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Treatment of varicose veins

treatment of varicose veins by a phlebologist

Knotted veins (varicose veins) is a very common vascular disease that has been known to people since ancient times.It is mentioned in Ancient Egyptian papyri;mummies with manifestations of varicose veins on the legs were even excavated.They looked for information about pathology in Hippocrates, Galen, and Avicenna.Modern doctors also often encounter varicose veins in patients and look for effective treatment methods.

The term "varicose veins" comes from Latin, the word "varix" is translated as "expansion".That is why the disease began to be called "Varicose Veins".With this disease, peripheral veins increase in volume, become long, tortuous, deformed, and knotted.Blood stagnates in the lower part of the leg because the valve begins to work poorly and the wall is weak.Most often, vascular damage is observed in the legs, because there is the greatest load on the vessels, you have to pump a large amount of blood and overcome the force of gravity.

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

What is the arrangement of the veins in the legs?

The legs have two groups of veins: superficial and deep or deep.The first is located in the subcutaneous tissue, which is on the surface of the feet.The latter is located deeper, in the thickness of the muscle, next to the arteries and tendons.Deep and superficial veins are connected by perforating or perforated veins.Its walls are composed of collagen and elastin fibers, with weak and few smooth muscles.

The vein wall has a three-layered structure:

  • At the top is the adventitia, which consists of loose connective fibers, smooth muscle cells extending along the wall, surrounded by small capillaries and nerves responsible for vessel trophism.
  • In the middle is the media, consisting of circular smooth muscle fibers.
  • The intima is located on the inside.The basis of the intima is the endothelium;between the cells there are longitudinal fibers of smooth muscle.  The inner shell is folded, the thickenings are opposite each other and resemble a swallow's nest or patch pocket.They are called valves and are responsible for the correct direction of blood flow.

Venous valves direct blood from the peripheral to the heart, as well as from superficial to deep veins.They prevent reverse outflow and increase venous pressure.In addition to valves, smooth muscles, tendons and leg muscles participate in maintaining normal tone.When any layer (usually the median and inner layer) is damaged, the vein loses its tone and expands, and varicose veins occur.

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 is collected into this vein through a series of smaller vessels.
  2. The small saphenous vein is located on the outside of the leg, equipped with a valve, and collects blood from veins in the front and back of the leg.

Communication between the large and small veins occurs through the connecting duct.

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

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

It's hard to say why people get varicose veins these days.Only a few risk factors have been identified, which cause the valves to weaken and the elasticity and tone of the walls of superficial and perforated veins to decrease.

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

  • Ancestry.The structure of the blood vessel wall is genetically determined;with some changes in the genes, they are weak and the valve does not close properly.As a result, with a slight increase in pressure in the veins, a reverse outflow of blood occurs, 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 (coagulation increases), vascular tone decreases, elastin and collagen fibers are destroyed, and the risk of blood clotting increases.
  • Obesity.People who are overweight move less, which slows down blood flow throughout the body.Excess subcutaneous fat on the abdomen leads to increased pressure in the abdominal cavity and compression of the main vein.This leads to blood stagnation in the leg vessels, and subsequently 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 drinking alcohol in large doses, dehydration occurs, blood thickens, clots form, small blood vessels become blocked and cause congestion.
  • Static work loads, such as heavy lifting, standing or sitting work.In such a situation, muscle tone decreases, blood moves worse from the bottom to the heart, stagnation occurs, and the veins in the legs expand because of this.  
  • Congenital pathology of blood clotting.Hypercoagulation, in which too many factors are produced that are responsible for the formation of blood clots, causes thrombosis and prevents the movement of blood through the vessels.
  • Wrong diet.A dietary deficiency in some vitamins (C, E, PP) and plant fiber leads to disturbances in the structure of the endothelium and other structural elements of the vascular wall.
  • Tight underwear.When wearing tight underwear, some veins are pinched, which causes blood flow to be blocked from the lower part of the body.
  • Frequent constipation.People with this problem have to constantly push, this increases the pressure in the stomach, as a result, the outflow of blood becomes difficult.
  • High heels.Excessive calf muscle tension and insufficient contraction causes blood to stagnate in the veins.
  • Hot climate.In summer, during the heat, the body becomes dehydrated.If you do not compensate for the problem by drinking a sufficient amount of fluid, the risk of blood clots in the vessels will increase.
  • Pathology of the heart and kidneys.This may be congenital or acquired heart defects, kidney failure.
  • Exceeding the dose of drugs that affect clotting.In this case, the blood vessels may become blocked with 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 stasis.
  • Vascular thromboembolism due to blood clot detachment.
  • Thrombophlebitis or inflammation of the vein wall.
  • PE (pulmonary embolism).In this case, blood flow in the pulmonary circulation is suddenly interrupted, which leads to death.A small blood clot can lodge in a small pulmonary artery and cause a heart attack or pulmonary edema.  
  • Trophic ulcers, eczema on the skin of the feet due to malnutrition.With poor blood circulation, little oxygen and nutrients enter the tissues, which affects regeneration or causes massive cell necrosis.
  • Edema syndrome.As a result of impaired blood flow and stagnation, fluid leaks through the blood vessel walls into the intercellular space.Swelling is soft in consistency, elastic, and most often appears near the affected vein, regardless of the time of day.  
  • Dermatitis.The inflammatory process in the skin develops due to disturbed blood flow and tissue nutrition. 
  • Hyperpigmentation, cyanosis of the affected skin area.
  • Consolidation of subcutaneous fat due to swelling and bleeding.

