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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 that has been known to humans since ancient times.It was mentioned in ancient Egyptian papyri; a mummy was even unearthed with varicose veins in its legs.They found information about pathology in the writings of Hippocrates, Galen, and Avicenna.Modern doctors also often encounter patients with varicose veins and are looking for effective treatments.

The word "varicose veins" originates from Latin, and the word "varix" is translated as "dilation."That's why the disease began to be called "varicose veins."In this disease, peripheral veins become enlarged, elongated, tortuous, deformed, and gnarled.Blood stagnates in the lower part of the leg as the valves begin to work poorly and the walls of the blood vessels weaken.Most commonly, vascular injuries occur in the legs because the blood vessels bear the greatest load and you have to pump large amounts of blood and overcome gravity.

Approximately 17-25% of people are diagnosed with varicose veins.Among young people, boys and girls are equally affected.In mature and older women, this pathology occurs 2-3 times more frequently than in men of the same age.This is due to the constant changes in hormones in women throughout their lives.

How are the veins in the legs arranged?

There are two groups of veins in the legs: superficial veins and deep veins.The first is located in the subcutaneous tissue, the surface of the leg.The latter is found deeper in the thickness of the muscle, close to arteries and tendons.Deep and superficial vessels are connected by perforating veins or perforating veins.Their walls are composed of collagen and elastin fibers, and their smooth muscle is weak and sparse.

The vein wall has three layers:

  • The top is the adventitia, which is composed of loose connective fibers and smooth muscle cells extending along the wall, surrounded by small capillaries and nerves responsible for vascular nutrition.
  • In the middle is the tunica media, which is composed of rounded smooth muscle fibers.
  • The intima is located on the inside.The basis of the intima is endothelial cells; between their cells are longitudinal fibers of smooth muscle.The inner shell is folded, with the thickened parts facing each other, similar to a bird's nest or patch bag.They are called valves and are responsible for the correct direction of blood flow.

Venous valves guide blood from peripheral sites to the heart and from superficial veins to deep veins.They prevent reverse outflow and increase venous pressure.In addition to valves, smooth muscles, tendons, and leg muscles are also involved in maintaining normal tone.When any layer (usually the middle and inner layers) is damaged, the veins lose tone and dilate, and varicose veins develop.

There are several superficial veins:

  1. The great saphenous vein is located on the inside of the leg; its walls are equipped with multiple valves; blood from the front surface of the femur is collected into this vein through a series of smaller vessels.
  2. The small saphenous vein is located on the outside of the calf and is equipped with a valve that collects blood from the veins in the front and back of the calf.

The communication between large and small veins is through connecting blood vessels.

The deep veins include the posterior tibial vein, anterior tibial vein, popliteal vein, and femoral vein.When the disease goes untreated for a long time, they develop varicose veins in the later stages.

What are the causes of varicose veins?Who is at risk?

It's difficult to say why people develop varicose veins.Only a few risk factors have been identified that lead to weakened valves and reduced elasticity and tone of the walls of superficial and perforating veins.

The following are factors that contribute to the development of the disease:

  • genetics.The structure of blood vessel walls is genetically determined; with some changes in genes, they weaken and the valves don't close well.As a result, a slight increase in venous pressure causes blood to flow out in the opposite direction, causing the blood vessels to overflow and expand.
  • Hormonal changes in women.This situation is typical for pregnant women or the second half of the cycle, when the amount of progesterone increases and estrogen levels decrease.As a result, blood rheology changes (increased coagulability), vascular tone decreases, elastin and collagen fibers are destroyed, and the risk of thrombosis increases.
  • obesity.Overweight people move less, which slows blood flow throughout the body.Excess subcutaneous fat in the abdomen can increase abdominal pressure and compress the main veins.This causes stagnation of blood in the blood vessels of the legs, further leading to varicose veins.
  • diabetes.Increased sugar levels in this disease damage the endothelium of blood vessels, thereby increasing the risk of blood clots.
  • alcoholism.When you drink large amounts of alcohol, dehydration occurs and your blood thickens, forming clots that clog small blood vessels and cause congestion.
  • Static occupational loads such as lifting heavy objects, standing or sitting at work.In this condition, muscle tone decreases and the flow of blood from the lower limbs to the heart becomes more difficult and stagnant, causing the veins in the legs to dilate.  
  • Congenital coagulation pathology.A hypercoagulable state produces a plethora of factors that cause clots to form in the blood, triggering thrombosis and impeding the flow of blood through blood vessels.
  • Wrong eating habits.A lack of multiple vitamins (C, E, PP) and plant fibers in the diet can lead to disorders of the endothelial structure and other structural elements of the blood vessel wall.
  • Tight underwear.When wearing tight underwear, some veins can be squeezed, causing blood flow to the lower body to be blocked.
  • Frequent constipation.People with this condition must constantly exert force, which increases pressure within the abdomen and makes it difficult for blood to flow out.
  • High heel.Excessive tightness and insufficient contraction of the calf muscles can cause blood to stagnate in the veins.
  • The climate is hot.Summer is hot and the body is prone to dehydration.If you don't compensate for the problem by drinking enough fluids, your risk of developing blood clots in your blood vessels increases.
  • Pathology of the heart and kidneys.These may be congenital or acquired heart defects, kidney failure.
  • Doses of drugs that affect blood clotting are exceeded.In this case, the blood vessels may become clogged with blood clots.
  • Operation.In this case, there is an increased risk of thrombosis due to blood loss and venous compression during the intervention.

