”Varicose veins” as a common “disease”, because of the high incidence and a wide range of treatment, the majority of patients are often very confused in the consultation, where to see? How to treat? Should it be conservative or surgical? What kind of surgery should be used? Many problems, often difficult to decide at one time, we will sort out the treatment methods of “varicose veins” today, how to choose the most appropriate treatment method.
I. Where to go to see a doctor?
”Varicose veins” belong to the venous system diseases, which are classified as peripheral vascular surgery diseases, so you should go to the peripheral vascular surgery department of the regular hospital for consultation.
Second, how to treat? Conservative or surgery?
As mentioned in the previous article, “varicose vein” can be a disease, but more as a manifestation of the disease, the fundamental pathophysiological basis is venous hypertension, which not only leads to varicose vein, but also can have limb acidity, sleepiness, sinking, swelling, skin itching, skin pigmentation, hard sclerosis, and even skin ulceration. .
Conservative treatment as a basic treatment cannot completely eradicate the varicose veins and cannot make the skin pigmentation disappear, but it can counteract the venous hypertension, counteract the pathological changes caused by venous hypertension, control the symptoms, control the progression of the disease and improve the signs to some extent.
If the patient has only a few varicose veins, a certain degree of limb discomfort, no skin pigmentation changes, not in the aesthetic problems caused by varicose veins, it is perfectly possible to choose conservative treatment, if the patient cares a lot about varicose veins and wants to remove them, or if the limb symptoms are not effective by conservative treatment, or if the skin of the limb already has pigmentation changes, then surgery should be chosen.
In addition, conservative treatment is used as a basic treatment throughout the surgical treatment.
Conservative treatment includes 3 aspects.
1. Body position.
The root cause of the disease is venous hypertension, venous hypertension from the pressure difference between the heart and the limb, reduce the pressure difference, the venous pressure is reduced, the disease can be controlled, if the patient has been lying down, or “upside down”, the disease will be cured, but this is not realistic, so what can be done is to try to avoid sedentary, standing, as much as possible to elevate the limb, including day and The only thing you can do is to avoid prolonged sitting and standing, and elevate your limbs as much as possible, both during the day and night.
2. Physical compression.
Including medical elastic stockings and elastic straps, physical compression can not reduce venous hypertension, but it can reduce the fluid leakage caused by venous hypertension, counteract the conduction of venous hypertension to the surface, and protect superficial veins and traffic veins. This can reduce the symptoms, improve the signs, and stop or slow down the development of the disease.
3.Drugs.
Medication to increase venous tone, promote venous reflux drugs, contraindicated diuretics.
These 3 aspects cooperate with each other, one is indispensable.
Third, choose what kind of surgery.
Venogram must be done before varicose vein surgery to clarify the patency of deep veins and the nature of the disease.
1.Simple saphenous varicose vein, if there is no problem with the deep veins.
Traditional surgery: high ligation of saphenous vein and varicose vein stripping, emphasizing “high ligation”, “branch ligation” and “varicose vein stripping”
Minimally invasive approach: laser surgery, emphasizing the selection of the appropriate laser frequency and pulse intensity for the size of the vein diameter.
Rotational surgery: emphasizes low speed, high negative pressure, small trauma, fast recovery, small and few incisions; disadvantage is slightly more expensive than traditional surgery.
2, deep vein thrombosis sequelae (PTS) this type of disease in different periods of the disease, different degrees of thrombus absorption, different degrees of patency of the deep veins, the adequacy of the collateral circulation compensation or not, the presence of combined iliac vein occlusion, its treatment is different, this article will not be expanded, later will be written specifically to describe.
In principle, deep vein valve function reconstruction is performed first, and then varicose vein stripping is performed, and varicose vein stripping is performed in the same way as simple saphenous varicose vein. Deep vein valve function reconstruction is commonly used in clinical practice: superficial femoral vein flap surgery (also known as ring ring surgery), which is performed outside the first pair of valves of superficial femoral vein by narrowing the vessels to 2/3 of their original size with autologous or artificial materials, so as to reconstruct the function of superficial femoral vein valves, which is suitable for patients with good quality of the first pair of valves of superficial femoral vein and relative incomplete closure caused by dilatation of the vein wall. Another surgical procedure we recommend is the N vein muscle collaterals, which is performed by suturing our own tendons to form “U” muscle collaterals, which play a role in replacing the valve function during limb movement, with strong and long-lasting effects.
4, iliac vein stenosis or occlusion, Buga syndrome and other conditions, such diseases varicose veins are not only limited to the lower extremities, can involve the inguinal region, lower abdomen, and even the upper abdomen, this varicose veins should first deal with venous occlusion and stenosis, in the form of surgery and intervention, and then deal with varicose veins.
The above information is provided for understanding, but it is difficult for the patients themselves to grasp it, so it is recommended that the specific treatment should be agreed with the specialist in the peripheral vascular surgery department of the regular hospital.