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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 people since ancient times.It is mentioned in the papyri of Ancient Egypt; a mummy with manifestations of varicose veins on the legs was even excavated.They find information about pathology in Hippocrates, Galen, and Avicenna.Modern doctors also often encounter varicose veins in patients and are looking for effective treatment methods.

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”.With this disease, the peripheral veins increase in volume, become long, tortuous, deformed, and knotty.Blood stagnates in the lower parts of the leg because the valves begin to work poorly and the walls weaken.Most often, vascular damage is observed in the legs, 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 with a 2-3 times greater frequency than in men of the same age.This is due to constant hormonal changes in the female body that occur throughout life.

How are the veins in the legs 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.The deep and superficial vessels are connected by perforating or perforating veins.Their wall consists of collagen and elastin fibers, with weak and few smooth muscles.

The venous wall has a three-layer structure:

  • At the top is the adventitia, which is composed of loose connective fibers, smooth muscle cells elongated along the walls, surrounded by small capillaries and nerves responsible for the trophism of the vessel.
  • 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 muscles.  The inner shell is folded, the thickenings are opposite each other and resemble swallows' nests or patch 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 reverse outflow and increase venous pressure.In addition to the valves, smooth muscles, tendons and muscles of the leg take part in maintaining normal tone.When any of the layers (usually the median and internal layers) are 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 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 valves, and collects blood from the veins on the front and back of the leg.

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

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

For what reasons does varicose veins appear, and who is at risk of getting sick?

It is difficult to say why people get varicose veins at the moment.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 the walls of blood vessels is determined genetically; with some changes in the genes, they weaken and the valves do not close well.As a result, with the slightest 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 (coagulability increases), vascular tone decreases, elastin and collagen fibers are destroyed, and the risk of blood clots increases.
  • Obesity.People who are overweight move little, 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 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, clogging small blood vessels and causing congestion.
  • Static occupational loads, such as lifting heavy loads, standing or sitting work.In such a situation, muscle tone drops, blood moves worse from the lower extremities to the heart, stagnation occurs, and the veins in the legs dilate because of this.  
  • Congenital pathologies of blood clotting.Hypercoagulation, in which too many factors are produced that are responsible for the formation of clots in the blood, 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 plant fiber leads to disturbances 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, which causes obstructed blood flow from the lower half of the body.
  • Frequent constipation.People suffering from this problem have to constantly push, this increases the pressure inside the abdomen, as a result, the outflow of blood becomes difficult.
  • High heel.Overstraining the calf muscles 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 volume of fluid, the risk of blood clots in the vessels will increase.
  • Pathologies of the heart and kidneys.These may be congenital or acquired heart defects, renal failure.
  • Exceeding doses of medications that affect coagulation.In this case, the blood vessels may become clogged with blood clots.
  • Operation.The risk of thrombosis in this case increases due to blood loss and compression of veins during the intervention.

How can varicose veins be complicated?

  • Thrombosis due to blood stagnation.
  • Vascular thromboembolism as a result of blood clot detachment.
  • Thrombophlebitis or inflammation of the venous wall.
  • PE (pulmonary embolism).In this case, blood flow in the pulmonary circulation is sharply disrupted, 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 outflow and stagnation, fluid leaks through the walls of blood vessels into the intercellular space.The 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 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

  • Using functional tests (application of a tourniquet), the condition of the valves is studied.They are named after the authors - Troyanov-Trendelenburg, Pratt, Sheinis, Delbe-Perthes, etc.. For the Troyanov-Trendelenburg test, you need to lay the patient horizontally, then offer to raise the leg 450.In this position, the doctor strokes the limb from the foot upward 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 veins in the legs should fill up 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 for assessing blood circulation through vessels.
  • Phlebography or X-ray examination using contrast, which helps to study the internal structure of the vessel.
  • Phleboscintigraphy is a technique using radioactive substances with further study on a special device for their distribution.

To study the 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 the 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 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.Ointments with nonsteroidal anti-inflammatory drugs are indicated for thrombophlebitis.Also in this situation, anticoagulants are used, which effectively resolve blood clots.Treatment should be selected by a doctor, after a thorough diagnosis and taking into account the characteristics of the patient.
  • Herbal medicine and additional techniques are of auxiliary value.It is advised to wear compression stockings, do gymnastics, skiing, cycling, and swimming.The “bicycle” exercise in a supine position, flexion and extension of the feet, gives good results; it improves the outflow of blood from the extremities.You can do the exercises if there are no complications.  It is also recommended to take a contrast shower in the morning (water your leg first 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 need to get out of bed slowly, 5-10 minutes.Your legs should be raised 10-15⁰ at night; to do this, place a cushion under your heels.You need to walk calmly, it is undesirable to cross your legs when sitting, and do not overwork.All patients are advised to wear compression stockings.
  • You need to eat right, include coarse fiber and foods rich in vitamins in your menu.  Citrus fruits, tomatoes, rose hips, black currants, nuts, legumes, 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 a laxative.