How can varicose veins become complicated?

  • Thrombus formation due to blood stasis.
  • Thrombus detachment leads to vascular thromboembolism.
  • Thrombophlebitis, or inflammation of the vein wall.
  • PE (Pulmonary Embolism).In this case, blood flow in the pulmonary circulation is drastically interrupted, leading to death.Small blood clots can become lodged in small pulmonary arteries, causing a heart attack or pulmonary edema.  
  • Nutritional ulcers and eczema appear on the skin of the legs due to tissue malnutrition.Due to poor circulation, little oxygen and nutrients enter the tissues, which can impair regeneration or cause massive cell necrosis.
  • Edema syndrome.Because blood outflow is impaired and stagnant, fluid leaks through the blood vessel walls into the intercellular spaces.The swelling is soft and rubbery in texture and most often occurs near the affected vein, regardless of the time of day.  
  • dermatitis.The inflammatory process in the skin occurs due to impaired blood flow and tissue nutrition. 
  • The affected skin areas are hyperpigmented and cyanotic.
  • Solidification of subcutaneous fat due to swelling and bleeding.

How to Diagnose Varicose Veins

  • The condition of the valve is studied through functional testing (using a tourniquet).They are named after their authors - Troyanov-Trendelenburg, Pratt, Sheinis, Delbe-Perthes, etc.For the Troyanov-Trendelenburg test, you need to position the patient horizontally and then raise the leg 450 degrees.In this position, the doctor strokes the limb from the feet upward to drain the superficial veins.The next step is to apply a tourniquet to the upper thigh and then the patient stands up from the couch.Healthy veins in your legs should be full in 15 seconds.  
  • A dual ultrasound scan of the veins (ultrasound vascular scan) provides the most information and allows you to visualize the blood vessels and the blood flow through them.
  • Doppler tracing is a method of assessing blood circulation in blood vessels.
  • A venogram or X-ray using a contrast agent helps study the internal structure of blood vessels.
  • Venoscintigraphy is a technique that uses radioactive substances and special devices to further study their distribution.

In order to study the superficial veins, they need to be examined and palpated.The first three methods are used as additional checks.The latter two methods are necessary to study the condition of deep or deep veins.

Treatment of varicose veins

Conservative treatment options

  • Medication cannot cure varicose veins, but with the help of medication, valve function, vascular nutrition, and blood circulation are partially improved, and the risk of thrombosis is reduced.Venotonics are used for this purpose.They can be used to treat any type of varicose veins.Ointments containing NSAIDs are indicated for the treatment of thrombophlebitis.Also in this case, the use of anticoagulants can effectively dissolve clots.Treatment options should be chosen by a physician after a thorough diagnosis and taking into account the patient's characteristics.
  • Herbal medicines and additional techniques have ancillary value.It is recommended to wear compression stockings while doing gymnastics, skiing, cycling, and swimming."Cycling" practice lying on your back, flexing and extending your feet, has a good effect; it can improve the blood flow in the limbs.If there are no complications, the exercises can be performed.It is also recommended to take a contrast shower in the morning (first warm water for the legs, then gradually reduce the temperature to cold water).Cool baths with decoctions of oak bark, horse chestnut, chamomile, and St. John's wort, and rubbing the skin with tinctures of white acacia flowers, longevity leaves, and apple cider vinegar can be helpful.Leeches help eliminate thrombophlebitis.
  • model.You need to get up slowly, for 5-10 minutes.Your legs should be elevated 10-15⁰ at night; for this, place a cushion under your heels.Walk calmly, do not cross your legs when sitting, and do not overwork yourself.Compression stockings are recommended for all patients.
  • You need to eat right and include crude fiber and vitamin-rich foods in your menu.Citrus fruits, tomatoes, rose hips, black currants, nuts, legumes, liver, onions, eggs and seafood are all useful.It is important not to drink alcohol, not to smoke, and to drink enough water during the day.For persistent constipation, laxatives are recommended.

surgical treatment

Phlebectomy or complete removal of the vein

The indications for this radical surgery are varicose veins involving a large number of veins.At the same time, there are complications - trophic ulcers that are difficult to treat, thrombophlebitis, persistent swelling of the legs, systemic symptoms (fatigue, dizziness, fainting).

