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Treatment of varicose veins

treatment of varicose veins by a phlebologist

Varicose veins (varicose veins) are a very common vascular disease known to people since ancient times.It is mentioned in ancient Egyptian papyri;a mummy with varicose veins in her legs was even excavated.They find information about pathology in Hippocrates, Galen and Avicenna.Modern doctors often encounter varicose veins in their patients and are looking for effective treatment methods.

The term "varicose veins" is of Latin origin, the word "varix" is translated as "expansion".Therefore, the disease began to be called "Varicose veins".With this disease, the peripheral vessels increase in volume, become long, curved, deformed and knotted.Blood stagnates in the lower parts of the leg, because the valves begin to work poorly and the walls weaken.Vascular damage is most often observed in the legs, because the vessels have the largest load, you have to pump a large volume of blood and overcome gravity.

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

How are the veins arranged in the legs?

There are two groups of venous veins in the legs: superficial and deep or deep.First, it is located in the subcutaneous tissue, that is, on the surface of the foot.The latter are located deeper, in the thickness of the muscles, next to the veins and tendons.Deep and superficial veins are connected by perforating or perforating veins.Their wall consists of collagen and elastin fibers, weak and less smooth muscles.

The venous wall has a three-layered structure:

  • Above is the adventitia, consisting of loose connective fibers, smooth muscle cells extending along the walls, surrounded by small capillaries and nerves responsible for the trophism of the vessel.
  • In the middle there is a media of circular smooth muscle fibers.
  • Intimacy lies within.The basis of the intima is the endothelium;between its cells are longitudinal fibers of smooth muscle.  The inner shell is folded, the thickenings are opposed to each other and look like swallow's nests or patch pockets.They are called valves and are responsible for the correct direction of blood flow.

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

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 small vessels.
  2. The lesser saphenous vein is located on the outside of the leg, is equipped with valves, and collects blood from veins in the front and back of the leg.

Connection between large and small vessels occurs through connecting vessels.

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

What causes varicose veins and who is at risk?

Nowadays, it is difficult to say why people get varicose veins.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 vessels decrease.

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

  • Heredity.The structure of the walls of blood vessels is determined genetically;with some changes in the genes, they are weakened and the valves do not close well.As a result, with the slightest increase in pressure in the vessels, a reverse flow of blood occurs, the vessels expand 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, the risk of blood clotting increases.
  • Obesity.Overweight people move less, which slows blood flow throughout the body.Excess subcutaneous fat on the abdomen leads to increased pressure in the abdominal cavity and compression of major arteries.This leads to stagnation of blood in the veins of the legs and subsequently to varicose veins.
  • Diabetes mellitus.In this disease, the increased level of sugar damages the vascular endothelium, which increases the risk of blood clots.
  • Alcoholism.Drinking large amounts of alcohol causes dehydration, thickens the blood, forms clots, blocks small vessels, and causes congestion.
  • Static occupational loads such as heavy lifting, standing or sitting work.In such a situation, muscle tone decreases, blood moves worse from the lower limbs to the heart, stagnation occurs, and therefore the veins in the legs expand.  
  • Congenital pathologies of blood coagulation.Hypercoagulation, in which many factors responsible for the formation of blood clots are produced, provokes thrombosis and prevents the movement of blood through the vessels.
  • Wrong diet.A diet lacking in a number of vitamins (C, E, PP) and plant fibers causes disturbances in the structure of the endothelium and other structural elements of the vascular walls.
  • Tight underwear.When wearing tight underwear, some of the vessels are compressed, which causes a violation of blood flow from the lower half of the body.
  • Frequent constipation.People suffering from this problem have to constantly push, which increases the pressure inside the abdomen, as a result, it becomes difficult for the blood to come out.
  • High heel.Excessive tension and insufficient contraction of the calf muscles causes stagnation of blood in the veins.
  • Warm climate.During the summer heat, the body becomes dehydrated.If you do not compensate the problem by drinking enough fluids, the risk of blood clots in the veins will increase.
  • Heart and kidney pathologies.These can be congenital or acquired heart defects, kidney failure.
  • Overdose of drugs affecting coagulation.In this case, blood vessels can be blocked by blood clots.
  • Operation.In this case, the risk of thrombosis increases due to blood loss and vessel compression during intervention.

How can varicose veins become complicated?

  • Thrombosis due to blood stagnation.
  • Vascular thromboembolism due to blood clot separation.
  • Thrombophlebitis or inflammation of the venous 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, a small amount of oxygen and nutrients enter the tissues, which disrupts regeneration or causes massive cell necrosis.
  • Edema syndrome.As a result of disruption of blood flow and stagnation, fluid leaks through the walls of blood vessels into the intercellular space.The swelling is soft, flexible and appears near the most affected vein regardless of the time of day.  
  • Dermatitis.The inflammatory process in the skin develops due to the disruption of blood flow and tissue nutrition. 
  • Hyperpigmentation, cyanosis of the affected areas of the skin.
  • Consolidation of subcutaneous fat due to swelling and bleeding.

