Sunday, 3 November 2013


Varicose illness - is polyetiologic disease.The origins of this disease are genetic predisposition (it is handed down), hormonal influences (pregnancy, reception of female sex hormones), a sexual belonging (women is more often are ill), the constitution (people of high growth and heavy weight are more suffer), a racial belonging (it is uncharacteristic for black and yellow-skinned), features of a way of life and labor activity.
More often varicose meets at people which are compelled to stand more than four hours on end: cooks, hairdressers, surgeons, etc. Office workers and people who sit much are subject to risk-this group includes bookkeepers, programmers, journalists, secretaries, translators, workers of banks. Additional harm brings sitting « a leg on a leg» at which veins are pressed. Naturally, using the automobile still aggravates a situation. Special group of risk form by people, which in connection with their sort of works widely using public transport. Long stay in a sitting position in trains, planes, buses causes "a syndrome of an economy class ", because long sitting is causes a venous stagnation. Carrying  of a high heels is worsen the situation. The constant tension of shin muscles breaks correct blood circulation and leads to varicose.
At last, excess weight raises loading on legs and as consequence, also quite often causes varicose.
Varicose illness is a disease at which the wall of hypodermic veins loses the elasticity. As a result of it vessels are stretched, on their separate sites appears knotty dilations which have denominated this illness («varix» in Latin are formed means "node").
The first mentions of treatment varicose illness meet in papyruses of Ancient Egypt (about 3 thousand years ago). Varicose illness is inherent only for human.  The most part of circulating blood (60-70 %) of representatives of kind Homo sapiens in connection with vertical posture during active ability to live is below a level of heart. The walls of veins of lower limbs at vertical position of body experiences the great pressure from within (a hypertension in superficial and deep veins). "Return" of blood from the lower limbs is provided not only by heart, but also by contraction of  foot muscles , shin muscles (" the muscular pump ", " peripheral heart ") and the venous valves interfering a flux of venous blood in the opposite direction.
In an organism of the human similar changes of veins can be observed in any area, but  more often it is appears  at superficial veins of the lower limbs . According to mass inspections of the population varicose dilatation of veins of the lower limbs meets at 9-22 % of all surveyed, mainly at women in the age of 25-55 years.
The history of studying varicose illness as separate disease takes the beginning more 3 thousand years ago when in Ancient Egypt attempts of its treatment were undertaken. One of ancient descriptions of the patient suffering варикозной illness, is given in Plutarch ' Biographies' . It was Kie Marius, the Roman tyrant who was given out in hands of the surgeon for the sake of disposal of the big tumors on a shin. He has endured painful procedure on one leg with great self-control but when the surgeon has started  with other leg  the patient has refused operation on it and has told: ' I see, that healing does not cost to a pain '. Galen deleted varicose veins by the blunt hook, and put wine on ulcers, he was against an often change of bandages. The interesting approach to understanding of essence varicose illness and to its treatment states Avicenna in the book ' the Canon of a medical science '.' Dilatation of shin and foot veins occurs owing to an abundance of blood going down in them. The dilatation of veins more often happens at old men , walkers, porters, ; more often it happens, if it happens, after sharp illnesses because of which the matter rush to legs of people that predisposed to this disease  from among mentioned. Frequently the matter which is taking place in dilated veins, rots and conducts to ulcers. . In treatment of varicose illness first of all it is necessary  to correct a mode and to avoid all condensing, any tiresome movements and long standing. The patient must constantly drink cheese whey, completely abstains from movements and applies bandages on legs with which it bandage from below upwards, from foots up to a knee. Thus use also knitting ointments, it is especial under a bandage, and it is the best way to not rise and to not go to the patient differently, as with the tied up leg. Sometimes a vein extend outside and cut out absolutely, in that case it should be removed completely, differently it will harm.
How movement of blood in veins of the lower limbs is carried out, what factors participate in it? Blood from capillaries should in some way to move against force of gravitation in the direction of the right departments of  the heart. Decisions of this question at the orthograde person interesting and difficult, it is possible to tell, that it is not investigated to the end. There are some mechanisms due to which blood flows from the lower limbs.
Human spends a great part of time laying.  The gravity in this case does not prevent in promotion of blood. Flux of blood is carried out due to respiratory movements, existence of a constant tone of muscles of a venous wall, constant support of blood from the arterial end of a capillary channel, draw action of the right departments of heart. Pressure in a belly cavity raises at a breath, valves of femoral veins are closed, lower hollow vein is squeezed at a level of a diaphragm and pressure increased in veins that conducts to short-term stagnation of blood in them . During an expiration there is a return process, and blood directs in veins of a chest cavity. The mechanism of return of venous blood in vertical position much more difficultly. Certainly the same factors of return operate here again, but their influence very small.  Activity of muscular formations of the lower limbs gets the major important. All people are subject to unpleasant sensations of blood stagnation because of long motionless presence in vertical position. These sensations force us to shift from one foot to the other, forcing to work muscles of legs.
  Work of our veins - rather difficult process. The big role in venous outflow is played with muscles of a shin. Outflow of blood from a skin and hypodermic cellular tissue is carried out all over again in superficial veins. Then through perforating veins in deep venous system and from there goes to heart. Return of venous blood is promoted by venous valves which occur from a wall of a vein. In at closure of shutters of valves blood from overlying departments will not penetrate in underlying. At an exhalation valves of deep veins open also blood goes to heart. Valves of perforating  veins are closed, that interferes with hit of blood from deep venous system in superficial and to overflow of last. At a breath pressure in a belly cavity raises and valves of deep veins are closed. Below the valve negative pressure which promotes opening of valves of perforating veins and to outflow of blood from superficial venous system in deep that interferes with occurrence of stagnation is created. At insufficiency of perforating  valve blood from deep system will penetrate in superficial, causing overflow of hypodermic veins, extension of them, increase in diameter and owing to relative insufficiency of valves. Illness gradually progresses. In the subsequent expansion of a vein can develop in the field of its mouth, so-called sapheno-femoral anastomosis. After that blood will free penetrate from the deep vein system in the gleam of the big hypodermic vein, causing fast progression of varicose illness, venous stagnation. Treatment of pathological dump, or surgical, that is bandaging of it, or with the help of sclerotherapy. At introduction of foam in a gleam of vessel there is its narrowing and at use further an elastic compressions, closing of a gleam. Carrying further elastic a stocking or bandage leads to  normalization of venous outflow and valves become solvent. At expressed insufficiency in the field of sapheno-femoral anastomosis its bandaging is necessary . Thus sclerotherapy causes the termination of dump of blood, foam will not penetrate into healthy veins, provides their safety and participation in venous outflow which at closing pathological arches is normalized. Developments of stagnation completely disappear.

