.People suffering from this problem have to constantly push themselves, this increases the pressure in the abdomen, as a result, the outflow of blood becomes difficult.
  • High heel.Overloading of calf muscles and insufficient contraction causes stagnation of blood in the veins.
  • Warm climate.In summer, during the heat, the body becomes dehydrated.If you do not compensate for the problem by taking in a sufficient amount of liquid, the risk of blood clots in the vessels will increase.
  • Heart and kidney pathologies.These can be congenital or acquired heart defects, kidney failure.
  • Exceeding the dosage of drugs that affect blood clotting.In this case, the blood vessels can be blocked by blood clots.
  • Operation.The risk of thrombosis in this case increases due to blood loss and vein compression during the intervention.

How complicated can varicose veins be?

  • Thrombosis due to blood stagnation.
  • Vascular thromboembolism as a result of blood clot detachment.
  • Thrombophlebitis or inflammation of the vein wall.
  • PE (pulmonary embolism).In this case, blood flow in the pulmonary circulation is severely disrupted, which leads to death.Small blood clots can lodge in small pulmonary arteries and cause a heart attack or pulmonary edema.  
  • Trophic ulcers, eczema on the skin of the legs due to tissue malnutrition.With poor blood circulation, little oxygen and nutrients enter the tissues, which hinders regeneration or causes massive cell necrosis.
  • Edema syndrome.As a result of impaired blood flow and stagnation, fluid leaks through the walls of blood vessels into the intercellular space.The swelling has a soft consistency, is elastic and most often occurs near the affected vein, regardless of the time of day.  
  • Dermatitis.The inflammatory process on the skin occurs due to disturbed blood flow and tissue nutrition. 
  • Hyperpigmentation, cyanosis of the affected skin areas.
  • Consolidation of subcutaneous fat tissue due to swelling and bleeding.

How to diagnose varicose veins

  • The condition of the valves is studied with functional tests (applying a tourniquet).They are named after the authors - Troyanov-Trendelenburg, Pratt, Sheinis, Delbe-Perthes, etc.. For the Troyanov-Trendelenburg test, you need to lay the patient horizontally, and then offer to raise the leg 450. In this position, the doctor strokes the limb from the foot up to empty the superficial veins.The next step is to apply a tourniquet to the upper half of the thigh, after which the patient gets up from the couch.Healthy leg veins should fill up after 15 seconds.  
  • Duplex ultrasound scanning of veins (ultrasound angioscanning) gives the most information and allows you to visualize the vessels and the blood flow through them.
  • Dopplerography is a method for assessing blood circulation through blood vessels.
  • Phlebography or X-ray examination using contrast, which helps to study the internal structure of the vessel.
  • Phleboscintigraphy is a technique using radioactive substances with further study on a special device for their distribution.

To study the superficial veins, they are examined and palpated.The first three methods are used as additional tests.The last two methods are necessary to study the condition of the deep or deep veins.

Treatment of varicose veins

Possibilities of conservative treatment

  • Drug therapy does not cure varicose veins, but with the help of drugs, valve function, trophism of blood vessels, blood circulation are partially improved and the risk of thrombosis is reduced.Venotonics are used for this purpose.They can be prescribed for any type of varicose veins.Ointments with non-steroidal anti-inflammatory drugs are indicated for thrombophlebitis.Anticoagulants are also used in this situation, which effectively dissolve blood clots.The treatment should be chosen by a doctor, after a detailed diagnosis and taking into account the patient's characteristics.
  • Herbal medicine and complementary techniques are helpful.Wearing compression stockings, doing gymnastics, skiing, cycling and swimming are advised.Exercise "bicycle" in a lying position, flexion and extension of the foot, gives good results;improves blood flow from the extremities.You can do the exercises if there are no complications.  Contrast showering in the morning is also recommended (first pour warm water on the leg, then gradually reduce the temperature to cold).  Cold baths with decoctions of oak bark, horse chestnut, chamomile, St. John's wort, rubbing the skin with tincture of white acacia flowers, Kalanchoe leaves and apple cider vinegar help.Leeches help to get rid of thrombophlebitis.
  • Fashion.You have to get out of bed slowly, 5-10 minutes.Legs should be raised by 10-15⁰ at night;to do this, place a pillow under your heels.You must walk calmly, it is undesirable to cross your legs when sitting, and do not strain yourself too much.All patients are advised to wear compression stockings.
  • You must eat properly, include coarse fibers and foods rich in vitamins in your menu.  Citrus fruits, tomatoes, pomegranates, black currants, nuts, legumes, liver, onions, eggs and seafood will be useful.It is important not to drink alcohol, not to smoke and drink enough water during the day.For long-term constipation, it is recommended to drink a laxative.

Surgical treatment

Phlebectomy or complete removal of veins

An indication for such a radical operation is varicose veins, which include a large number of veins.At the same time, complications occur - trophic ulcers that are difficult to treat, thrombophlebitis, persistent leg swelling, general symptoms (fatigue, dizziness, fainting).

