Focus: Superficial varicose veins of the 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, abdominal tumor, etc., all manifesting 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 the lower extremities, a clear 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 physical work.
Etiology.
(1) weakness of the vein wall.
(2) blood reflux due to venous valve insufficiency.
(3) elevated pressure in superficial veins, such as in pregnancy.
The main clinical manifestations are bulging, dilated and bent superficial veins, especially in the lower legs, even curled into a mass, soreness, swelling, weakness, swelling of the feet after prolonged standing, 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 diseases 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 treatments for the disease are.
(1) Palliative treatment.
For those who cannot tolerate surgery during pregnancy, early clinical manifestations of the disease, advanced age or poor general condition, the patient should take appropriate bed rest, elevate the affected limbs and avoid prolonged standing. 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 arteriosclerosis occlusive disease should use elastic stockings with caution, and elastic stockings should be worn during the day, and at night, the elastic stockings should be removed and sleep in a slightly elevated position of the lower limbs.
(2) Local sclerotherapy injection: 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 nerves and cause intractable pain in the limb, sclerotherapy leakage into the skin and subcutaneous fat necrosis and The formation of refractory 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 sclerotherapy in the treatment of appropriate patients, the efficacy of which remains to be observed.
(3) Topical drug treatment.
There are no topical drugs with definite efficacy for varicose veins of lower limbs.
(4) Surgical treatment.
High ligation and stripping of saphenous vein + point stripping of superficial varicose veins, this surgery is suitable for most patients with varicose veins, the surgery is performed by high ligation of saphenous vein and its branches in the inguinal area where the saphenous vein merges into the deep vein (femoral vein), the whole process of stripping the main trunk of saphenous vein, and point stripping of superficial varicose vein masses in the lower limbs, the treatment is complete and the recurrence rate is low.
Saphenous vein high ligation + stripping + deep vein valve repair is suitable for patients with deep vein valve insufficiency, which is not effective with high saphenous vein ligation + stripping alone, and the surgery is based on the original high ligation and stripping to repair the elongated and flaccid valve to restore its function of preventing venous backflow.
Saphenous vein high ligation + stripping + (laparoscopic) dissection of the penetrating vein is suitable for patients with valve insufficiency of the penetrating branch and persistent ulcers of the lower extremities even after high ligation and stripping alone;
(5) Endovenous laser treatment.
It is a minimally invasive treatment for saphenous varicose veins developed in recent years, which uses laser energy to produce blood bubbles in the lumen of the vein and transmits heat energy to the vessel wall in its unique way; 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, penetrating venous valve insufficiency of the lower extremity.
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.