How to identify varicose veins

  • Using functional tests (application of a tourniquet), the condition of the valves is studied.They are named after authors - Troyanov-Trendelenburg, Pratt, Sheinis, Delbe-Perthes, etc.The next step is to apply a tourniquet to the upper half of the thigh, after which the patient gets off the couch.Healthy veins in the legs should fill up after 15 seconds.  
  • Duplex ultrasound scanning of the vessels (ultrasound angioscanning) provides the most information and allows visualization of the vessels and the blood flow through them.
  • Dopplerography is a method to evaluate blood circulation through the vessels.
  • Phlebography or X-ray examination using contrast, which helps to study the internal structure of the vessel.
  • Phleboscintigraphy is a method of conducting additional studies using radioactive substances in a special device for their distribution.

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

Treatment of varicose veins

Conservative treatment options

  • Drug therapy does not cure varicose veins, but with the help of drugs, valvular function, vascular trophism, blood circulation partially improves and the risk of thrombosis decreases.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.Also in this case, anticoagulants are used, which effectively dissolve blood clots.The treatment should be selected by the doctor after a comprehensive diagnosis and taking into account the characteristics of the patient.
  • Herbal medicines and complementary techniques have adjunctive value.Compression stockings are recommended for gymnastics, skiing, cycling and swimming.Exercise "bicycle" in the back position, bending and stretching the legs gives good results;improves blood flow from the extremities.If there are no complications, you can do the exercises.  It is also recommended to take a contrast shower in the morning (first wash your feet with warm water, then gradually reduce the temperature to cold).  Cool baths with decoctions of oak bark, horse chestnut, chamomile, St. John's wort, tincture of white acacia flowers, Kalanchoe leaves and apple cider vinegar help.Leeches help to get rid of thrombophlebitis.
  • Mode.It is necessary to get out of bed slowly, for 5-10 minutes.Your legs should be raised 10-15⁰ at night;To do this, place a pillow under your heels.You need to walk calmly, it is undesirable to cross your legs while sitting, and do not work too hard.All patients are advised to wear compression stockings.
  • You need to eat right, include foods rich in fiber and vitamins in your menu.  Citrus fruits, tomatoes, hips, black currants, nuts, legumes, liver, onions, eggs, seafood will be useful.During the day, it is important not to drink alcohol, not to smoke, and to drink enough water.It is recommended to drink laxatives for persistent constipation.

Surgical treatment

Phlebectomy or complete removal of veins

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

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

Only surgery can radically save the patient from varicose veins and restore the function of the valves.If the condition is very severe, untreated and neglected, this method of treatment remains the only one.Disadvantages of the intervention are giving anesthesia and keeping the patient under observation in the hospital for several days, postoperative trauma with scars.

Laser therapy (endovascular microthermocoagulation)

Laser treatment of varicose veins is used when 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, pleurisy), pathologies of the gastrointestinal tract, testicles, and pathologies of the gastrointestinal tract.peritonitis), nervous system (Chronic injuries, meningitis, encephalitis and their consequences), genitourinary system (inflammation of the kidneys, prostate, pathology of the uterus with appendages), skin diseases (furunculosis, dermatitis, psoriasis, etc.).

Contraindications to laser use are oncology, decompensated pathology of kidneys, liver, heart, cerebral sclerosis, pregnancy.

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

Radiofrequency coagulation (ablation)

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

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

The main advantages of the method are its painlessness, non-injury and the need to stay in the hospital.Patients can return to their normal activities the next day.

The disadvantage is the high cost of intervention.

Sclerotherapy

In varicose veins of small and large superficial veins (in large veins, it is performed under the control of duplex Doppler ultrasound) in the initial stage and without complications.

Pregnant and lactating mothers, 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 scars and does not cause injury.

The disadvantage is the risk of the sclerosing drug entering a deep vein, the reduction of effectiveness in contact with blood, and the possibility of using it only at the initial stage.

Is it possible to treat varicose veins at home?

It is allowed to use auxiliary methods for the treatment of varicose veins that relieve symptoms at home.To improve blood flow and relieve swelling, they use pharmacy or self-made ointments, herbal baths and lotions, compresses, 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 several weeks.Add a few drops of peppermint oil to make the product smell good.In the evening, lubricate the legs with tincture to get rid of heaviness and itching, strengthen blood vessels and prevent fragility.It is also recommended to make a compress from the tincture.If there is no chestnut, it is replaced with nutmeg, the recipe remains the same.Tincture with musk nuts can not only be used to rub painful feet;it is recommended to drink 20 drops per day.After the bottle is finished, a new tincture is prepared.But there should be a 2-week break between taking the next part.