Surgery is prohibited in patients with ischemic heart disease, severe infection, elderly patients, late pregnancy, local inflammation of the legs (erysipelas, pustular rash, eczema).

Only surgery can fundamentally eliminate the patient's varicose veins and restore valve function.If the condition is too severe and left untreated or ignored, this treatment method remains the only option.The disadvantage of interventional treatment is that it requires anesthesia and requires the patient to be observed in the hospital for several days, and there is scarring of the postoperative wound.

Laser treatment (intravascular microthermal coagulation)

If the pathology is related to diseases of the cardiovascular system (CHI, hypertension), peripheral vascular changes (phlebitis, thrombophlebitis), respiratory diseases (asthma, chronic bronchitis, pleurisy), gastrointestinal diseases (cholecystitis, ulcers, peritonitis), neurological diseases (chronic injuries, meningitis, encephalitis and their consequences), genitourinary system (kidneys, prostatitis, uterine adnexal lesions), skin diseases (furuncles, dermatitis, psoriasis, etc.).

Contraindications to the use of laser include tumors, decompensated pathology of the kidneys, liver, heart, encephalosclerosis, pregnancy.

The main advantages of laser treatment are that it is effective in eliminating dilation of superficial veins, is fast (operation time is 15-20 minutes), does not require going to the hospital, and is less invasive.
Among the disadvantages, it is worth highlighting the poor accessibility of the technology; not all clinics have the appropriate equipment.Treatment is expensive and of little use in severely affected veins and deep veins.If the laser is used incorrectly, it can cause thermal burns and sometimes discoloration of the affected area.

Radiofrequency coagulation (ablation)

This surgery is suitable for trophic ulcers caused by great saphenous vein disease and long-term untreated varicose veins.

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

The main advantages of this method are that it is painless, non-invasive and does not require hospitalization.Patients can resume normal activities the next day.

The disadvantage is the higher cost of intervention.

Sclerotherapy

It is suitable for varicose veins of small and large superficial veins (on large vessels, under the control of Doppler ultrasound) in the initial stage and without complications.

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

The main advantages are low price, fast recovery and no need for hospitalization.The process leaves no traces and causes no harm.

The disadvantages are that sclerotherapy has the risk of entering deep veins, is less effective after contact with blood, and can only be used in the initial phase.

Can varicose veins be treated at home?

Adjuvant treatments for varicose veins can be used at home to relieve symptoms.They use drugstore or homemade ointments, herbal baths and lotions, compresses, decoctions and infusions to improve blood flow and relieve swelling.Here are some recipes.

chestnut tincture

Take about 200 grams of ripe 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.At night, lubricate the legs with the tincture to eliminate heaviness and itching, strengthen blood vessels and prevent their fragility.Tinctures are also recommended for compresses.If chestnuts are not available, substitute nutmeg and the recipe will remain the same.Musk fruit tincture can be used for more than just sore feet; it is recommended to drink 20 drops a day.When the bottle is used up, a new tincture is made.But there should be two weeks between taking the next portion.

calendula ointment

The infusion is made from marigolds - pour a tablespoon of boiling water, put on the fire, cook for a few minutes and leave in a thermos for 3 hours.Strain the infusion and add it to some kind of fat; lanolin, petroleum jelly, badger fat are all suitable.For scent, it is recommended to add a drop of aromatic oil (rose, bergamot, tangerine, sage, lavender, etc.).Apply the ointment morning and night and massage gently from the bottom of the legs to the knees until completely absorbed.The calendula infusion also contains thyme, hop cones and nettles.

chamomile oil

Place medicinal chamomile flowers in a half-liter dark glass jar, filling the container to the top.Pour half a liter of any type of vegetable oil, such as olive oil, corn oil, hemp oil.Leave for a month, shaking or stirring occasionally.After this, the oil infusion is filtered.For added fragrance, add a few drops of tea tree, peppermint, lavender and grapefruit fragrance oils.Apply chamomile oil to your feet in the morning and evening while massaging lightly.You can also use the infusion as a nighttime compress.

Mugwort-based compresses

Take a packet of kefir or fermented roasted milk, 3 tablespoons of dried mugwort.The grass is crushed and mixed with kefir (ryazhenka).When the grass is wet, place it on the cheesecloth along with the thickened liquid.Then apply a compress to the leg, cover it with wax paper (do not use cellophane film), and secure everything with several layers of bandages.Keep your legs elevated and remove the dressing after half an hour.It is recommended to perform this procedure twice a day.Instead of wormwood, you can use hops, chamomile flowers, rope, clover, oak or birch leaves, St. John's wort, horsetail, pansies flowers, yarrow.A combination of different plants can produce good results.To increase the effectiveness of post-operative compression, it is recommended to lie down for a period of time with your legs raised.All of the listed herbs can be steeped and used as a foot soak.The water for the bath should be lukewarm and the duration of the entire process should be about 25 minutes.It relieves fatigue, swelling, and reduces skin itching and pain.