Surgical treatment

Phlebectomy or complete removal of veins

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

The operation is contraindicated in case of ischemic heart disease, severe infections, in very old patients, in the second half of pregnancy, in case of local inflammation of the legs (erysipelas, pustular rashes, 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 give anesthesia and keep the patient in the hospital for several days under observation, postoperative trauma with scars.

Laser therapy (endovascular microthermocoagulation)

Treatment of varicose veins with a laser 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), the genitourinary system (inflammation of the kidneys, prostate, pathology of the uterus with appendages), with skin diseases (furunculosis, dermatitis, psoriasis, etc.).

Contraindications to 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 eliminating dilation of superficial veins, speed (duration of manipulation 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 is 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 resulting from long-term and untreated varicose veins.

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

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

The disadvantage is the high cost of the intervention.

Sclerotherapy

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

Pregnant and nursing mothers, allergies to drugs, 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 for hospitalization.The procedure leaves no marks and does not cause injury.

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

Is it possible to cure varicose veins at home?

At home, it is allowed to use auxiliary methods for treating varicose veins, which alleviate symptoms.They use ointments from pharmacies or self-prepared ones, 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 ripened 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 a couple of weeks.To make the product smell good, add a couple of drops of peppermint oil.In the evening, lubricate 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, it is replaced with nutmeg, the recipe remains the same.Tincture with musk nuts can not only be used to rub sore feet; it is recommended to drink 20 drops a day.After the bottle is finished, a new tincture is made.But there should be a pause of 2 weeks between taking the next portion.

Calendula-based ointment

An infusion is made from calendula flowers - pour a tablespoon of boiling water, put on fire, cook for a couple of 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 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 leg to the knee, until completely absorbed.Thyme, hop cones, and nettle 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 in half a liter of any type of vegetable oil, for example, from olives, corn, hemp.  Leave for a month, shaking or stirring from time to time.After this, the oil infusion is filtered.For scent, add a couple drops of tea tree, mint, lavender, and grapefruit aroma oil.Apply chamomile oil to the foot early in the morning and late in the evening, while simultaneously doing 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 (ryazhenka).When the grass is wet, place it on cheesecloth along with a thick 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 legs 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 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 raised up.All of 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 skin itching and pain.

Traditional recipes for internal use

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

  • Clover
  • in succession
  • Leaves and berries of lingonberries, viburnum, strawberries, raspberries
  • 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 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 eliminate heaviness in the limbs. Apply them in a thin layer, moving from bottom to top, with soft massage movements.The frequency of manipulations is 1-3 times a day.

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

You can fight swelling by applying cabbage leaves or raw grated potatoes to your feet.You need to cover the compress with waxed or regular thick paper, not cellophane, so that the skin can breathe.The procedure is done before bedtime and the lotion is left overnight.

Doctors also prescribe medications 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 medications, venous tone increases, the walls become elastic, they don’t stretch as much, lymph flow improves, the liquid part of the blood stops leaking into the intercellular space, and swelling goes away.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.A number of remedies are advised 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 (to the very edge of the container).Infuse for a week, shaking occasionally, then filter and rub the tincture on your feet every day.Rub the skin with soft massage movements, from fingers to knees.

With the help of tincture they fight inflammation, swelling, cramps, 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.After this, you need to take butter (unsalted) and mix with crushed garlic in a ratio of 1:2 (2 parts butter and 1 part garlic).Apply this mixture to the affected leg, cover with wax paper, bandage it, the compress can be kept overnight.

The compress eliminates pain and burning sensation, 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 thoroughly mixed and left for a week.Drink a 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 sore spots.Keep the compress for about half an hour; if desired, you can leave it on all night.To increase efficiency, drink half a glass of potato juice at the same time.The product relieves swelling and discomfort in the leg, eliminates heaviness, reduces fatigue and inflammation.

What is the effect 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 putting on 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, swelling is relieved, convulsive contractions of the calves disappear, 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 wear the products every day; you need to put them on in the morning, before getting out of bed, always in a lying position.

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 proper therapeutic effect.It is best to be prescribed by a doctor, but stockings or tights with low compression, for prevention, are easy to purchase yourself.

Before purchasing, you need to determine exactly what compression class you need.Inquire about the labeling features of the products 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 packaging, then this product has nothing to do with medical underwear.