Superficial varicose veins of lower extremities are common manifestations of venous system diseases, such as cardiac insufficiency, inferior vena cava stenosis or occlusion, Buga syndrome, iliac vein stenosis or occlusion, lower extremity deep vein valve insufficiency, deep vein thrombosis and its sequelae, large and small saphenous vein valve insufficiency, penetrating vein valve insufficiency, arteriovenous fistula, N vascular trapping syndrome, and abdominal tumor, all of which manifest as superficial varicose veins. Therefore, superficial varicose veins of the lower extremities are only a symptom, not a disease diagnosis. For patients with superficial varicose veins of lower extremities, a definite diagnosis should be made before choosing the appropriate treatment measures.
The majority of superficial varicose veins in the lower extremities are saphenous varicose veins (a few are small saphenous varicose veins or both small and large saphenous varicose veins), which are extremely common clinically, with about 25% of women and 15% of men worldwide suffering from these diseases, the onset of which is often associated with genetic factors and can be triggered by prolonged standing and heavy work.
Etiology.
1, weakness of the vein wall.
2, venous valve insufficiency leading to blood reflux.
3, elevated pressure in superficial veins, such as pregnancy.
The main clinical manifestations are bulging, dilated and bent superficial veins, especially in the lower legs, even curled into a ball, soreness, swelling, weakness, swelling of the feet after standing for a long time, brown pigmentation and eczema in the skin of the lower legs and ankles in the late stage. If the time is too long or improper treatment can lead to lower limb edema, local tissue hypoxia, causing skin keratinization, desquamation, minor trauma can lead to poor healing, delayed for a long time chronic ulcers, commonly known as “old rotten leg”. About 20-25% of lower limb venous disease combined with lower limb ulcer formation.
Since varicose veins of lower extremities are a common disease, there are a lot of propaganda and advertisements about the treatment methods of this disease in various newspapers and media, which are uneven, and doctors also make different suggestions due to different levels of understanding, which is difficult for patients to choose.
Choosing the right treatment for superficial varicose veins of lower limbs should be combined with different etiology, pathogenesis, clinical manifestations and general condition of the patient as well as treatment requirements.
The treatment methods of the disease are.
1. Palliative treatment.
It is suitable for those who cannot tolerate surgery during pregnancy, early clinical manifestations of the disease, advanced age or poor general condition, and patients should take appropriate bed rest, elevate the affected limbs and avoid standing for a long time. Medical elastic stockings (sequential decompression stockings) have good elasticity and binding force, which can reduce the superficial venous hypertension produced by muscle contraction during activity, together with appropriate medication to increase the elasticity of the venous wall and reduce exudation; however, patients with combined lower limb atherosclerosis occlusive disease should use elastic stockings with caution, and elastic stockings should be worn during the day, and removed at night and sleep in a slightly elevated position of the lower limbs.
2.Local sclerotherapy injection.
That is, the so-called “injection”, “injection therapy”, “liquid knife”, etc., is a non-cause-specific treatment, high recurrence rate, more complications (such as sclerotherapy allergy, loss of Peripheral nerve loss and intractable pain in the limb, leakage of sclerosing agent into the subcutis leading to skin and subcutaneous fat necrosis and formation of intractable ulcers, and even deep vein thrombosis), only as an adjuvant treatment for patients with mild local recurrence after surgery. At present, domestic vascular surgery scholars promote the use of new domestic foam sclerosing agent in the treatment of appropriate patients, the efficacy is yet to be observed.
3.Topical drug treatment.
At present, there is no topical drug with definite efficacy for varicose veins of lower limbs.
4.Surgical treatment.
(1) High saphenous vein ligation and stripping + spot stripping of superficial varicose veins: This surgery is suitable for most patients with varicose veins, and the surgery involves high ligation of the saphenous vein and its branches in the inguinal area where the saphenous vein merges into the deep vein (femoral vein), stripping the main trunk of the saphenous vein throughout, and spot stripping the superficial varicose vein masses in the lower extremities, which is a complete treatment with low recurrence rate.
(2) High saphenous vein ligation + stripping + deep vein valve repair: It is suitable for some patients with deep vein valve insufficiency, and the efficacy of simple high saphenous vein ligation + stripping is not good, so the surgery is based on the original high saphenous vein ligation and stripping, and the elongated and relaxed valve is repaired to restore its function of preventing venous blood backflow.
(3) Saphenous vein high ligation + stripping + (laparoscopic) penetrating vein dissection: for patients with penetrating branch valve insufficiency, who still have persistent lower limb ulcers after high ligation and stripping alone.
5. Endovenous laser treatment.
It is a minimally invasive treatment method for saphenous varicose veins developed in recent years, which uses laser energy to produce blood bubbles in the venous cavity and transmits heat energy to the vessel wall in its unique way, and the vessel wall fibrosis shrinks and closes, while the skin remains intact. The procedure is performed under local anesthesia and is minimally invasive with only tiny skin puncture points, resulting in a quick recovery and short hospital stay, but is only appropriate for some patients. However, there are complications such as nerve damage, skin damage, incomplete superficial vein closure, deep vein thrombosis, and phlebitis.
The diagnosis of chronic venous insufficiency (CVI) of lower limbs includes.
1, superficial varicose veins of the lower extremities.
2, lower extremity penetrating venous valve insufficiency.
3.Deep venous insufficiency of the lower extremity.
4.Whether combined with iliac vein stenosis or iliac vein compression syndrome.
5.Whether combined with inferior vena cava disease.
6.Whether combined with deep vein thrombosis and thrombosis sequelae.
7.Whether combined with lower limb arterial ischemic disease.
8.Whether combined with arteriovenous fistula.