Phlebeurysm

A team of qualified cardiovascular surgeons/phlebologists in the medical clinic diagnoses and treats all types of varicose veins at any stage of the disease, as well as associated pathologies. Our asset, which we are proud of, is treatment according to Israeli protocols that show maximum effectiveness in clinical practice.

Varicose veins – The trigger for the development of varicose veins is a disruption in the normal function of the venous valves with the occurrence of a backflow (reflux) of blood.

As a rule, the valves that are exposed to the highest mechanical stress are the first to be affected. In this case, there is a pathological leakage of blood through the mouth of the large and small saphenous veins, sometimes also through large perforating veins. An excessive blood volume arising in the superficial veins gradually leads to overstretching of the vein wall. The total blood volume in the superficial venous bed of the lower extremities increases. This increased blood volume continues to flow via the perforating veins into the deep venous system and overstretches them. As a result, dilatation and valve insufficiency of the perforating veins occur.

Symptoms and signs of the disease

Signs of illness are not necessarily accompanied by pain. On the contrary, most patients say that at the beginning of the disease they are more worried about aesthetic problems than about pain.

The clinical picture depends on the localization of the pathological process, as well as the stage of the disease.

Varicose veins of the lower extremities manifest themselves as follows:

• Feeling of heaviness in the legs, feeling of fullness in the legs.
• The appearance of cramps in the calf muscles, cramps of the feet and fingers.
• Feel tired after walking for a long time.
• Swelling of the ankle in the evening.
• Venous relief pattern on the skin, spider veins, spider veins.
• Accompanying symptoms of the disease are cellulite, itching on the legs, dry ankles and calves, thinning and sagging skin, long-healing ulcers, uneven pigmentation - from dark spots to colorless areas, pronounced nodule formation with a color from bluish to dark purple or burgundy, trophicUlcers.

Progressive venous disease is accompanied by a deterioration in general health:

• Unstable blood pressure, hypertension, hypotension.
• A feeling of chronic fatigue and apathy develops.
• Arrhythmia, tachycardia.
• Shortness of breath, frequent respiratory diseases.

Obvious symptoms of varicose veins of the lower extremities in women may become more pronounced before menstruation and decrease afterward.

Symptoms of venous pathology in the upper extremities are characterized by numbness of the hands, spastic conditions of the fingers, goosebumps, tingling and cold.

Varicose veins of the esophagus are manifested by belching, burning, pain behind the breastbone, inflammation of the esophagus and stomach, difficulty swallowing and signs of reflux esophagitis, anemia.

Diagnosis of the disease

Effective treatment of varicose veins is not possible without prior comprehensive diagnostics. The diagnosis is clarified by the clinical picture and data analysis after hardware studies.
The following methods are most often used for diagnosis:

• duplex or triplex ultrasound angioscanning;
• phlebography with contrast;
• MRI with venography;
• Contrast angiography.

To determine the presence of reflux in the affected veins and assess blood flow, several test manipulations are performed:

• Inspection of veins with compression on different segments.
• Valsalva maneuver or stress test.
• Parana test with imbalance to assess the veins in the calf area.
• Walking test of different intensity.

Additional methods to clarify the diagnosis:

• Plethysmography to determine venous reflux and obstruction.
• CT, MRI to visualize tissues and structures in the affected area.
• Infrared thermography to assess the temperature balance in the affected area of the body.
• During intravascular ultrasound, the vessel walls are visualized from the inside using a catheter.

The results of the diagnostic studies carried out are comprehensively evaluated. Any diagnosis is a great help in determining further treatment tactics.
Clinical laboratory tests of blood and urine complement the clinical picture and can indicate concomitant diseases.

How are varicose veins treated?

If alarming symptoms of varicose veins appear, you should consult a doctor to make a diagnosis and start treatment in a timely manner. In regional medical institutions, this issue is handled by general surgeons, in clinics by phlebologists and angiosurgeons.

The multidisciplinary medical clinic has a well-equipped phlebology department staffed by a team of surgeons with extensive practical experience. The center offers a high level of service and quality of treatment, which is reflected in the excellent clinical results of which we are proud.

Varicose veins of the lower extremities and other pathologies can be treated in the first stages of development. As the process progresses, it increasingly proves to be ineffective and sometimes only retains symptomatic significance.

Therapeutic effects cannot completely eliminate the disease, but as long as it is possible to delay the destruction of blood vessels and the development of complications, this must be done by all available means.

Conservative treatment

• At the beginning of the treatment of varicose veins, medications are limited to venotonic agents.
• To reduce the risk of thrombosis and occlusion, injections of anticoagulants and low molecular weight heparin fragmin are used.
• New oral anticoagulants.
• In the case of inflammatory symptoms in blood vessels and surrounding tissues, the use of non-steroidal anti-inflammatory topical medications with diclofenac and indomethacin is indicated.

How can you additionally treat varicose veins?

