Treatment of varicose veins

Varicose veins (varicose veins) are a very common vascular disease that has been known to people since ancient times.It is mentioned in the papyri of Ancient Egypt;a mummy was even excavated with signs of varicose veins on the legs.They find information about pathology in Hippocrates, Galen and Avicenna.Modern doctors also often encounter varicose veins in patients and are looking for effective methods of treatment.

The term "varicose veins" is of Latin origin, the word "varix" is translated as "expansion".That is why the disease began to be called "Varicose veins".In this disease, the peripheral veins increase in volume, become long, curved, deformed and knotty.Blood stagnates in the lower parts of the leg because the valves begin to work poorly and the walls weaken.Damage to the vessels in the legs is most often observed, since there is the greatest load on the vessels, you have to pump large volumes of blood and overcome the force of gravity.

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

How are the leg veins arranged?

The legs have two groups of venous vessels: superficial and deep or deep.The first are located in the subcutaneous tissue, that is, on the surface of the leg.The latter are located deeper, in the thickness of the muscles, next to the arteries and tendons.Deep and superficial vessels are connected by perforating or perforating veins.Their wall consists of collagen and elastin fibers, with weak and little smooth muscle.

The venous wall has a three-layered structure:

• At the top is the adventitia, which consists of loose connective fibers, smooth muscle cells elongated along the walls, surrounded by small capillaries and nerves responsible for vessel trophicity.
• 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 its cells there are longitudinal fibers of smooth muscle.  The inner shell is folded, the thickenings are opposite each other and look like swallow's nests or pockets.They are called valves and are responsible for the correct direction of blood flow.

Venous valves direct blood from the peripheral parts to the heart, as well as from the superficial to the deep veins.They prevent backflow and increase venous pressure.In addition to the valves, smooth muscles, tendons and muscles of the legs are involved in maintaining normal tone.When one of the layers (usually the middle and inner layers) is damaged, the veins lose their tone and expand 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 collects in this vein through a series of smaller vessels.
2. The small saphenous vein is located on the outside of the leg, is equipped with valves and collects blood from the veins of the front and back of the leg.

Communication between the large and small veins takes place through connecting vessels.

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

What causes varicose veins and who is at risk?

It's hard to say why people get varicose veins right now.Only a number of risk factors have been identified, due to which the valves weaken and the elasticity and tone of the walls of the superficial and perforating veins decrease.

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

• Heredity.The structure of blood vessel walls is determined genetically;with some gene changes, they weaken and the valves don't close properly.As a result, at the slightest increase in pressure in the veins, a backflow of blood occurs, the vessels overflow and expand.
• Hormonal changes in the body of 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 clots increases.
• obesity.Overweight people move little, which slows down blood flow in the body.Excess subcutaneous fat on the abdomen leads to increased pressure in the abdominal cavity and compression of the main veins.This leads to stagnation of blood in the vessels of the legs and further 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 large doses of alcohol, dehydration occurs, the blood thickens, clots form, which clog the small blood vessels and cause congestion.
• Static occupational loads, such as lifting heavy loads, working in a standing or sitting position.In such a situation, muscle tone falls, blood moves worse from the lower limbs to the heart, stagnation occurs, and the veins of the legs expand because of this.  
• Congenital pathologies of blood coagulation.Hypercoagulation, in which too many factors responsible for the formation of blood clots are produced, provokes thrombosis and impedes the movement of blood through the vessels.
• Wrong diet.A diet deficient in a number of vitamins (C, E, PP) and vegetable fiber leads to disorders in the structure of the endothelium and other structural elements of the vascular walls.
• Tight underwear.When wearing tight underwear, some of the veins are pinched, resulting in a difficult blood flow from the lower half of the body.
• Frequent constipation.People suffering from this problem have to constantly push, this increases the pressure in the abdomen, as a result of which the outflow of blood becomes difficult.
• High current.Overexertion of the calf muscles and their insufficient contraction leads to stagnation of blood in the veins.
• Hot climate.In the summer, during the heat, the body becomes dehydrated.If you do not compensate for the problem by drinking enough fluid, the risk of blood clots in the vessels will increase.
• Pathologies of the heart and kidneys.These can be congenital or acquired heart defects, kidney failure.
• Exceeding doses of drugs that affect coagulation.In this case, blood vessels can 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 can varicose veins be complicated?