Traditional recipes for internal use

Various herbal infusions work well to improve blood flow in the veins.Use the following herbs:

  • clover
  • successively
  • Bilberry, viburnum, strawberry, raspberry leaves and berries
  • coltsfoot
  • marigold
  • Sophora japonica
  • Melissa
  • Schisandra chinensis
  • hawthorn

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

Bee pollen and honey are great for treating varicose veins.Pollen should be taken internally.Honey can also be eaten, but it still works well as a compress.It is recommended to add various herbal infusions to honey.

Treatment of varicose veins in pregnant women

Pregnancy is accompanied by hormonal storms and overload in the female body, which often leads to varicose veins.Conservative treatment with topical creams, ointments, and gels is performed during this time.

The most effective ointments have a decongestant effect and eliminate heaviness in the limbs.Apply them in a thin layer, moving from bottom to top and using gentle massaging motions.The operating frequency is 1-3 times a day.

Folk remedies can also help.It is recommended to prepare baths with herbal decoctions (chamomile, thyme, hops, calendula, mugwort, coltsfoot, oak bark, birch leaves, etc.).

You can combat swelling by applying cabbage leaves or raw grated potatoes to your feet.You'll want to cover the dressing with wax paper or regular thick paper, not cellophane, so the skin can breathe.The procedure is completed before bedtime and the lotion is left overnight.

Doctors also prescribe internal medications for pregnant women.Some intravenous supplements do not negatively affect the development of the fetus or the health of the mother.They are usually based on plant extracts.

After taking the drug, the venous tone increases, the blood vessel walls become elastic and do not stretch too much, the lymphatic flow improves, the liquid part of the blood stops leaking into the intercellular spaces, and swelling disappears.You cannot take these medications without a doctor's prescription.

Traditional methods of treating varicose veins

There are many folk recipes for infusions, decoctions, lotions and compresses.It is recommended to even take some remedial measures internally.Here are a few options for treating varicose veins using traditional methods.

clove tincture

Take a container with a capacity of one and a half liters and pour flowers and clove leaves into it.Then fill everything with vodka or medical alcohol so that the liquid completely covers the grass (to the very edge of the container).Infuse for a week, shaking occasionally, then strain and rub the tincture on your feet daily.Working from fingers to knees, rub skin with gentle massaging motions.

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

garlic ointment

Peel the whole head of garlic cloves and grind them in a meat grinder or press them through a garlic press.After that, you need to take butter (unsalted) and mix it with crushed garlic in a ratio of 1:2 (2 parts butter and 1 part garlic).Apply this mixture to the affected leg, cover it with wax paper, and bandage it. The compress can be left on overnight.

The compress relieves pain and burning, has antibacterial properties, softens the skin and aids in wound healing.

honey with garlic

You need to take a head of garlic and 250 ml of honey (preferably linden or buckwheat).Mix the two ingredients thoroughly and let sit for a week.Drink one tablespoon three times a day before meals.
This product relieves swelling, fatigue, pain, and makes varicose veins less noticeable.

potato juice

Grate raw potatoes with a grater or blender and apply the pulp to the sore area.Leave the compress on for about half an hour; you can leave it on overnight if needed.To increase efficiency, drink half a cup of potato juice at the same time.This product relieves leg swelling and discomfort, eliminates heaviness, and reduces fatigue and inflammation.

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

Compression garments cannot cure varicose veins.But wearing it can slow the progression of the disease, relieve many of the symptoms caused by the disease, and improve health.

After wearing compression stockings, the lumen of the saphenous vein becomes narrower, allowing blood and lymph to flow better without stagnation in the limbs.At the same time, the swelling is reduced, the spasmodic contraction of the calf disappears, the legs are less tired and there is no heaviness.

The main types of compression garments used to treat varicose veins are tights, socks, stockings and pantyhose.It is recommended to wear this product every day; you need to put them on before getting up in the morning and always in a lying position.

Knitwear has different levels of compression, chosen depending on the stage of varicose veins.Only suitable underwear will have the desired therapeutic effect.It's best to get a prescription from your doctor, but you can easily buy low-pressure stockings or tights as a precaution.

Before buying, you need to determine exactly what level of compression you need.Ask about the labeling characteristics of your chosen company's products.Reputable companies always use the word "compression" to define the category and define it in millimeters of mercury.If "DEN" is written on the packaging, the product is not related to medical underwear.