How to diagnose varicose veins

  • Using a functional test (the use of a tourniquet), the condition of the valve is studied.They are named after authors - Troyanov-Trendelenburg, Pratt, Sheinis, Delbe-Perthes, etc.For the Troyanov-Trendelenburg test, you need to place the patient horizontally, then offer to raise the leg 450. In this position, the doctor strokes the limb from the leg up to empty the superficial veins.The next step is to apply a tourniquet to the upper part of the thigh, after which the patient gets up from the couch.Healthy veins in the legs should be filled after 15 seconds.  
  • Duplex ultrasound scanning of veins (ultrasound angioscanning) provides the most information and allows you to visualize the vessels and blood flow through them.
  • Dopplerography is a method to assess 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 technique using radioactive material with further studies on special devices for its distribution.

To study superficial veins, they are examined and palpated.The first three methods are used as additional examinations.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, valve function, vascular trophism, blood circulation partially improves, and the risk of thrombosis decreases.Venotonic is used for this purpose.They can be prescribed for any type of varicose veins.Ointment with nonsteroidal anti-inflammatory drugs is indicated for thrombophlebitis.Also in this situation, anticoagulants are used, which effectively solve blood clots.Treatment should be chosen by the doctor, after a comprehensive diagnosis and taking into account the characteristics of the patient.
  • Herbal medicine and complementary techniques have added value.It is advisable to wear compression stockings, do gymnastics, ski, bike, and swim."Bicycle" exercises in the supine position, flexion and extension of the legs, give good results;it increases the outflow of blood from the legs.You can do the exercise if there are no complications.  It is also recommended to take a contrast shower in the morning (water your feet first with warm water, then slowly reduce the temperature to cold).  Cold bath with a decoction of oak bark, horse chestnut, chamomile, St. wort.John, rubbing the skin with tincture of white acacia flowers, Kalanchoe leaves, and the help of apple cider vinegar.Leeches help get rid of thrombophlebitis.
  • Mode.You need to get out of bed slowly, 5-10 minutes.Your feet should be elevated 10-15⁰ at night;to do this, place a cushion under your heel.You need to walk calmly, it is undesirable to cross your legs while sitting, and do not overwork.All patients are advised to wear compression stockings.
  • You need to eat properly, include coarse fiber and vitamin-rich foods in your menu.  Citrus fruits, tomatoes, rose hips, black currants, nuts, beans, liver, onions, eggs, and seafood will be useful.It is important not to drink alcohol, not to smoke, and to drink enough water during the day.For persistent constipation, it is recommended to drink laxatives.

Surgical treatment

Phlebectomy or complete removal of veins

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

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

Only surgery can radically eliminate the patient's varicose veins and restore valve function.If the condition is too severe, untreated and neglected, this method of treatment remains the only one.The disadvantage of the intervention is the need to provide anesthesia and keep the patient in the hospital for several days under observation, 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 the peripheral vessels (phlebitis, thrombophlebitis), diseases of the respiratory system (asthma, chronic bronchitis, pleurisy), pathologies of the gastrointestinal tract (cholecystitis, ulcers, peritonitis), injuries of the nervous system (Chritis meningitis), nervous system, meningitis.genitourinary system (inflammation of the kidneys, prostate, pathology of the uterus with appendages), with skin diseases (furunculosis, dermatitis, psoriasis, etc.).

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

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

Radiofrequency freezing (ablation)

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

Radiofrequency freezing is contraindicated in acute thrombophlebitis, limited patient mobility, pregnancy, and mental disorders.

The main advantage of this method is that it is painless, the absence of injuries, and the need to stay in the hospital.The patient can return to normal activities the next day.

The downside is the high cost of the intervention.

Sclerotherapy

Indicated for small and large superficial varicose veins (on large vessels it is carried out under duplex Doppler ultrasound control) in the early stages and without complications.

Pregnant and lactating mothers, allergies to medicines, deep vein thrombosis, infectious and inflammatory skin lesions on the legs are not treated with this method.

