There is so much information available about varicose vein treatment methods that it is often difficult for patients to make the right choice. Here is a brief introduction to the current methods of varicose vein treatment.
Broadly speaking, varicose vein treatment methods can be categorized into three main categories: physical therapy, drug therapy and surgical treatment.
1.Physical treatment
The most fundamental cause of varicose veins is the increase in venous pressure in the lower extremities due to the effect of gravity when humans walk upright, which is essentially a physical problem, so physical therapy is also the most basic and effective treatment for venous diseases of the lower extremities. The specific methods include: elevation of the limb, elastic bandage wrapping, elastic stockings and airbag pulsation compression pump.
(1) Elevating the lower extremity is simple and easy, and the effect is indeed the most basic treatment for all lower extremity venous diseases, which is applicable to all patients with lower extremity venous diseases, and can also be used by normal people as a method of maintenance and prevention of venous diseases. However, the effective way to lift the leg should be to raise the lower extremity after lying down to ensure that the lower extremity is higher than the heart in order to promote the effect of venous blood flow back by gravity. Generally, if the condition is serious (such as combined ulcers, thrombophlebitis, dermatitis or swelling is serious), you can rest in bed for a few days, but usually you can lift your leg once every 1 to several hours according to the condition and the severity of the condition, and you can lift your leg for several minutes each time.
(2) elastic bandage to promote venous reflux has a long history, the efficacy is really, traditionally marching long distance will use this method. However, with the widespread use of professional medical elastic stockings, elastic bandages are used less and less. Compared with elastic stockings, the disadvantage of elastic bandages is that they are inconvenient to use, unattractive, and not easy to control the elasticity, uneven pressure, and easy to produce strangulation marks. At present, they are only used in the early post-operative period of varicose veins. Older people who have difficulty in wearing elastic stockings, or whose lower limbs are thick and cannot be fitted with the right size elastic stockings can also choose elastic bandages. The elastic bandage is best to be tied under the guidance of professional doctors to avoid crushing the skin.
(3) Elastic stockings are one of the biggest advances in the prevention and treatment of venous diseases of the lower limbs in recent decades. The basic principle is the same as that of elastic bandage, which is to promote venous blood return by squeezing to prevent blood stagnation in the veins of lower limbs. Compared to elastic bandages, the advantages are ease of use and aesthetics, in addition to the gradient of pressure from top to bottom of the medical compression stocking, which is more conducive to promoting venous reflux.
The main disadvantage of compression stockings is that they are still expensive, generally more than 300 yuan for the therapeutic type. There are also a lot of cheaper compression stockings on the market, but the pressure is often not in line with the requirements, and it is easy to relax for a long time and not effective, from the letter price ratio to see professional medical stockings or higher.
The price is higher than that of professional medical socks. Pay attention to avoid using the elastic sleeve which can only wrap the calf belly to treat the venous disease, it can aggravate the ankle vein stasis and more easily form ulcers.
(4) Airbag squeeze pump
It is an airbag type leggings that can be automatically inflated and deflated according to a set frequency, which can actively squeeze the muscles of the lower limbs and efficiently promote venous reflux by cyclic inflation and deflation. It can be used for the auxiliary treatment of refractory bruised ulcers.
2.Medication
The basic principle of drug therapy is to enhance venous tone, improve venous permeability and reduce exudation. The effect of medication can significantly relieve the symptoms caused by venous stasis and prevent complications to some extent, but it does not improve venous stasis itself. Although medications are an adjunctive treatment for varicose veins and cannot be expected to make varicose veins disappear, they are still a very important measure for patients with existing complications (e.g., swelling, pigmentation, dermatitis, thrombophlebitis, and ulcers). At present, the commonly used oral medications include mydriatic, diosmin, abortifacient, etc., and the topical medications include xylitol, heptaosaponin gel, etc.