In parallel with therapeutic treatment, the patient is recommended to perform certain exercises that strengthen the muscular corset of the lower extremities and have a general strengthening effect. The best exercises while lying down are, for example, the "bicycle", in which you alternately pull and stretch your toes towards you, like in ballet.

• Caution should be exercised during water and thermal treatments, as hot baths and showers, beach holidays in the sun with sunbathing can aggravate the situation. The vessels need to be strengthened, this is facilitated by hardening with a contrast shower, during which warm and cold water is alternately poured onto the legs.
• For pain, inflammation and a feeling of heaviness in the legs, daily cool foot baths with decoctions of oak bark, chamomile, marigold, birch leaves, St. John's wort, white acacia flowers and horse chestnut are recommended.
• It is useful to rub freshly squeezed juice from aloe leaves into the skin; it softens the skin and prevents inflammation.
• It is worth changing your habits and quitting smoking. The diet should be dominated by vitamin-rich foods with lots of fiber, fresh vegetables, citrus fruits and seafood.
• You need to adjust your drinking regime by drinking enough water (1. 5 to 2 liters) every day. At the same time, you should reduce the consumption of coffee, strong tea, chocolate and alcohol.

If the veins in the legs are dilated, the doctor may recommend regular or permanent wearing of compression stockings.

Attention! In any case, you should listen to your doctor's recommendations and strictly follow them. Self-medication is unacceptable!

Causes of the disease

Family history suggests that varicose veins are genetic and can be inherited.

In many clinical cases it is impossible to determine the exact cause of the disease. The researchers concluded that the culprit is a combination of several internal and external factors.

Causes of varicose veins:

• congenital defect of the valve system;
• physical inactivity, lack of activity;
• Pregnancy;
• Working conditions with prolonged stress on the legs, long standing, in a static position;
• treatment with certain hormone preparations;
• uncomfortable shoes, high heels;
• Obesity;
• tight underwear, clothing that tightens the hips and knees (e. g. very tight jeans, shapewear);
• lifting weights regularly;
• systemic pathology of the kidneys, heart and blood vessels;
• diabetes mellitus;
• regular intestinal problems, frequent diarrhea or constipation.

Varicose veins of the lower extremities (varicose veins)- Expansion of the superficial veins of the lower extremities, accompanied by valvular insufficiency and circulatory disorders. The term "varicose veins" comes from Latin. Varix – "swelling".

As a result, the veins cease to function properly, the entire circulatory system is disrupted, which is complicated by congestion, disruption of trophism in the tissues, and blockage of blood vessels by blood clots.

Many complications are life-threatening, so if varicose veins are suspected, immediate diagnosis and treatment must be carried out professionally.

Types of diseases

The blood flow in the vessels changes, slows down and blood clots can form in uneven walls. Changes in the functionality of blood vessels lead to blood congestion, venous insufficiency and persistent disorders of capillary circulation in the periphery.

According to WHO, varicose veins occur in 45% of women and 20% of men.

According to the generally accepted international classification CEAP, varicose veins are divided into six disease classes based on the fact that C0 means the complete absence of subjective, visual and clinical signs.

• C1 – the initial stage, manifested by a capillary network and spider veins on the skin.
• C2 – visible thickening of veins under the skin, vein pattern in the lower extremities in the form of blue threads.
• C3 – Swelling of the legs occurs due to prolonged standing on the feet or resting (night sleep).
• C4 – the surface of the skin changes, unevenly pigmented areas appear, venous eczema, accompanied by itching and ulcers, lipodermatosclerosis.
• C5 – venous ulcers on the surface of the skin that heal after some time.
• C6 – non-healing venous trophic ulcers.

When classifying varicose veins of the lower extremities, a distinction is made between the pathology of superficial and/or deep vessels and perforation of the connecting veins.

According to its origin, a venous deformity can be:

• congenital, manifests itself in infants;
• acquired;
• secondary, arising against the background of other pathologies, injuries;
• idiopathic, with unknown cause.

The complete classification of varicose veins of the lower extremities and organs also includes complications – backflow of blood, reflux and/or occlusion, obstruction of the lumen.
Varicose veins of the lower extremities are not the only, although most common, manifestation of varicose veins. There are also varicose veins of the esophagus, sublingual veins, retina, scrotum (varicose veins in men), stomach, erectile tissue of the rectum (hemorrhoids), pelvic veins and female genital organs - vulva, labia, uterus.

Surgical treatment of varicose veins

RFO (radiofrequency obliteration of saphenous veins)is a modern method for treating varicose veins. During the treatment, the inner wall of the vein is irradiated with radiofrequency radiation. Due to the thermal effect, the vein is "welded", separated from the general blood flow and replaced by connective tissue after a few months.

Advantages

• The procedure is carried out without general anesthesia; local anesthesia is sufficient;
• Maximum safety for the patient's health
• XRF requires no special preparation;
• During the manipulation, the patient does not feel any pain or discomfort;
• Radiofrequency ablation of lower extremity veins is highly effective;
• Low probability of complications, almost all patients tolerate this procedure well;
• Radiofrequency ablation can be combined with tributary mini-phlebectomy or sclerotherapy;
• There are no scars or marks left after radiofrequency ablation;
• Literally a few days after the procedure, the patient can return to his normal lifestyle.

