Minimally invasive interventional treatment of varicose veins in the lower extremities – Foam sclerosis
With the progress and development of society and the improvement of people’s demand for quality of life, the disease of varicose veins in lower extremities is getting more and more attention. What method of treatment can obtain satisfactory clinical recovery and at the same time achieve minimally invasive, economic, safe and cosmetic efficacy has been paid much attention by many experts and scholars.
The etiology and pathogenesis of varicose veins in the lower extremities are complex, mainly related to weakness of the vein wall, venous valve insufficiency or congenital defects, and elevated pressure in superficial veins. In recent years, a large number of studies have also demonstrated the importance of genetic influences and genetic factors in varicose veins of the lower extremities. Triggering factors for varicose veins in the lower extremities include prolonged standing, heavy physical labor, pregnancy, chronic cough, and habitual constipation.
Varicose veins of lower limbs can cause a series of clinical symptoms, such as soreness, swelling and heaviness in the lower limbs in the mild cases, and as the disease progresses, it can cause itching and pigmentation of the skin in the sock area, which can seriously affect the beauty of the skin, and even the local formation of untreated venous ulcers, commonly known as “old rotten legs”, which seriously affects the quality of life of patients. There are more treatment methods about varicose veins of lower extremities, at present, there are three main aspects about varicose vein treatment of lower extremities at home and abroad.
1) Non-surgical treatment is mainly applicable to those who have mild symptoms, pregnancy and cannot tolerate surgery. The principle of treatment is to remove the triggering factors of varicose veins in lower extremities, such as reducing labor intensity, shortening standing time, keeping bowel movement smooth, etc., and then wearing medical type elastic stockings, which can generally improve the symptoms to some extent.
2) Surgical treatment is the traditional surgical treatment of high ligation or/and vein stripping of the saphenous vein. This method has been used for almost 100 years and its efficacy is confirmed. In recent years, surgical punctal stripping has also achieved some success, but in the end, some patients may be afraid of surgery or may not be physically able to tolerate surgery because of the anesthesia and trauma, the obvious postoperative pain and the long recovery period, the obvious surgical scars and the aesthetic impact. Moreover, there is a certain recurrence rate of saphenous vein ligation and vein stripping, and the recurrence rate of a single saphenous vein ligation is higher.
3) Minimally invasive treatment
In recent years, there are more methods of minimally invasive treatment of varicose veins, mainly as follows: transilluminated direct vision vein rotation, endovenous laser closure, endovenous radiofrequency closure lumpectomy traffic branch surgery, endovascular sclerotherapy, subcutaneous continuous suturing of varicose vein masses, electrocoagulation treatment. Among them, endovascular sclerotherapy as an effective method of minimally invasive treatment of varicose veins has been widely used in clinical practice, and its efficacy can be comparable to traditional surgery, and to some extent even better than surgery.
Endovascular sclerotherapy for varicose veins is the injection of sclerosing agent into varicose veins, so that the vein lining is chemically stimulated to produce sterile inflammation, fibrous tissue proliferation, endothelial injury with varying degrees of thrombosis, thrombus mechanization, and eventually replaced by fibrous tissue, narrowing the lumen, fibrous tissue contraction so that the vein lumen adhesion, occlusion or embolism. This reduces or eliminates the pressure in the vein, relieves the cause of weakness of the vein wall and elevated venous pressure in varicose veins, and achieves the purpose of treatment.
Endovascular sclerotherapy injections use two types of sclerosing agents, liquid or foam preparations, depending on the site of the varicose vein to be treated and the extent of the lesion. The indications for liquid and foam sclerotherapy of varicose veins are wide, and the diameter of varicose veins that can be successfully treated is roughly 3mm~15mm. In recent years, foam sclerotherapy of varicose veins of lower extremities has made rapid development in China and internationally. The advantages of foam sclerotherapy for varicose veins of lower extremities are: minimally invasive, cosmetic; economic, safe; easy to operate.
Foam sclerotherapy of varicose veins of the lower extremities can be performed on patients with unobstructed deep veins, no history of deep vein thrombosis and no tendency of thrombosis, no serious local infection, no serious arterial disease and patients who can get out of bed.
The specific treatment procedure is short, simple and has a quick recovery. The entire procedure is performed without anesthesia, and the varicose vein is punctured directly under the guidance of a large DSA device, just like a normal intravenous infusion. After the treatment is completed, the needle is removed and the varicose vein is wrapped with a cotton pad and elastic bandage for 24 hours, after which a medical type elastic stocking is worn for more than 6 weeks. The treated varicose veins can be completely occluded, the symptoms of soreness and swelling of the lower limbs and itching of the skin can disappear, and the local pigmentation of the skin can improve or even disappear, which is conducive to the healing of venous ulcers and obviously improves the quality of life.
Slight pain and streak-like sensation at the sclerotherapy site and local pigmentation may occur after the operation, and generally these conditions will disappear on their own within a short period of time, or disappear after simple treatment.
With the interplay and penetration of various disciplines, foam sclerotherapy can also be combined with multiple methods of treatment according to the needs of the patient’s condition (location of varicose veins, diameter, patient’s physique, etc.), which can achieve more satisfactory results to a certain extent.
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Figure 1 The varicose veins of the lower extremities were visible before the patient’s treatment, and the patient’s varicose veins of the lower extremities disappeared completely with only a small amount of pigmentation visible at the follow-up 1 month after the foam sclerotherapy, see Figure 2.
Figure 3 Foam sclerotherapy performed by direct puncture of the main trunk of the saphenous vein with an intravenous indwelling needle under X-ray guidance to eliminate varicose veins caused by increased pressure from the main trunk vein, with negative shadowing of the foam sclerosing agent in the lumen of the vein, see Figure 4.