The operation is contraindicated in ischemic heart disease, severe infections, in very old patients, in the second half of pregnancy, in case of local inflammation of the legs (erysipelas, pustular rash, eczema).

Only surgery can radically rid the patient of varicose veins and restore valve function.If the situation is too severe, untreated and neglected, this method of treatment remains the only one.Disadvantages of the intervention are the need to administer anesthesia and keep the patient in the hospital for observation for several days, postoperative trauma with scars.

Laser therapy (endovascular microthermocoagulation)

Laser treatment of varicose veins is used if the pathology is combined with diseases of the cardiovascular system (CHI, hypertension), changes in peripheral vessels (phlebitis, thrombophlebitis), diseases of the respiratory system (asthma, chronic bronchitis, pleuritis), pathologies of the gastrointestinal tract (cholecystitis, peritonitis, inflammation of the intestine).injuries, meningitis, encephalitis and their consequences), genitourinary system (inflammation of the kidneys, prostate, uterine pathology with appendages), skin diseases (furunculosis, dermatitis, psoriasis, etc.).

Contraindications for laser use are oncology, decompensated kidney, liver, heart pathology, cerebral sclerosis, pregnancy.

The main advantages of laser therapy are its effectiveness in removing the expansion of superficial veins, speed (the duration of the manipulation is 15-20 minutes), no need to go to the hospital and low trauma.
Among the disadvantages, it is worth highlighting the poor availability of the technique;not all clinics have the appropriate equipment.Treatment is expensive and of little use for severely affected and deep veins.If the laser is used incorrectly, you can get a thermal burn, and sometimes there is depigmentation in the places of exposure.

Radiofrequency coagulation (ablation)

The operation is indicated for extensive lesions of the saphenous veins, trophic ulcers resulting from long-term and untreated varicose veins.

Radiofrequency coagulation is contraindicated in acute thrombophlebitis, limited mobility of the patient, pregnancy and mental disorders.

The main advantages of the method are painlessness, the absence of injuries and the need for a hospital stay.Patients can return to normal activities the very next day.

The disadvantage is the high cost of the intervention.

Sclerotherapy

Indicated for varicose veins of small and large superficial veins (on large blood vessels it is performed under the control of duplex Doppler ultrasound) in the initial phase and without complications.

Pregnant and nursing women, drug allergies, deep vein thrombosis, infectious and inflammatory skin lesions on the legs are not treated with this method.

The main advantages are low cost, quick recovery, no need for hospitalization.The procedure leaves no traces and does not cause injury.

The disadvantage is the risk of the sclerosing drug entering deep veins, reduced effectiveness when in contact with blood, and the possibility of use only in the initial stages.

Is it possible to cure varicose veins at home?

At home, it is allowed to use auxiliary methods for the treatment of varicose veins that relieve symptoms.To improve blood flow and relieve swelling, they use ointments from pharmacies or self-prepared, baths and lotions based on medicinal herbs, poultices, drink decoctions and infusions.Below are some recipes.

Chestnut tincture

Take about 200 g of ripe and peeled chestnuts.Pass through a meat grinder or grind with a blender.Fill everything with a liter of vodka, put it in a dark corner and leave it for a few weeks.To make the product smell good, add a few drops of peppermint oil.In the evening, rub your legs with tincture to get rid of heaviness and itching, strengthen blood vessels and prevent their brittleness.It is also recommended to make a poultice from the tincture.If there are no chestnuts, replace them with nutmeg, the recipe remains the same.Musk nut tincture can't just be used to rub sore feet;it is recommended to drink 20 drops a day.After the bottle is finished, a new tincture is made.But there should be a break of 2 weeks between taking the next portion.

Ointment based on calendula

An infusion is made from calendula flowers - pour a spoonful of boiling water, put on fire, cook for a few minutes, leave for 3 hours in a thermos.Strain the infusion and add some kind of fat;Lanolin, vaseline, badger fat are suitable.For the fragrance, it is recommended to add a drop of aromatic oil (rose, bergamot, citrus, sage, lavender, etc.).Thyme, hop cones and nettle are also added to the calendula infusion.

Chamomile oil

Medicinal chamomile flowers are placed in a dark-colored, half-liter glass container so that the container is filled to the top.Pour half a liter of any kind of vegetable oil, for example, olive, corn, hemp.  Let it stand for a month, shaking or stirring from time to time.After that, the oil infusion is filtered.For fragrance, add a few drops of tea tree, mint, lavender and grapefruit aroma oil.Apply chamomile oil to the foot early in the morning and late at night, while gently massaging.You can also make night compresses from the infusion.

Compress based on wormwood

Take a package of kefir or fermented baked milk, 3 tablespoons of dried wormwood.The grass is crushed and mixed with kefir (ryazhenka).When the grass is wet, place it on the cheesecloth along with the thick liquid.Then a dressing is applied to the leg, covered with wax paper (cellophane is not used) on top, and everything is fixed with several layers of bandages.  Keep your legs elevated and remove the compress after half an hour.It is recommended to do the procedure twice a day.Instead of wormwood, you can take hops, chamomile flowers, string, clover, oak or birch leaves, St. John's wort, horsetail, tricolor violet flowers, yarrow.Combinations of different plants give a good effect.To improve the effect of the wrap after the procedure, it is recommended to lie down with your legs elevated for a while.All the mentioned plants can be infused and used for a foot bath.The water in such a bath should be warm, the duration of the procedure is about 25 minutes.Relieves fatigue, swelling, reduces itching and pain on the skin.

