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.
Etiologies include.
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 curved superficial veins in lower limbs especially in calves, even curled into clusters, soreness and swelling, weakness, swollen feet after standing for a long time, brown pigmentation and eczema in the skin of calves and ankles in 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 treatment methods of the disease are.
1.Palliative treatment: It is suitable for those who are pregnant, have mild clinical manifestations in the early stage of the disease, are too old or have poor general condition to tolerate surgery, and the patients should take proper bed rest, elevate the affected limbs and avoid standing for a long time. Medical elastic stockings have good elasticity and binding force, which can reduce the superficial venous hypertension produced by muscle contraction during activity, with appropriate medication to increase the elasticity of the vein 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 the elastic stockings should be 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 means, high recurrence rate, more complications ( Such as sclerotherapy allergy, loss of peripheral nerves and cause intractable pain in the limbs, sclerotherapy leakage into the subcutaneous lead to skin and subcutaneous fat necrosis and the formation of refractory ulcers, and even cause deep vein thrombosis), only as an adjuvant treatment for patients with mild local recurrence after surgery.
3.Topical drug treatment: There is no topical drug with definite effect on varicose veins of lower limbs.
4.Surgical treatment.
Saphenous vein high ligation + superficial varicose vein spot stripping, this surgery is suitable for most patients with varicose veins.
Saphenous vein high ligation + stripping + deep vein valve repair is suitable for some patients with deep vein valve insufficiency, which is not effective with high saphenous vein ligation + stripping alone.
Saphenous vein high ligation + stripping + (laparoscopic) ligation and dissection of the penetrating branch is suitable for patients with insufficiency of the valve of the penetrating branch and those who still have persistent ulcers in the lower limbs after high ligation and stripping alone;
5.Minimally invasive treatment: It is the minimally invasive treatment method of saphenous varicose vein developed in recent years, such as laser, radiofrequency electrocoagulation, etc. It is very traumatic, with only tiny skin puncture points, fast recovery and short hospitalization time, but it is only suitable for some patients.
The diagnosis of chronic venous insufficiency 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.