• Thrombosis due to blood stagnation.
• Vascular thromboembolism as a result of the release of a blood clot.
• Thrombophlebitis or inflammation of the venous wall.
• PE (pulmonary embolism).In this case, blood circulation in the pulmonary circulation is sharply impaired, which leads to death.Small blood clots can lodge in the small pulmonary arteries and cause a heart attack or pulmonary edema.  
• Trophic ulcers, eczema on the skin of the legs due to tissue malnutrition.With poor blood circulation, little oxygen and nutrients enter the tissues, which impairs regeneration or causes massive cell necrosis.
• Edema syndrome.As a result of impaired blood flow and stagnation, fluid leaks through the walls of blood vessels into the intercellular space.The swelling is soft, 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 impaired blood flow and tissue nutrition. 
• Hyperpigmentation, cyanosis of the affected areas of the skin.
• Consolidation of subcutaneous fat due to swelling and hemorrhage.

How to diagnose varicose veins

• Functional tests (application of a tourniquet) examine the condition of the valves.They are named after the authors - Troyanov-Trendelenburg, Pratt, Scheinis, Delbe-Perthes, etc.For the Troyanov-Trendelenburg test, you should place the patient horizontally, then offer to raise the leg to 450. In this position, the doctor strokes the limb from the foot up to empty the superficial veins.The next step is to apply a tourniquet to the upper half of the thigh, after which the patient rises from the couch.Healthy leg veins should fill in 15 seconds.  
• A duplex ultrasound scan of the veins (ultrasound angioscan) provides the most information and allows you to visualize the vessels and the blood flow through them.
• Doppler is a method of assessing blood circulation through the vessels.
• Phlebography or x-ray examination with contrast, which helps to study the internal structure of the vessel.
• Phleboscintigraphy is a technique using radioactive substances with additional examination of a special device for their distribution.

To examine the superficial veins, they are examined and palpated.The first three methods are used as additional studies.The last two methods are necessary to examine the condition of the deep or deep veins.

Treatment of varicose veins

Options for conservative treatment

• Drug therapy does not cure varicose veins, but with the help of drugs, valve function, vascular trophism, blood circulation are partially improved and the risk of thrombosis is reduced.Venotonics are used for this purpose.They can be prescribed for any type of varicose veins.In thrombophlebitis, ointments with non-steroidal anti-inflammatory drugs are indicated.Also in this situation, anticoagulants are used, which effectively break down blood clots.The treatment must be chosen by a doctor after a thorough diagnosis and taking into account the characteristics of the patient.
• Herbal medicine and complementary techniques have ancillary value.It is recommended to wear compression stockings, do gymnastics, skiing, cycling and swimming.The "bicycle" exercise in a lying position, flexion and extension of the feet gives good results;improves blood flow from the limbs.You can do the exercises if there are no complications.  It is also recommended to take a contrast shower in the morning (first water your feet with warm water, then gradually reduce the temperature to cold).  Cool baths with decoctions of oak bark, horse chestnut, chamomile, St. John's wort, rubbing the skin with tincture of white acacia flowers, Kalanchoe leaves and apple cider vinegar help.Leeches help get rid of thrombophlebitis.
• Mode.You should get out of bed slowly, 5-10 minutes.Your legs should be elevated 10-15⁰ at night;to do this, place a pillow under your heels.You need to walk calmly, it is not desirable to cross your legs when sitting, and do not overwork.All patients are advised to wear compression stockings.
• You need to eat properly, include in your menu coarse fiber and foods rich in vitamins.  Citrus fruits, tomatoes, rose hips, currants, nuts, legumes, liver, onions, eggs and seafood will be useful.It is important not to drink alcohol, not to smoke and drink enough water during the day.In case of persistent constipation, it is recommended to drink a laxative.

