Treatment of varicose veins

Varicose veins (varicose veins) are a very common vascular disease, known since ancient times.It is mentioned in the papyri of ancient Egypt;a mummy showing signs of varicose veins on her legs was even searched.They find information on pathology in Hippocrates, Galen and Avicenna.Modern doctors also often face varicose veins in their patients and are looking for effective treatment methods.

The term "varicose veins" is of Latin origin, the word "varicose veins" is translated as "expansion".That is why the disease began to be called "Varicose Veins".With this disease, the peripheral veins enlarge, become long, tortuous, deformed and knotted.Blood stagnates in the lower parts of the leg because the valves begin to malfunction and the walls weaken.Most often, vascular damage is observed in the legs, since it is the vessels that experience the greatest load, it is necessary 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, boys and girls are equally affected.In mature and elderly women, this pathology occurs with a frequency 2 to 3 times higher 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 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 to say 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 is made up of collagen and elastin fibers, with weak and not very smooth muscles.

The vein wall has a three-layer structure:

• At the top is the adventitia, 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, made up of circular smooth muscle fibers.
• The intima is located inside.The base of the intima is the endothelium;between its cells are longitudinal fibers of smooth muscle.  The inner shell is folded, the thickenings face 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 peripheral parts to the heart, as well as from superficial veins to deep veins.They prevent reverse flow and increase venous pressure.In addition to the valves, smooth muscles, tendons and leg muscles participate in maintaining normal tone.When one of the layers (usually the middle and inner layers) is damaged, the veins lose their tone and dilate, and varicose veins appear.

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 by 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 in the front and back of the leg.

Communication between large and small veins occurs via connected vessels.

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

Why do varicose veins appear and who is at risk of getting sick?

It's hard to say why people get varicose veins these days.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 genetically determined;with some changes in the genes, they become weaker and the valves do not close well.As a result, at the slightest increase in pressure in the veins, a reverse flow of blood occurs, the vessels overflow and expand.
• Hormonal changes in the body in women.  This situation is typical for pregnant women or 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.Overweight people move little, which slows blood circulation 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 then 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 you drink large doses of alcohol, dehydration occurs, the blood thickens, clots form, blocking small blood vessels and causing congestion.
• Static work loads, such as lifting heavy loads, working standing or sitting.In such a situation, muscle tone decreases, blood flows worse from the lower extremities to the heart, stagnation occurs, and the veins in the legs dilate because of this.  
• Congenital pathologies of blood coagulation.Hypercoagulation, in which too many factors responsible for the formation of clots in the blood are produced, causes thrombosis and hinders the circulation of blood in the vessels.
• Bad diet.A diet deficient in a number of vitamins (C, E, PP) and plant fiber leads to disruptions in the structure of the endothelium and other structural elements of the vascular walls.
• Tight underwear.When you wear tight underwear, some veins are pinched, leading to 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, making it difficult for blood to flow.
• High heel.Excessive strain on the calf muscles and insufficient contraction causes blood to stagnate in the veins.
• Hot climate.In summer, during extreme heat, the body becomes dehydrated.If you do not compensate for the problem by drinking enough fluids, the risk of blood clots forming in the vessels will increase.
• Pathologies of the heart and kidneys.These may include congenital or acquired heart defects and kidney failure.
• Exceeding doses of medications that affect clotting.In this case, blood vessels may become blocked by blood clots.
• Operation.The risk of thrombosis increases in this case due to blood loss and compression of the veins during the procedure.

How can varicose veins be complicated?

• Thrombosis due to blood stagnation.
• Vascular thromboembolism resulting from the detachment of a blood clot.
• Thrombophlebitis or inflammation of the vein wall.
• PE (pulmonary embolism).In this case, blood flow in the pulmonary circulation is severely disrupted, which leads to death.Small blood clots can lodge in the small arteries of the lungs and cause a heart attack or pulmonary edema.  
• Trophic ulcers, eczema of the skin of the legs due to tissue malnutrition.When blood circulation is poor, little oxygen and nutrients penetrate the tissues, impairing regeneration or causing massive cell necrosis.
• Edema syndrome.Due to impaired blood flow and stagnation, fluid escapes through the walls of blood vessels into the intercellular space.The swelling has a soft, elastic consistency 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 circulation and tissue nutrition. 
• Hyperpigmentation, cyanosis of 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, and then offer to raise the leg to 450. In this position, the doctor strokes the limb from the foot upwards to empty the superficial veins.The next step is to apply a tourniquet to the upper half of the thigh, after which the patient gets up from the sofa.Healthy leg veins should fill after 15 seconds.  
• Duplex ultrasound of veins (ultrasound angiography) provides the most information and allows you to visualize the vessels and the blood flow through them.
• Dopplerography is a method for assessing blood circulation in the vessels.
• Phlebography or contrast radiological examination, which allows the internal structure of the vessel to be studied.
• 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 deep or deep veins.

Treatment of varicose veins

Conservative treatment options

• Drug treatment 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 containing nonsteroidal anti-inflammatory drugs are indicated for thrombophlebitis.Also in this situation, anticoagulants are used to effectively resolve blood clots.Treatment should be chosen by a doctor, after a thorough diagnosis and taking into account the patient's characteristics.
• Herbal medicine and additional techniques have auxiliary value.It is advisable to wear compression stockings, do gymnastics, skiing, cycling and swimming.The “bicycle” exercise in supine position, flexion and extension of the feet, gives good results;it improves the flow 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 (first water your leg 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.
• Fashion.You should get out of bed slowly, 5 to 10 minutes.Your legs should be elevated 10 to 15⁰ at night;To do this, place a cushion under your heels.You need to walk calmly, it is undesirable to cross your legs while sitting and not to 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.In case of persistent constipation, it is recommended to drink a laxative.