3.Surgical treatment
The basic principle of varicose vein surgery is to remove or close the diseased veins, because the valves in these veins have been destroyed and the blood flows backwards, which not only fails to play the role of normal blood return, but also makes the blood returning through the normal veins flow backwards again through these diseased veins, forming a dead circulation locally. The classical method of surgical treatment is a high ligation of the saphenous vein (where it is the main reflux point), a trunk tap and stripping of the varicose branch veins. In recent years, a number of new methods have emerged, including laser, radiofrequency, microwave and sclerotic closure. The basic principle is to close the vein that would otherwise require surgical stripping by physical heat (laser, radiofrequency, microwave) or chemical (sclerosis) methods to block venous backflow and dead circulation.
(1) Vein high ligation + stripping
The basic procedure is performed by making a small incision at the root of the thigh, performing a high ligation of the saphenous vein (which is the most important reflux point), and then stripping the main saphenous vein and varicose branch veins. This procedure has been clinically tested for more than 100 years and is safe and reliable. In recent years, with the improvement of surgical skills and the application of minimally invasive techniques, in some specialized treatment units for venous diseases, the surgical incision can be made very small (about 2 cm in the inguinal area and about 3 mm in the rest of the body), the recovery is fast, and the postoperative hospital stay has been shortened from about a week to about a day. Improvements in technology have also reduced the complication rate of the procedure to almost zero and the cost is low, and the method is still the most commonly used for varicose veins in developed countries as well.
(2) Vein Closure (Laser, Radiofrequency, Microwave)
In recent years, there are many minimally invasive closure methods, such as laser, radiofrequency, microwave, etc. The basic principle is to close the main trunk of the saphenous vein by physical heat instead of surgical stripping, so as to block the backflow and dead circulation of the vein. Some of the varicose branch veins can also be closed by laser, but most of the branch veins still require surgical stripping. The advantages of this type of approach are relatively less invasive, smaller and less incision, better postoperative cosmetic results, and faster postoperative recovery. The disadvantage is that the diseased vein remains in place and there is a certain chance of recurrence of recanalization. In addition the nature of these methods is artificially induced phlebitis and some patients can have longer local pain after surgery not suitable for pigmentation. In addition, laser or radiofrequency closure has a certain probability of nerve and skin “burns”. Minimally invasive closure methods are relatively expensive and are mainly suitable for cases with mild lesions and particularly high cosmetic requirements.
(3) Sclerotic closure
Scleroclastic closure is to stop the venous reflux by injecting drugs into the diseased vein to destroy the vein lining and close it, (i.e., the advertised treatment of varicose veins without an incision). The principle is the same as laser and radiofrequency closure. Sclerotherapy has a history of several decades, but it was not widely carried out in large domestic hospitals in the past, because the sclerosing agent sodium ichthyate used in the past had strong corrosive properties, which easily caused skin pain, necrosis and other complications. In addition, the previous sclerotherapy only targets the varicose branch veins but not the saphenous vein trunk, and the root cause is not removed, so there is a high recurrence rate.
In recent years, a new type of sclerotherapy has been introduced and produced in China with milder effect, polyglaucine, which was historically used as a local anesthetic drug, and the injection rarely causes pain, rarely causes skin damage, and is safe to use. Sclerosing agent injection, if combined with high ligation of the saphenous vein and sclerotic occlusion of the main trunk, can achieve similar results as traditional surgery, and the recurrence rate is much lower than simply dealing with varicose branches, and even if recurrence can be resolved by simple supplemental injection. The disadvantage is that for thick diseased veins postoperative phlebitis can easily occur if compression is not good, so this method is not recommended for cases with very severe varicose veins. The advantages of scleroclastic closure are that it is less invasive, there is no incision in the visible part of the leg (only a small incision in the groin is possible), no semi-anesthesia is needed, and you can live normally the day after surgery. This is a good option for cases that are not particularly severe.
Also for very mild varicose veins, sclerotherapy injections are the only solution for cosmetic problems.