Surgical treatment

Phlebectomy or complete removal of veins

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

The operation is contraindicated in ischemic heart disease, severe infections, in very elderly patients, in the second half of pregnancy, in case of local inflammation of the legs (erysipelas, pustular rash, eczema).

Only surgery can radically rid the patient of varicose veins and restore the function of the valves.If the situation is too severe, untreated and neglected, this method of treatment remains the only one.The disadvantages of the intervention are the need to apply 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 peripheral vessels (phlebitis, thrombophlebitis), diseases of the respiratory system (asthma, chronic bronchitis, pleurisy), pathologies of the gastrointestinal tract (cholecystitis, ulcers, peritonitis), nervous system (chronic injuries, meningitis, encephalitis and their consequences), genitourinary system (inflammation of the kidneys, prostate,pathology of the uterus with appendages), with skin diseases (furunculosis, dermatitis, psoriasis, etc.).

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

The main advantages of laser therapy are its effectiveness in removing the expansion of superficial veins, speed (the duration of manipulation is 15-20 minutes), the absence of the need for a hospital and low trauma.
Among the disadvantages, it is worth highlighting the poor accessibility of the technique;not all clinics have appropriate equipment.Treatment is expensive and of little use for severely affected and deep veins.If the laser is used incorrectly, you can get a thermal burn, and sometimes depigmentation occurs at the sites of exposure.

Radiofrequency coagulation (ablation)

The operation is indicated for extensive lesions of the saphenous veins, trophic ulcers as a result of prolonged and untreated varicose veins.

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

The main advantages of the method are its painlessness, lack of injury and the need for a hospital stay.Patients can return to normal activities the very next day.

A disadvantage is the high cost of the intervention.

Sclerotherapy

Indicated for varicose veins of small and large superficial veins (on large vessels it is performed under the control of duplex Doppler ultrasound) in the initial stage and without complications.

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

The main advantages are low cost, quick recovery, no need for hospitalization.The procedure leaves no traces and does not hurt.

The disadvantage is the risk of the sclerosing drug entering a deep vein, reduced effectiveness in contact with blood and the possibility of use only in the initial stages.

Is it possible to treat varicose veins at home?

In home conditions, it is allowed to use auxiliary methods for the treatment of varicose veins that relieve symptoms.They use ointments from pharmacies or self-made, baths and lotions based on herbs, compresses, drink decoctions and infusions to improve blood flow and relieve swelling.Below are some recipes.

Chestnut tincture

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 for several weeks.To make the product smell good, add a few drops of peppermint oil.In the evening, rub the legs with the tincture to get rid of heaviness and itching, strengthen blood vessels and prevent their fragility.It is also recommended to make a compress from the tincture.If there is no chestnut, replace it with nutmeg, the recipe remains the same.Musk nut tincture can be used not only to rub sore feet;it is recommended to drink 20 drops per day.Once the bottle is finished, a new tincture is made.But there should be a gap of 2 weeks between taking the next portion.

Ointment based on calendula

An infusion of calendula flowers is made - pour a tablespoon of boiling water, put on fire, cook for a few minutes, leave for 3 hours in a thermos.Strain the infusion and add it to some kind of fat;lanolin, vaseline, badger fat are suitable.For 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 light movements from the bottom of the leg to the knee 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 of a dark shade so that the container is filled to the top.Pour half a liter of any kind of vegetable oil, for example from olive, corn, hemp.  Leave for a month, shaking or stirring occasionally.The oil infusion is then strained.For fragrance, add a few drops of tea tree, peppermint, lavender, and grapefruit essential oils.Early in the morning and late in the evening, anoint your feet with chamomile oil while giving a light massage.You can also make night compresses from the infusion.