Traditional recipes for internal use

Various herbal infusions improve blood flow in the veins.The following herbs are used:

  • Clover
  • consecutively
  • Leaves and berries of cranberry, viburnum, strawberry, raspberry
  • Coltsfoot
  • Calendula
  • Japanese Sophora
  • Melissa
  • Schisandra
  • hawthorn

The grass is dried, then chopped and made into a mixture of different types of plants.Then take 3 tablespoons, pour over a liter of boiling water, leave overnight in a thermos and drink 1/3 of a glass before meals.

Varicose veins are well treated with bee pollen and honey.Pollen should be consumed internally.Honey can also be eaten, but still makes good poultices.It is recommended to add infusions of various plants to honey.

Treatment of varicose veins in pregnant women

Carrying a baby is accompanied by a hormonal storm in the female body and overload, which often causes varicose veins.Treatment in this period is carried out conservatively, using local creams, ointments and gels.

The most effective ointments have a decongestant effect and eliminate heaviness in the limbs. Apply them in a thin layer, moving from the bottom up, with light massage movements.The frequency of manipulations is 1-3 times a day.

Folk remedies also help.It is recommended to prepare baths with herbal decoctions (from chamomile, thyme, hop cones, calendula, wormwood, podbela, oak bark, birch leaves, etc.).

You can fight swelling by applying cabbage leaves or raw grated potatoes to your feet.The compress should be covered with wax or regular thick paper, not cellophane, so that the skin can breathe.The procedure is done before going to bed, and the lotion is left on overnight.

Doctors also prescribe drugs for internal use to pregnant women.There are venotonics that do not negatively affect the development of the fetus and the health of the mother.Most often, they are based on plant extracts.

After taking the drugs, the venous tone increases, the walls become elastic, they don't stretch as much, the lymph flow improves, the liquid part of the blood stops leaking into the intercellular space, and the swelling disappears.You cannot take these medicines without a doctor's prescription.

Traditional methods of treating varicose veins

There are many folk recipes for infusions, decoctions, lotions and poultices.Several medicines are advised to be taken even internally.Below are some options for treating varicose veins with traditional methods.

Lilac tincture

Take a container with a volume of one and a half liters, pour lilac flowers and leaves into it.Then everything is filled with vodka or medical alcohol so that the liquid completely covers the grass (up to the edge of the container).Infuse for a week, shaking occasionally, then filter and rub the tincture on your feet every day.Rub the skin with light massage movements, from the toes to the knees.

With the help of the tincture, they fight against inflammation, swelling, cramps and pain in the legs.

Garlic oil

A whole clove of garlic is peeled, ground in a meat grinder or pressed through a garlic press.After that, you should take butter (unsalted) and mix it with crushed garlic in a ratio of 1:2 (2 parts of butter and 1 part of garlic).Apply this mixture to the affected leg, cover with waxed paper, bandage, the poultice can be kept overnight.

Compression removes pain and burning, has antiseptic properties, softens the skin and helps heal wounds.

Honey with garlic

You should take a head of garlic and 250 ml of honey (preferably linden or buckwheat).Both ingredients are mixed well and left for a week.Drink a tablespoon three times a day, before meals.
The product relieves swelling and fatigue, pain, and varicose veins become less noticeable.

Potato juice

Raw potatoes are crushed on a grater or in a blender, and the pulp is applied to painful places.Keep the compress for about half an hour;if you wish, you can leave it on all night.To increase effectiveness, drink half a glass of potato juice at the same time.The product relieves swelling and discomfort in the leg, eliminates heaviness, reduces fatigue and inflammation.

What is the effect of wearing a compression suit for varicose veins?

Compression garments cannot cure varicose veins.But wearing it slows down the disease, alleviates many of the symptoms caused by it, and improves well-being.

After wearing compression stockings, the vein lumen narrows, blood and lymph flow better and do not stagnate in the limbs.At the same time, the swelling is alleviated, the convulsive contractions of the calves disappear, the legs are less tired and there is no feeling of heaviness.

The main types of compression garments prescribed for varicose veins are leggings, socks, stockings and long tights.It is recommended to wear the products every day;it is necessary to put them on in the morning, before getting out of bed, always in a lying position.

There are different degrees of compression of knitwear, they are chosen depending on the stage of varicose veins.Only proper underwear will have a proper therapeutic effect.It is best to have them prescribed by a doctor, but it is easy to buy socks or tights with low compression for prevention.

Before buying, you need to determine exactly which compression class you need.Ask about the product labeling features of the chosen company.Reputable companies always use the word "compression" to define the class and define it in mmHg.If "DEN" is written on the packaging, then this product has nothing to do with medical underwear.