1.What is varicose vein?
Varicose veins are varicose and dilated veins caused by blood stagnation and weakness of the vein walls. Varicose veins can occur in many parts of the body, and the most common sites for varicose veins are the lower extremities, as well as the esophagogastric fundic veins, varicose veins of the spermatic cord, and varicose veins of the abdominal wall. It is worth emphasizing that varicose veins themselves may be secondary to other pathologies, such as vena cava occlusion. There are many causes of varicose veins in the lower extremities, the most common being simple superficial varicose veins of the lower extremities, which are mainly due to the insufficiency of the saphenous valves. Another important cause is primary deep vein insufficiency (PDVI), which is often combined with saphenous vein valve insufficiency and presents with tortuous dilatation of superficial veins. In addition, post thrombosis syndrome of lower limb deep vein, because of poor deep vein reflux, compensatory tortuous dilatation of superficial veins occurs; lower limb arteriovenous fistula, venous malformation bone hypertrophy syndrome can also have lower limb superficial varicose vein performance; lower vena cava reflux obstruction, such as Buga syndrome, can also lead to lower limb varicose veins.
2.Current domestic status of varicose veins?
At present, the incidence of varicose veins in lower extremities in China has accounted for about 5% of the total population in urban areas, and about 20% in rural areas. Based on such a high incidence rate, vascular surgery departments have sprung up all over the country in recent years. In addition to the traditional high ligation + stripping surgery, new treatment methods are emerging, such as sclerotherapy injection, laser occlusion, lumpectomy, etc. The treatment of varicose veins in the lower extremities has become the primary disease in vascular surgery clinics or wards around the country.
Vascular surgery all over China has adopted the above techniques in recent years and made great progress in the treatment of varicose veins. However, in an overview, there are still some problems in the treatment of varicose veins in China. Firstly, the selection of surgical style is a problem. There are many medical institutions that rely on the equipment they have rather than on the specific condition of the patient, or on a single surgical approach. Second, ignore the prevention of complications. Strictly speaking, varicose veins are the clinical manifestation of many kinds of diseases, and varicose veins themselves are not harmful to the body except for the aesthetic changes in the image, but some complications brought about by the long-term development of varicose veins, such as: thrombosis, ulcers, edema, etc., are the main factors that affect the patients’ daily life, so the main purpose of treating varicose veins is to prevent these complications. Thirdly, the therapeutic effect of drugs is exaggerated. At present, the only clinically proven effective drugs for varicose veins are the vein spirit and calcium hydroxybenzene sulfonate. Many of the advertised effects of traditional Chinese medicine and other ointments are inaccurate or the therapeutic effects are exaggerated. Even the above three drugs can only be used as adjuvant drugs in clinical practice and cannot replace surgery.
3.The people with high varicose veins:
(1)People who are engaged in heavy physical labor and standing for a long time: standing for a long time, poor venous reflux.
(2) People engaged in aquaculture or fishing operations: the veins of the lower limbs are susceptible to cold, vasoconstriction and poor venous return
(3) Pregnant women: the enlarged uterus compresses the iliac vein, and the venous return of the lower limbs is poor.
(4) obese people: increased abdominal pressure, poor venous reflux in the lower limbs.
4.The prevention of varicose veins:
(1) Long-term heavy labor and long-term standing work, it is best to wear elastic stockings, so that the superficial veins are in a state of compression.
(2) Women should give special care to their legs during menstruation and pregnancy and other special periods, take more rest and massage their legs frequently to help blood circulation and avoid varicose veins.
(3) Obese people should lose weight, although obesity is not the direct cause, but the excessive force pressed on the legs may cause poor venous reflux in the legs and aggravate the dilated veins.
5.Treatment of varicose veins in lower limbs:
(1) conservative treatment, for early, light symptoms, unwilling to surgery patients, can take conservative treatment
① oral medicine: pulse of the spirit, love pulse Lang calcium hydroxybenzene sulfonate
②Wearing elastic stockings: to put pressure on the veins of the lower extremities to improve the venous reflux of the lower extremities and prevent the progress of the disease.
③Intermittent inflatable pressure pump: The principle is to use several independent air bags to inflate the lower extremity pressure one by one according to the sequence from the bottom to the top, so as to promote the return of most of the venous blood or lymphatic fluid to the deep veins. It is suitable for chronic deep vein thrombosis sequelae, venous ulcers, and lymphedema of the lower extremities. It is the preferred conservative treatment for patients with severe varicose veins.
(4) Injection of sclerosing agent: local injection of sclerosing agent to sclerosis and occlusion of varicose veins.
(2) Surgical treatment: With the continuous development of vascular surgery technology, the understanding of varicose veins has been deepened, and the surgical methods have been innovated and improved, there are many types of varicose veins, and the condition is complicated, so we should choose the appropriate surgical plan according to the patient’s specific situation, and in many cases multiple methods can be combined.
①Traditional surgical treatment
High saphenous vein ligation with stripping is the classic procedure for the treatment of saphenous varicose veins, which continues today. This procedure includes ligation of the main trunk of the saphenous vein at the confluence of the saphenous vein, ligation of the superficial spinous vein, superficial abdominal wall vein, external pubic vein, medial femoral vein, and five major branches of the lateral femoral vein, stripping of the lower varicose saphenous vein, and venous ligation of the penetrating branches.
②Suture ligation method: a method using high ligation of the saphenous vein and suture ligation of varicose veins (including varicose veins in clusters) in a septum.
③Point stripping: Firstly, the saphenous vein and all its branches are ligated at the junction of the saphenous vein and the femoral vein, and the main trunk of the thigh is stripped, while the varicose lesions below are removed in a point-by-point method.
④Valvuloplasty
The principle is that the saphenous vein is formed into an inverted funnel by the annular contraction of the saphenous vein, and the backflow of blood from the femoral vein fills between the layers of the saphenous vein, so that the sinus layer, the outer wall of the sinus layer (outer wall of the saphenous vein) is vasodilated, and the inner wall of the saphenous vein is closed by the backflow of blood and the inverted funnel valve, which blocks the backflow of blood from the femoral vein.
⑤ Sclerosing agent injection This method is to inject sclerosing agent into the varicose vein, such as 5% cod liver oil sodium acid, phenol glycerol liquid, etc. to make the endothelial cells of the blood vessel occur aseptic inflammatory degeneration, the cells are wrinkled due to enzyme metabolic disorder, nutritional disorder, and finally replaced by fibrous connective tissue, the vein is fibrous occlusion, to achieve the purpose of varicose vein atrophy.
(6) Electrocoagulation
Electrocoagulation is the use of electrocoagulation to destroy the endothelium of varicose veins, assist local compression to occlude the tube, and then form thromboembolism and fibrosis to occlude the lumen, to achieve the purpose of eliminating varicose veins.
(7) Laser therapy: The treatment principle is similar to electrocoagulation, using laser to destroy the endothelium of varicose veins and local compression to occlude the lumen to achieve the treatment effect.
(8) Lumpectomy: For those with more traffic branches and heavier liposclerosis in the lower limbs, lumpectomy can be used to dissect the traffic veins.
⑨ Interventional treatment: for varicose veins caused by iliac vein stenosis, spermatic vein reflux, etc., interventional treatment should be performed to release the primary disease.