Varicose veins in the lower extremities is not strictly speaking an exact name of the disease. It is a clinical manifestation, a symptomatic descriptive diagnosis. A variety of diseases can cause varicose veins in the lower extremities, such as: lower extremity deep vein valve insufficiency, sequelae of deep vein thrombosis, Buga’s syndrome, inferior vena cava obstruction syndrome, congenital venous malformation bone hypertrophy syndrome (KTS), and iliac vein compression syndrome. The most common simple varicose veins of the lower extremities are mostly genetically related, and many patients have a family history. Most patients do not consider varicose veins in the lower extremities as a disease because they are not painful, not itchy, and at most somewhat unsightly. Some even go untreated throughout their lives without causing any complications. However, some patients may develop itchy skin, eczema, ulcers, or even redness, subcutaneous hard nodes, blood clots, or wounds that do not heal due to trauma, insect bites, and other triggers, or bleeding after trauma. This part of patients should then consider consulting or actively treating, or even having surgery. Of course, some young female patients also choose surgical treatment, especially minimally invasive surgery, for “beautiful legs”.
There is a lot of information available about varicose vein treatment methods and it is often difficult for patients to make the right choice. Broadly speaking, varicose vein treatment methods can be categorized into three main categories: physical therapy, medication and surgery.
1.Physical treatment
The most fundamental reason for the occurrence 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 disease in the lower extremities. The specific methods include: elevating the limb, elastic bandage wrapping, wearing elastic stockings, etc.
(1) Elevating the lower limb is simple and easy, and the effect is indeed the most basic treatment for all lower limb venous diseases, which is applicable to all patients with lower limb 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 elevate the lower limb after lying down to ensure that the lower limb is higher than the heart in order to promote the effect of venous blood return by gravity. Generally, if the condition is serious (such as combined ulcers, thrombophlebitis or swelling is serious), bed rest is possible.
(2) Elastic bandage to promote venous reflux has a long history, the efficacy is true, traditionally marching long distances will use this method. However, as professional medical elastic stockings are widely used, 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) The elastic stocking is one of the biggest advances in the prevention and treatment of lower limb venous disease in recent decades. The basic principle is the same as that of elastic bandage, which is to promote venous blood return by squeezing and prevent blood stagnation in the veins of lower limbs. Compared to elastic bandages, the advantages are ease of use and aesthetics, and the gradient of pressure from top to bottom in medical compression stockings, which is more conducive to promoting venous reflux.
The main disadvantage of compression stockings is that they are still expensive, generally more than 400 yuan for the treatment type. There are also a lot of cheaper compression stockings on the market, but their pressure often does not meet the requirements, and it is easy to relax for a long time and not effective, from the letter to price ratio of professional medical stockings is still 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.
2.Medication
The basic principle of medication 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 an important measure for patients with existing complications (e.g., swelling, pigmentation, dermatitis, thrombophlebitis, and ulcers). The commonly used oral medications include Mizorin, Destructor, etc., and topical medications include Xylitol, 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 does not play the role of normal blood return, but also causes the blood returning through the normal veins to flow backwards again through these diseased veins, forming a dead circulation locally. The classic method of surgical treatment is a high ligation of the saphenous vein (which is the main point of reflux), trunk stripping and stripping of the varicose branch veins. In recent years, a number of new methods have emerged, including laser, radiofrequency and sclerotic closure, the basic principle of which is to close the vein that would otherwise require surgical stripping by physical heat (laser, radiofrequency) or chemical (sclerosis) methods to block venous reflux and dead circulation.
(1) High ligation + stripping of veins
The basic procedure is performed by making a small incision at the base of the thigh, performing a high ligation of the saphenous vein (which is the main point of reflux), and then stripping the main saphenous vein and the 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 groin area and about 5 mm in the rest of the body), with a quick recovery and a postoperative hospital stay of about one week. Improvements in technology have also reduced the complication rate of this procedure to almost zero and at a lower cost, and this method is still the most commonly used method for varicose veins in developed countries as well.
(2) Vein closure (laser, radiofrequency)
In recent years, many minimally invasive closure methods have emerged, such as laser, radiofrequency, etc. The basic principle is to close the main trunk of the saphenous vein that was originally surgically ablated by physical heat, so as to block venous backflow and dead circulation. 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 a longer period of local pain and discomfort and pigmentation after surgery. 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 has strong corrosive properties, which easily causes skin pain, necrosis and other complications. In addition, the previous sclerotherapy only targets the varicose branch veins but not the saphenous vein trunk, which does not remove the root cause of the disease and therefore has a high recurrence rate. In recent years, a new type of sclerotherapy has been introduced and produced in China with milder effects, polyglaucine, which was historically used as a local anesthetic drug and rarely causes pain and skin damage when injected, making it 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.
My advice is.
1, if you have varicose veins in the lower limbs, you must go to a regular hospital and choose whether to treat or not and whether to operate after the cause of the disease is clear. Don’t make a decision blindly to avoid misdiagnosis and mistreatment, which will bring you unnecessary pain and loss.
2.Wearing medical elastic stockings is helpful to reduce the fatigue, soreness and heaviness of lower limbs caused by varicose veins, and beneficial to delay the development of the disease, which can be tried.
3, sclerotherapy of varicose veins in the lower limbs is not suitable for all patients, to listen to the advice of vascular surgeons, do not listen to the “no drugs, no surgery” can cure varicose veins fancy.
4.Laser or radiofrequency, many advanced devices and techniques have their own scope of application and cannot be a “cure for all diseases”. The “individualized treatment plan” formulated for your condition is the best and most suitable method for you.
Summary.
Varicose veins are not a major problem.
To find the cause, you need to see a doctor.
If you are biased, it will cost you money and add to the problem.
The decision to operate or not to operate should be made carefully.