Surgical treatment

Phlebectomy or complete removal of veins

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

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

Only surgery can radically rid the patient of varicose veins and restore the function of the valves.If the situation is too serious, untreated and neglected, this treatment method remains the only one.The disadvantages of the procedure are the need to perform anesthesia and keep the patient in the hospital for several days under observation, postoperative trauma with scarring.

Laser therapy (endovascular microthermocoagulation)

Laser treatment of varicose veins is used if the pathology is associated 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 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, its speed (the duration of the manipulation is 15-20 minutes), the absence of the need to go to the hospital and its 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 of little use for deep and severely affected veins.If the laser is used incorrectly, you can experience a thermal burn and sometimes depigmentation occurs at the exposure sites.

Radiofrequency coagulation (ablation)

The operation is indicated in cases of extensive lesions of the saphenous veins, trophic ulcers resulting from long-term and untreated varicose veins.

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

The main advantages of the method are its painlessness, absence of injury and the need for hospitalization.Patients can resume their normal activities the next day.

The disadvantage is the high cost of the procedure.

Sclerotherapy

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

Pregnant and lactating women, drug allergies, deep vein thrombosis, infectious and inflammatory skin lesions of the legs are not treated by this method.

The main advantages are low price, quick recovery and no hospitalization required.The procedure leaves no marks and does not cause any injuries.

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

Is it possible to treat varicose veins at home?

At home, it is allowed to use auxiliary methods of treating varicose veins, which alleviate the symptoms.They use pharmacy or self-prepared ointments, herbal baths and lotions, compresses, decoctions and infusions to improve blood circulation and relieve swelling.Below are some recipes.

Chestnut tincture

Take approximately 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 let it sit for a few weeks.To make the product smell good, add a few drops of peppermint oil.In the evening, lubricate the legs with the tincture to eliminate 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.Not only can musk tincture be used to rub sore feet;it is recommended to drink 20 drops per day.Once the bottle is finished, a new tincture is prepared.But there should be a break of 2 weeks between taking the next portion.

Calendula-based ointment

An infusion is prepared from calendula flowers - pour a tablespoon of boiling water, put on fire, cook for a few minutes, leave for 3 hours in a thermos.Filter the infusion and add it to some kind of fat;lanolin, petroleum jelly, badger fat are suitable.For the smell, it is recommended to add a drop of aromatic oil (rose, bergamot, citrus, sage, lavender...).Rub the ointment morning and evening, using gentle movements from the lower 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 half a liter of any type of vegetable oil, for example, olive, corn, hemp.  Leave for a month, shaking or stirring from time to time.After that, the oil infusion is filtered.For fragrance, add a few drops of aromatic tea tree oil, mint, lavender and grapefruit.Apply chamomile oil to the foot early in the morning and late in the evening, while performing a light massage.You can also make nightly compresses from the infusion.

Wormwood compress

Take a pack of kefir or cooked fermented milk, 3 tablespoons of dried wormwood.The grass is crushed and mixed with kefir (ryazhenka).When the herb is wet, place it on cheesecloth with thick liquid.Then a compress is applied to the leg, covered 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 purple 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.Any of the herbs listed can be infused and used to prepare a foot bath.The water for such a bath should be lukewarm, the duration of the procedure is about 25 minutes.It relieves fatigue, swelling, reduces itchy skin and pain.

Traditional recipes for internal use

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

• Clover
• successively
• Leaves and berries of lingonberries, viburnum, strawberries, raspberries
• Coltsfoot
• Calendula
• Japanese sophora
• Melissa
• Schisandra
• hawthorn

The herb is dried, then ground 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 of a glass before meals.

Varicose veins are well treated with bee pollen and honey.Pollen should be consumed internally.Honey can also be consumed, 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 causes 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, from bottom to top, with gentle massaging movements.The frequency of manipulations is 1 to 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 combat swelling by applying cabbage leaves or grated raw potatoes to your feet.You should cover the compress with regular waxed or thick paper, not cellophane, so that the skin can breathe.The procedure is carried out 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 drugs, venous tone increases, the walls become elastic, they stretch less, lymphatic flow improves, the liquid part of the blood ceases to seep into the intercellular space and the 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 advisable to take a number of remedies 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 lilac flowers and leaves into it.Then the whole thing is filled with vodka or medical alcohol so that the liquid completely covers the grass (up to the edge of the container).Infuse for a week, shaking occasionally, then strain and rub the tincture onto your feet daily.Rub the skin with gentle massaging movements, from fingers to knees.

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

Garlic ointment

Garlic cloves of a whole head are peeled, crushed in a meat grinder or pressed 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 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.

Garlic honey

You need to take a head of garlic and 250 ml of honey (preferably linden or buckwheat).The two ingredients are mixed thoroughly 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 visible.

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 you want, you can leave it overnight.To increase effectiveness, 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 it causes and improves well-being.

After putting on compression stockings, the lumen of the saphenous veins narrows, blood and lymph circulate better and do not stagnate in the limbs.At the same time, swelling is relieved, 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.It is recommended to wear the products every day;you must put them on in the morning, before getting up, 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 appropriate therapeutic effect.It is best to get a prescription from a doctor, but low compression stockings or tights, as a preventative measure, are easy to buy yourself.

Before purchasing, you need to determine exactly what compression class you need.Find out about the product labeling features of the company of your choice.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.