Compress based on wormwood

Take a package of kefir or fermented baked milk, 3 tablespoons of dried wormwood.The grass is crushed and mixed with kefir (stew).When the grass is wet, place it on a cheesecloth along with a thick liquid.Then a compress is applied to the leg, covered on top with wax paper (cellophane film is not used) and everything is fixed with several layers of bandage.  Keep your legs elevated and remove the compress after half an hour.It is recommended to perform 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 flowers, yarrow.Combinations of different plants give a good effect.To improve the effect of the compress after the procedure, it is recommended to lie down for a while with your legs elevated.All of the herbs listed can be steamed and used in a foot bath.The water in such a bath should be warm, the duration of the procedure is about 25 minutes.Relieves fatigue, swelling, reduces itching and pain on the skin.

Traditional recipes for internal use

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

• clover
• sequentially
• Leaves and fruits of blueberries, viburnum, strawberries, raspberries
• Podbel
• Calendula
• Japanese sophora
• Melissa
• Schizandra
• 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 cup before meals.

Varicose veins are well treated with bee pollen and honey.Pollen should be consumed internally.Honey can also be eaten, but it still makes good compresses.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 the female body and overload, which often provokes varicose veins.Treatment during this period is carried out conservatively, using local creams, ointments and gels.

The most effective ointments have a decongestant effect and remove heaviness in the limbs. Apply them in a thin layer, moving from the bottom up, with light massaging movements.The frequency of manipulations is 1-3 times a day.

Public funds also help.It is recommended to prepare baths with herbal decoctions (from chamomile, thyme, hop cones, calendula, wormwood, hemlock, oak bark, birch leaves, etc.).

You can fight the swelling by smearing your feet with cabbage leaves or raw grated potatoes.You should cover the compress with wax or regular thick paper, not cellophane, so that the skin can breathe.The procedure is done before going to bed 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.Most often they are based on plant extracts.

After taking the drugs, the venous tone increases, the walls become elastic, they do not stretch as much, the lymph flow improves, the liquid part of the blood stops flowing into the intercellular space, and the swelling disappears.You cannot take these medicines without a doctor's prescription.

Traditional methods of treating varicose veins

There are many folk recipes for infusions, decoctions, lotions and compresses.A number of medicines are recommended to be taken even internally.Below are several 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 lilac leaves into it.Then everything is filled with vodka or medical alcohol so that the liquid completely covers the grass (up to the very edge of the container).Insist for a week, shaking occasionally, then filter and rub your feet with the tincture every day.Rub the skin with light massage movements from the fingers to the knees.

With the help of tincture, they fight inflammation, swelling, spasms and pain in the legs.

Garlic ointment

Garlic cloves from a whole head are peeled, ground in a meat grinder or pressed through a garlic press.Then you need to take oil (unsalted) and mix it with crushed garlic in a ratio of 1: 2 (2 parts of oil and 1 part of garlic).Apply this mixture to the sick leg, cover with wax paper, bandage it, the compress can be kept all night.

The compress relieves pain and burning sensation, has antiseptic properties, softens the skin and supports wound healing.

Honey with garlic

You need to take a head of garlic and 250 ml of honey (preferably linden or buckwheat).Both ingredients are thoroughly mixed 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 mash is applied to the sore spots.Keep the compress for about half an hour;if desired, you can leave it all night.To increase effectiveness, 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 is the effect of wearing compression clothing on varicose veins?

Compression clothing cannot cure varicose veins.But wearing it slows down the disease, alleviates many of the symptoms it causes, and improves well-being.

After wearing compression hosiery, the lumen of the saphenous veins narrows, blood and lymph flow better and do not stagnate in the limbs.At the same time, the swelling is relieved, the convulsive contractions of the calves disappear, the legs are less tired and there is no feeling of heaviness.

The main types of compression clothing prescribed for varicose veins are leggings, socks, stockings and long tights.The products are recommended to be worn every day;you should put them on in the morning before you get out of bed, always lying down.

There are different degrees of compression of knitwear, they are chosen depending on the stage of varicose veins.Only the right underwear will have the right therapeutic effect.It is best to have it prescribed by a doctor, but low-compression socks or tights for prevention are easy to buy yourself.

Before you buy, 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.