Calendula-based ointment

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

Chamomile oil

Medicinal chamomile flowers are placed in a half-liter glass container of a dark shade so that the container is filled to the top.Pour half a liter of any kind of vegetable oil, for example, olive, corn, hemp.  Leave 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, peppermint, lavender, and grapefruit essential oils.Apply chamomile oil on your feet early in the morning and late in the evening, and massage lightly at the same time.You can also make compresses at night without infusion.

Compress based on wormwood

Take a package of kefir or fermented baked milk, 3 tablespoons of dry wormwood.The grass is crushed and mixed with kefir (ryazhenka).When the grass is wet, put it on gauze with a thick liquid.Then a compress is applied to the leg, it is covered with wax paper (cellophane film is not used) and everything is fixed with several layers of bandage.  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 purple flowers, yarrow.Combinations of different plants give a good effect.After the procedure, to improve the effect of the compress, it is recommended to lie down for a while with your legs up.All the listed herbs can be brewed and used to prepare a foot bath.The water in such a bath should be warm, the duration of the procedure is about 25 minutes.Eliminates fatigue, swelling, reduces skin itching and pain.

Traditional recipes for internal use

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

  • clover
  • consistently
  • Lingonberries, viburnum, strawberries, raspberry leaves and berries
  • Coltsfoot
  • Calendula
  • Japanese sofora
  • Melissa
  • Schisandra
  • hawthorn

The grass is dried, then crushed and a mixture of different types of plants is prepared.Then take 3 tablespoons, pour a liter of boiling water, leave overnight in a thermos and drink 1/3 cup before meals.

Varicose veins are well treated with bee pollen and honey.Pollen should be consumed internally.Honey can also be eaten, but it still makes a good compress.It is recommended to add infusions of different herbs to the baby.

Treatment of varicose veins in pregnant women

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

The most effective ointments have a decongestant effect and relieve heaviness in the limbs. Apply them in a thin layer, moving from the bottom up with soft 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 (chamomile, thyme, hop cones, calendula, wormwood, coltsfoot, oak bark, birch leaves, etc.).

You can fight swelling by rubbing cabbage leaves or raw grated potato on your feet.In order for the skin to breathe, it is necessary to cover the compress with wax or ordinary thick paper, not cellophane.The procedure is done before going to bed and the lotion is left overnight.

Doctors also prescribe drugs for internal use to pregnant women.There are venotonics that do not adversely affect the development of the fetus and the health of the mother.They are mostly based on plant extracts.

After taking the drug, the venous tone increases, the walls become elastic, they do not stretch as much, the lymph flow improves, the leakage of the liquid part of the blood into the intercellular space stops, and 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 compresses.Some remedies are even recommended to be taken internally.Below are several options for treating varicose veins using traditional methods.

Lilac tincture

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

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

Garlic ointment

Garlic cloves are peeled from the whole head, ground in a meat grinder or pressed with a garlic press.After that, you need to take butter (without salt) 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 injured leg, cover it with wax paper, wrap it, the compress can be kept overnight.

The compress relieves pain and burning, has antiseptic properties, softens the skin and helps heal wounds.

Honey with garlic

You need to take a head of garlic and 250 ml of honey (preferably linden or buckwheat).Both substances are thoroughly mixed and left for a week.Drink a spoon three times a day before meals.
The product relieves swelling and fatigue, pain, and varicose veins are 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;you can leave it on all night if you want.To increase efficiency, you need to drink half a glass of potato juice at the same time.The product relieves swelling and discomfort in the legs, relieves heaviness, reduces fatigue and inflammation.

What are the effects of wearing compression garments for varicose veins?

Compression garments cannot treat varicose veins.But wearing it slows down the disease, relieves many of the symptoms it causes, and improves well-being.

After wearing compression knitwear, the lumen of the saphenous veins narrows, blood and lymph flow better and do not stagnate in the limbs.At the same time, the swelling is removed, the convulsive cramps in 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, stockings, socks and long tights.It is recommended to wear the products every day;they should always be placed in a lying position in the morning, before getting out of bed.

Knitting has different degrees of compression, which are selected depending on the stage of varicose veins.Only the right underwear will have the necessary therapeutic effect.It is better to be prescribed by a doctor, but for prevention, it is easy to buy socks or tights with low compression yourself.

Before buying, you need to determine exactly what compression class you need.Be interested in the labeling features of the products of the company of your choice.Reputable companies always use the word "compression" to identify the class and specify it in mmHg.If "DEN" is written on the packaging, this product has nothing to do with medical underwear.