How to treat varicose veins?

Vascular surgeon Alexander Vladimirovich Albitsky: "Complications of varicose veins lead to disability"

Anna Kerman, XX2 century

Varicose veins of the lower extremities, or, as it is more often called, simply varicose veins, like any common disease, has become an excellent target for manufacturers of various "miracle drugs". Fans of healthy lifestyle "treat" him with a decoction of mouse tails, pharmacy shelves are literally packed with pills and creams promising quick relief ... And we in the editorial office of the portal "XX2 century" decided to talk to an expert, deputy chief physician of the Yusupov Hospital for surgery, phlebologist, Ph.D. Alexander Albitsky to figure out how to deal with varicose veins from the standpoint of evidence-based medicine.

XX2 CENTURY. Alexander Vladimirovich, let's start with the most important question: how to distinguish the methods of treatment of varicose veins, which have proven effectiveness, from the numerous fuflomycins in abundance on the market?

A. Albitsky. To begin with, varicose veins are a disease that cannot be treated with pills, ointments and any other medications. This is a surgical pathology, and it can be cured in a person only surgically.

Previously, large operations were performed for the treatment of varicose veins, with incisions, with stitches. They significantly reduced the patient's quality of life after surgery. Now it's all gone in the past. The need for large, voluminous surgical interventions today occurs very rarely, only in cases when the patient, for example, has a relapse of the disease, or if the patient has some anatomical features that force surgeons to resort to open methods of performing operations.

But in general, minimally invasive methods of treating varicose veins are now "at the helm". Laser endovenous obliteration is considered the "gold standard", followed by radiofrequency obliteration and other thermal techniques. After such an operation, the patient can go home on the same day. However, I prefer to be discharged the next day, after the morning dressing, ultrasound examination of the operated limb and examination.

XX2 CENTURY. And are there new ways of surgical treatment of varicose veins?

A.V. Yes, regularly. For example, there are techniques involving the use of various adhesives and sclerosants, that is, drugs that have a chemical effect on the vein wall. There is a chemical burn of the vein wall, the vein "sticks together" and the blood flow in the vein disappears.

Ultimately, all methods, both new and old, strive for one thing: in various ways – thermal, chemical, with the help of special glue – to close the lumen of the vein, thereby eliminating the pathological blood flow.

XX2 CENTURY. Why is it so important to eliminate it?

A.V. The essence of varicose veins is in the insufficiency of the valves. There are valves in the veins that regulate blood flow. Normally, our blood flows through the veins of the lower extremities from the bottom up, that is, to the heart. And after the blood flow passes through these valves, the flaps should close. In patients with varicose veins, the shutters do not work – that's why varicose veins develop.

That is, the main cause of this disease is valvular venous insufficiency. And there can be many reasons for its development. First of all, of course, heredity. But professional factors also contribute. For example, varicose veins develop more often in those who constantly have to be on their feet: hairdressers, surgeons, people who do hard physical labor, athletes.

Another risk factor is the different types of diseases in which there is a pressure difference. For example, varicose veins can develop in a patient with bronchial asthma, because he has different pressure between the chest and in the veins of the lower extremities.

In general, varicose veins, as it is fashionable to say now, is a disease of civilization. Passive lifestyle, computers – all this affects the risk of developing varicose veins.

Previously, it was believed that, basically, the female half is more susceptible to this disease ... Indeed, women suffer from varicose veins somewhat more often than men. But today this disease can be found in men, women, the elderly, and the young.

XX2 CENTURY. Then the issue of prevention becomes especially urgent. Is it possible to prevent the development of varicose veins, at least at a young age? Maybe a contrast shower, baths, something like that?

AV: While there is no disease, and the venous valves work well – you can do anything you want: contrast shower, Charcot shower and so on. It is better to give up sports related to the impact load on the legs. For example, instead of tennis or running, go swimming or start cycling. But this does not mean that procedures or sports will prevent the development of varicose veins, if there are any prerequisites for it.

XX2 CENTURY. If the disease cannot be prevented, then you can start treating it as early as possible. By what symptoms can you suspect the presence of varicose veins in order to consult a doctor in a timely manner?

A.V. First of all, characteristic complaints arise: heaviness in the legs, fatigue, swelling of the legs in the evening. Only then do the so-called varicose veins appear on the legs. The patient not only feels these changes, but also sees them.

It is important to understand that by itself, without surgery, varicose veins will not go away. As I say in such cases to my patients: "It will not get better, it will only get worse." Perhaps with pills, ointments and compression underwear, we can slow down the pathological process for a while or reduce the severity of symptoms, improve the quality of life. But varicose veins themselves are not going anywhere.

XX2 CENTURY. And what does it threaten?

A.V. The development of various complications. In the first place, of course, deep vein thrombosis and superficial thrombophlebitis. And then, as the most dangerous and formidable complications, the development of pulmonary embolism (PE), a fatal complication, all this develops against the background of varicose veins.

I have listed the systemic complications affecting the body as a whole. But there are also locals. This is a change in the color of the skin, that is, it is a pronounced hyperpigmentation due to the fact that there is a release of shaped blood elements under the skin, this is the formation of so-called varicose eczema, this is bleeding from varicose inflows, this is the formation of trophic ulcers, which then do not heal for a long time. Trophic ulcers themselves require surgical treatment, and the volume of intervention is usually very significant. That is, the main ones are thrombosis, embolism, trophic ulcers.

Complications of varicose veins lead to disability.

XX2 CENTURY. It sounds threatening. And can varicose veins proceed asymptomatically, "silently", so that it cannot be noticed until complications appear?

A.V. No, if this disease exists, then it necessarily manifests itself. Asymptomatic may occur, for example, thrombosis on the background of varicose veins. But the disease itself is never "silent". And to confirm the diagnosis, highly informative methods are now being used, in particular, ultrasound duplex or triplex angioscanning, which allows not only to see the vessels, but also to assess the state of blood flow, vein walls and valves.

XX2 CENTURY. Okay, let's say the diagnosis is made, an operation is prescribed and performed. How effective is surgical treatment of varicose veins?

But. Q. If we operate on a person according to indications, if a person has varicose veins, if we perform the operation correctly and we have the right treatment method, then we will cure him.

XX2 CENTURY. And there will be no relapse?

A.V. Relapse is possible in cases when the patient was under-examined before surgery. For example, during the diagnosis, they did not notice any features of the anatomical structure or incorrectly estimated the extent of the lesion. As a result, this patient's intervention will not be carried out in full, in insufficient volume, and a relapse of varicose veins will occur.

A relapse should be distinguished from the development of the disease again, when the operation was performed, for example, in a large subcutaneous system, and the disease appeared in a small one. But in principle, if the surgical intervention was carried out correctly and to the required extent, it relieves the patient of varicose veins. And in the future, if the patient follows all the recommendations of the doctor, then, of course, he will be healthy.

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