How it goes

The procedure is carried out under ultrasound control. Local anesthesia is administered before the procedure begins so that the patient does not feel any pain or discomfort during the treatment.
Let's look at how XRF is performed step by step:

• Before the operation, the lower limbs are thoroughly treated with antiseptic agents. The doctor then uses a marker to mark the vein that is prone to varicose veins. The doctor then inserts a high-frequency catheter into the vein and treats the desired area with high-frequency waves.
• At the end of the procedure, the catheter is removed, the doctor applies a bandage and helps the patient put on compression stockings.
• The procedure takes 30 to 50 minutes. To stop blood flow through a weakened vessel, it must be destroyed. Then the body itself will redirect the blood through healthy veins. As a result, after ablation, the walls of the veins stick together and form scar tissue inside (this is safe and imperceptible) and varicose veins disappear.

rehabilitation

Immediately after the operation, the patient must walk (about 30 minutes) to avoid stagnation of blood and lymph. After radiofrequency ablation of the veins of the lower extremities, the recommendations of doctors must be carefully followed:

• During the week, increased physical activity and heavy lifting are prohibited;
• It is necessary to walk more and stay in the same position as little as possible (except for sleep);
• For 3-4 weeks you need to stop taking a hot bath, you can only take a shower;
• You do not need to visit the bathhouse for at least a month;
• It is necessary to drink as much plain water as possible, on average about 2. 5 liters, while minimizing the amount of salt;
• A week after the operation you need to start physiotherapy, which the doctor will inform you about;
• It is possible that the doctor will prescribe some medications after radiofrequency ablation of the veins of the lower extremities.

Following these rules will help you avoid complications and prevent further development of varicose veins.

A week after the operation, a re-examination (ultrasound examination of the veins of the lower extremities) is required. You can obtain further information about radiofrequency ablation of the veins of the lower extremities in a personal consultation with a specialist.

Laser coagulation of veins

Endovasal (endovenous) laser coagulation (obliteration) of varicose veins (EVLK, EVLO) is a modern method of eliminating blood backflow in superficial and perforating veins using the thermal energy of laser radiation. EVLO eliminates the need for incisions and does not require the patient to be hospitalized. The international term is EVLA (endovenous laser ablation).

Main stages

• Venous puncture. Is carried out under ultrasound control.
• Positioning the light guide. The light guide is a thin optical fiber. Laser radiation is supplied at its end. The light guide is inserted into the diseased vein. Its end is attached to the point where the varicose vein flows into healthy deep veins, i. e. at the anastomosis.
• Tumescent anesthesia. A "cushion" of anesthetic is created around the vein to better press the vein against the light guide and avoid damaging the surrounding tissue.
• Laser venous coagulation. Laser radiation is supplied to the working part of the light guide.
• At the same time, the light guide is slowly pulled out of the vein. This means that the laser heats the vein evenly to a temperature of 85 °C. A heated vein, like any protein, contracts when heated. The lumen of the vein disappears, blood flow stops.

rehabilitation

Immediately after the operation, the patient must walk (about 40 minutes) to avoid stagnation of blood and lymph. After EVLO of the veins of the lower extremities, the recommendations of doctors must be followed:

• During the week, increased physical activity and heavy lifting are prohibited;
• It is necessary to walk more and stay in the same position as little as possible (except for sleep);
• For 3-4 weeks you need to stop taking a hot bath, you can only take a shower;
• You do not need to visit the bathhouse for at least a month;
• It is necessary to drink as much plain water as possible, on average about 2. 5 liters, while minimizing the amount of salt;
• A week after the operation you need to start physiotherapy, which the doctor will inform you about;
• After the operation, the doctor may prescribe some medications.

Sclerotherapyis a method for the non-surgical (minimally invasive) removal of varicose and spider veins of the lower extremities.

Advantages of venous sclerotherapy:

• absolute outpatient care that requires no further preparation,
  speed of execution,
• no anesthesia required,
• Absence of complications typical of surgical treatment methods such as nerve damage,
• the absence of "thermally induced phlebitis" characteristic of coagulation methods, accompanied by stabbing pain along the clotted vein.

Therefore, venous sclerotherapy for varicose veins is now an effective and safe method that can be used in some cases as an alternative to other surgical procedures.

The sclerotherapy method is based on the obliteration of the vein by introducing a chemical into its lumen, which "washes away" the inner layer (endothelium) and subsequent endofibrosis develops. The degree of endothelial damage depends on the concentration and amount of the administered drug.

The modern medical center uses advanced technologies to treat varicose veins, ensuring maximum effectiveness of all treatment measures. Thanks to the use of modern equipment by experienced specialists, you will get rid of varicose veins in the shortest possible time, without complications and without the need for long-term rehabilitation.

Treatment in a modern clinic means health and a significant improvement in quality of life.