The main advantages are low price, quick recovery, no need to be hospitalized.This procedure leaves no trace and does not cause injury.

The disadvantages are the risk of sclerosing drugs entering deep veins, reducing effectiveness when in contact with blood, and the ability to use only in the early stages.

Is it possible to cure varicose veins at home?

At home, it is allowed to use additional methods to treat varicose veins, which reduce symptoms.They use ointments from the pharmacy or self-prepared, herbal baths and lotions, compresses, decoctions and infusions to increase blood flow and relieve swelling.Below are some recipes.

Chestnut colored

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.To make the product smell good, add a few drops of peppermint oil.In the evening, lubricate the legs with tincture to relieve heaviness and itching, strengthen blood vessels, and prevent their fragility.It is also recommended to make a compress from the tincture.If there are no chestnuts, they are replaced with nutmeg, the recipe remains the same.Tinted with musk nut can not only be used to rub sore feet;encouraged 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 part.

Calendula-based ointment

An infusion is made from calendula flowers - pour a spoonful of boiling water, heat, cook for a few minutes, leave for 3 hours in a thermos.Filter the infusion and add it to some kind of fat;lanolin, Vaseline, badger fat are suitable.For the smell, it is recommended to add a drop of aromatic oil (rose, bergamot, citrus, sage, lavender, etc.) Rub the ointment in the morning and evening, with gentle movements from the bottom of the feet to the knees, until it is completely absorbed.Thyme, hop cones, and nettles are also added to the calendula infusion.

Chamomile oil

Medicinal chamomile flowers are placed in a half-liter glass jar with a dark color so that the container is filled to the top.Pour half a liter of any type of vegetable oil, for example, from olive, corn, flax.  Leave for a month, shaking or stirring from time to time.After this, the oil infusion is filtered.For scent, add a few drops of tea tree, peppermint, lavender and grapefruit essential oils.Apply chamomile oil to the feet in the early morning and late evening, while doing a light massage at the same time.You can also make a night compress from the infusion.

Compress based on wormwood

Take a packet of kefir or fermented baked milk, 3 tablespoons of dried wormwood.Grass is crushed and mixed with kefir (ryazhenka).When the grass is wet, place it on cheesecloth along with the thickened liquid.Then a compress is applied to the leg, covered with wax paper on top (cellophane film is not used), and everything is fixed with several layers of bandage.  Keep your feet 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 flower, yarrow.A combination of different plants gives a good effect.To increase the effect of the compress after the procedure, it is recommended to lie down for a while with your legs raised.All the herbs listed can be infused and used to make a foot bath.The water in such a bath should be warm, the duration of the procedure is about 25 minutes.It relieves fatigue, swelling, reduces itching and skin pain.

Traditional recipes for internal use

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

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

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

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 various herbs to honey.

Treatment of varicose veins in pregnant women

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

The most effective ointment has a decongestant effect and removes heaviness in the limbs. Apply it in a thin layer, moving from the bottom up, with a gentle massaging motion.The frequency of manipulation is 1-3 times a day.

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

You can fight swelling by placing raw cabbage leaves or grated potatoes on your feet.You need to cover the compress with waxed or regular thick paper, not cellophane, so that the skin can breathe.This procedure is done before bedtime and the lotion is left 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.They are most often based on plant extracts.

After taking the drugs, the tone of the veins increases, the walls become elastic, they do not stretch much, the lymph flow improves, the liquid part of the blood stops leaking into the intercellular space, and the swelling disappears.You should not take this medicine 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 advised to be taken even internally.Below are some 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 purple leaves into it.Then everything is filled with vodka or medical alcohol so that the liquid completely covers the grass (to the 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 a gentle massaging motion, from fingers to knees.

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

Garlic ointment

Garlic cloves from the whole head are peeled, ground in a meat grinder or pressed through a garlic press.After this, 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 affected leg, cover with wax paper, wrap, the compress can be kept overnight.

The compress relieves pain and burning, it 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 ingredients are mixed thoroughly and left for a week.Drink one 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 the sore spot.Keep the compress for about half an hour;If you want, you can leave it overnight.To increase efficiency, drink half a glass of potato juice at the same time.The product relieves swelling and discomfort in the legs, removes heaviness, reduces fatigue and inflammation.

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

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

After wearing compression stockings, the lumen of the saphenous vein narrows, blood and lymph flow better and do not stagnate in the limbs.At the same time, the swelling is relieved, the spasmodic contractions 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, socks, stockings, and long tights.It is recommended to use the product every day;you need to put it on in the morning, before getting out of bed, always in a lying position.

There are different compression levels of knitwear, they are chosen depending on the stage of varicose veins.Only the right underwear will have the right therapeutic effect.It is better to be prescribed by a doctor, but stockings or tights with low compression, for prevention, are easy to buy yourself.

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