treatment for varicose veins in legs

treatment for varicose veins in legs


  TREATMENT OF VARICOSE VENUSES OF LOWER LIMBS
Does venous disease therapy exist?

Although there is no radical cure for varicose disease, experienced doctors are able to alleviate most of its symptoms.
There are many treatment options. Treatments are distinguished in conservative (elastocompressiva and pharmacological therapy) and ablative, which include a series of effective mini-invasive treatments (endovascular procedures with Laser and Radiofrequency, Sclerotherapy) and invasive (conservative or removial surgery). Most of the experts in phlebology, beyond the elastocompressiva and pharmacological therapy, consider Laser thermal ablation or Radiofrequency as the first choice for the surgical treatment of varicose disease as globally accepted as safer, simpler and more effective methods , thus optimizing long-term results.

Hygienic-behavioral rules to be adopted in the presence of varicose disease

There are precautionary measures aimed at reducing the symptoms and slowing the disease: do not stand still or sit for too long periods, perform dorsiflexion movements of the feet, avoid direct exposure of the legs to sources of heat (sun, lamps, stoves, fireplaces, etc.), sleep keeping the limbs higher than the rest of the body, walking every day for at least 20 minutes, walking stairs, exercising, preferring swimming and walking. Sports such as football, tennis, horse riding, martial arts, weight lifting, competitive cycling, basketball, volleyball are to be avoided.
Proper nutrition is equally important, so it is advisable to eat healthy and light enriching the diet with lots of fruit (blueberries, oranges, lemons, kiwis).

Elastocompressive therapy

The introduction of graduated elastic stockings was the treatment that determined the most important impact on venous stasis, becoming the "gold standard" conservative therapy.
The elastic stockings exert an external backpressure that favors a better venous return towards the heart thus resolving the stasis; they have a multiple action on the superficial and deep venous system, on the blood volume, on the tissues, on the microvasculotissutal compartment and on any endoluminal thrombus.
The compression is measured in mmHg, and the stockings are divided into four classes: the most used are the class 1 ^ (preventive) and the class 2 ^ (therapeutic).

Compressive therapy is typically used to temporarily relieve symptoms associated with varicose veins and is not a long-term solution to the underlying problem.

Drug therapy

The principle of drugs used in chronic venous insufficiency is to improve vascular tone and capillary permeability, to promote venous return and to reduce the inflammatory damage of the endothelium, thus leading to an improvement in symptoms.
Bioflavonoids (Diosmin, Hesperidin, Oxerutin, Anthocyanosides, Micronized purified flavonoic fraction) improve the symptoms by reducing the inflammatory response of the endothelium.
Glucosaminoglycans (heparansulphate and dermatan sulfate) restore the glycocalyx on the endothelial wall, and inhibit platelet and leukocyte adhesion. They have been recommended in the treatment of severe forms of venous insufficiency and venous ulcers.
The mesoglycan (a mixture of glucosaminoglycans represented by 47.5% heparan sulfate, 35.5% dermatan sulfate, 8.5% chondroitin sulfate, 8.5% heparin slow), in addition to intervening in the antithrombotic sense, is able to restore the physiological barrier properties selective from the endothelial capillaries performing an effective anti-edema activity.
Among the blood-borne drugs, Pentoxifylline and Prostaglandin E1 are reported.
In the presence of thrombophlebitic complication it is necessary to start an anticoagulant therapy.

Endovascular treatmentEndovascular treatment of the large and small saphenous vein, which includes the Laser technique and Radiofrequency, is a minimally invasive percutaneous procedure that has numerous advantages compared to traditional surgical treatment.

The purpose of the procedure is to destroy the vein from the inside using heat. It is performed under local anesthesia and strictly under ultrasound guidance. Icy tumescent local anesthesia increases the efficacy of endovascular treatment and prevents damage to the nerves, tissues adjacent to the vein and skin. The diseased vein is pointed with a cannula needle through which a catheter is introduced, which allows insertion into the vein of an optical fiber or a radiofrequency catheter. Subsequently, local anesthesia is performed under ultrasound guidance, injecting the tumescent solution around the segment of vein that is to be treated. The laser or the radiofrequency catheter is then activated and gradually withdrawn along the vein. The heat released by these innovative systems damages the inner wall of the vein in a definitive manner, causing its occlusion. This treatment avoids skin scars and risks of spinal anesthesia, reduces pain during surgery and in the post-operative period, improves the patient's quality of life, and allows an earlier recovery of normal daily and work activities. .

The patient is promptly invited to walk and can return home within a few hours of treatment. International studies prove that the functional and aesthetic results of endovascular surgery are optimal, with a minimum rate of relapse even after years. These techniques are considered highly effective by the latest American Venous Forum (AVF) and Society of Vascular Surgery (SVS) guides, and are considered to be first choice compared to classical surgical vein stripping and stripping treatment.

High ligation and stripping of the saphenous vein

This traditional technique is rapidly being abandoned in favor of new endovascular treatments. After a surgical incision in the groin and the isolation of the cross, a plastic "stripper" is passed along the saphenous vein so that it can be removed with a real tear technique, called stripping. The procedure is invasive (with greater discomfort for the patient than the other methods of treatment) and is burdened by a very high recurrence rate in the follow-up (Figure 26).

Phlebectomy

Phlebectomy is the removal of a vein through a small incision under local anesthesia. A hook is inserted through the anesthetized skin and with gentle pulling movements, the varicose branches are hooked and removed. This technique can be done in combination with the primary procedure or performed at a later time (Figure 27).

Sclerotherapy

Internationally, in many clinics, sclerotherapy is used to treat incompetent saphenous veins. Several times, the chemical solution is mixed with gas or room air to form a foam. In most cases, this form of therapy is less effective when compared to thermal ablation, although it may seem less expensive and faster. However, in many parts of the world where you do not have the ability to perform thermal ablations, the foam sclerotherapy technique offers a good alternative to the surgical treatment of varicose veins, even if weighed by a high rate of relapses in a very short time.
The complications and risks of sclerotherapy are rare, but may include the following:
• skin discoloration
• incomplete obliteration of the vein
• allergic reactions
• transient scotomas
• paradoxical embolisms
• blood clots
• formation of scabs and scars
• cutaneous necrosis at the administration sites
• small skin ulcers
• superficial and deep venous thrombosis
• formation of new blood vessels around the treated area

Follow-up after treatment

Follow-up visits are important in determining whether the treatment produced the desired results regardless of the technique used. Venous disease can recur even years after the procedure. For this reason the annual follow-up is fundamental and represents the only real surveillance for the reappearance of the disease.

Varicorragia

In the presence of severe chronic venous insufficiency, with significant venous hypertension and skin changes,spontaneous bleeding may occur. Usually these are minor bleeding: forstop them is enough to elevate the leg and apply a compression. In case of bleedingsignificant amounts may however require further treatment, such as sclerotherapy or ligationof varices adjacent to the bleeding site.