What are varicose veins of the lower extremities?
Varicose veins are morphological changes to the venous system. Their main cause is the destruction of venous valves, which assure blood flow in the direction from the extremities to the heart. If the valves are dysfunctional or destroyed, the blood flow is reversed, leading to increased venous pressure (not to be mistaken with arterial blood pressure). The result is swelling, enlargement of the veins, reduced blood flow and a number of clinical symptoms. In the classic approach, varicose veins refer to the lower extremities.
Vein insufficiency can affect the superficial or the deep venous systems, as well as the veins connecting these systems – the perforator veins.
Causes of varicose veins
The causes of varicose veins are not entirely clear. There is increased occurrence in some families, however this problem is a lot more complex. Several factors must be present at the same time for the patient to develop varicose veins.
One of the leading causes is elastin and collagen fiber destruction. These fibers build the walls of the veins and their degeneration leads to venous valve insufficiency and reversed blood flow in the veins.
Varicose veins are usually apparent on examination. The patients often say that they have “internal varicose veins” and not “external” ones.
Internal varicose veins is a sort of simplification, as such a medical term does not exist. They are changes to the venous system caused by earlier deep vein thrombosis. Such episodes contribute to valvular incompetence and reversed blood flow in the deep veins, which is far more dangerous than typical superficial varicose veins.
The main symptoms of abnormal veins in the lower extremities in the form of varicose veins is the feeling of “heavy legs”. Such leg heaviness worsening during the day and while standing is the main symptom of varicose veins. Pain and swelling can also occur. It is important to remember that swelling is always a result of venous outflow deficit, as blood flowing from the arterial system must be drained by the veins to the heart and the lungs. If such a deficit exists, then the result is swelling of the leg.
Other symptoms include painful muscle cramps, which must also be diagnosed. They could also be a result electrolyte imbalance caused by different medication.
The diagnostic process
The first and foremost diagnostic examination is a lower limps Doppler ultrasonography. We not only visualize the abnormal veins but also observe blood flow – is the blood flowing in the direction to the heart or does the patient have reflux (backwards flow). This examination allows us to assess the morphology and function, which is crucial in planning the right treatment.
Treating varicose veins
In our clinic we have a comprehensive approach to varicose veins therapy. We offer all endovenous thermoablation treatment options . One of the main method is using endovenous lasters, which contracts the veins by shining specific laser light wavelength into the light of the vein.
Other methods include radiofrequency ablation (treating the vein with radio-energy) and steam vein sclerosis -heating the vein with high-pressure pulses of steam.
These methods differ in technology, as different type of energy is used to occlude the vein.
The most widely known method is endovenous laser ablation (EVLA), that is laser closure of the veins.
Radiofrequency also works by heating the vein to a certain temperature, which will cause permanent damage to the inner wall of the vein and its closure (RFA, RFITTH).
Steam micro pulses work similarly, as during the procedure the vein endothelium (inner membrane) is destroyed, which forms a permanent scar within the light of the venous vessel.
A next step in minimally invasive varicose vein treatment is intravenous chemical ablation with the use of cyjanoacrylate adhesive.
All these methods are supplemented by microsurgical removing of larger varicose veins and sclerotherapy of small lesions.
Sclerotherapy is a non-surgical method where certain medication (sclerosant) is injected into the lumen of the vein to contract it and cause fibrosis. Such veins are no longer needed for circulation and only exaggerate the symptoms of varicose veins.
Recommendations after the procedure
After the surgery a patient is always required to wear compression stockings. It is a graduated compression that will allow for the lesions to heal properly. We recommend prolonged compression if the patient has an increased risk of recurrence. Such medical stockings have graduated compression, meaning there is a different level of compression at different heights. Thanks to that, they fit well to the limb and they reduce the chance of secondary lesions to form (teleangiectasia – “spider legs”). Depending on the prognosis and results expected, the doctor will decide on how long the compression should be work.
Postoperative care after intravenous ablation
The day after the procedure that doctor will assess the lower limbs. If there are no problems, the next visit takes place after one week. During that visit wound closure strips are removed. We do not use classical surgical sutures. After the next 3 weeks, during the follow-up visit the doctor checks to what extent have the varicose veins been eliminated. Thanks to these visits we can be sure that the disease has been properly treated.
How to prevent varicose veins
Varicose vein prophylaxis includes several elements. We have to know, which situations in life can lead to varicose veins. One of them is prolonged standing or seating. It is very important to remember about physical activity in form of, for example, taking a walk. This will greatly improve blood outflow from the legs.
We must also remember that obesity exacerbates the symptoms of vein insufficiency. In this case widely understood physical activity is also recommended.
Anesthesia during varicose vein treatment
In our clinic we offer the best existing topical anesthesia combined with intravenous sedation to maximally reduce patient discomfort.
The best method of treating varicose veins
It is difficult to choose one most successful method. We have to remember that this disease may have a different course in every one of us, therefore the therapy must also be individually adjusted for each patient.
During the procedure different methods are usually combined. Moreover, sclerotherapy or mini-phlebectomy may be performed. Such combination helps the patient return to health sooner.
Presently, a new method of non-thermal (chemical) intravenous ablation with cyanoacrylate tissure adhesive is gaining popularity. Such procedure eliminate the need for postoperative compression and tumescent anesthesia (a type of topical anesthesia used during thermoablation).