 So-called " the muscular-venous pomp " has basic role in promotion of blood in this case .  A shin played a leading role in work of a muscular-venous pomp.  There is a pushing out of blood from deep veins in the direction of heart because of contraction shin muscles in norm.  The underlying valve is closed at increase of pressure in a vessel, and overlying opens.  Pressure in deep veins is reduced up to zero after contraction of muscles, creating a positive gradient of pressure. During a relaxation of muscles venous vessels are filled by blood from underlying vessels and from superficial veins that in the following contraction  to push out its top again, but already only by the main vessels. Anyhow, as a result of the coordinated work of muscles and closing valves blood flows against a gravity to the right heart. Outflow  by hypodermic veins is carried out by means of their confluence at a level of a groin in a femoral vein, or through connecting perforating veins basically on a shin. Some scientists name a muscular file of a shin " peripheral heart ", confirming thus the basic role in venous outflow from the bottom limbs. At infringement of work of valves perforating veins, at occurrence of an obstacle in deep veins develops complex of symptoms -  chronic venous insufficiency. Venous blood is late in sine, small veins, that conducts to changes of parameters of a capillary exchange and development of hypostases, pigmentation, an itch and other attributes of heavy venous insufficiency.

The mechanism of  varicose  dilatation of veins

Valves in norm will consist of two shutters which are focused aside hearts. In the field of an attachment of the valve to a wall diameter of a wall is a little bit more. In norm at closure of shutters blood from overlying departments cannot penetrate in underlying. If it occurs, this condition refers to as a reflux. Valves in veins are distributed unequally. It is more than them there where work of the muscular pump is most expressed, that is on a shin.

On the basis of long studying varicose illnesses the majority of scientists came to belief about the hereditary, genetically determined character of disease. The reason of varicose dilatation of veins is hereditary weakness of their wall. Venous valves occur from walls of veins. Will consist in norm of their two shutters which are focused aside hearts. In the field of an attachment of the valve to a wall, diameter of a vein is a little bit more. In norm at closing of shutters of the valve blood from an overlying department cannot penetrate in underlying. Valves on veins are distributed unequally. If the valve by some reasons completely is not closed, blood moves upwards - downwards, than  happens venous stagnation and varicose dilatation of the veins, located below idle valve is caused. At varicose dilatation of veins there is a progressing insufficiency of below located venous valves and blood cannot  to move to the dilated vein in a direction to heart. There is its stagnation that is shown by hypostases, hyperpigmentation, trombophlebitises, and in the started cases trophic ulcers. All mechanism of venous outflow changes. In legs can be late up to 2,5 litres of blood. The pain becomes stronger also.

Classification of varicose illness:
By pathogenesis
Primary (at insufficiency of valves deep, communicative and superficial veins
Secondary (at a thrombosis deep or communicative veins, at congenital pathological arteriovenous fistulas - syndrome Parks-Webber-Rubashov).
On localization:
-in pool of the big hypodermic vein
-in pool of a small hypodermic vein
-varicose dilatation of veins of lateral surfaces of the bottom limbs
-associated defeats
On stages of frustration of blood circulation:
1. compensated (dilatation of veins without clinical attributes of frustration of blood circulation)
2. subcompensated (pains and passing hypostases)
3. decompensated' A'-constant swelling of shins, a pain, the hypostases, the expressed trophic frustration of a skin (infiltration, pigmentation, inflammation)
4. decompensated ' B '-in this stage there are trophic ulcers.
In the form of disease:
Descending (high veno-venous dump through sapheno-femoral anastomosis or through insolvent perforating veins , uniting big hypodermic and femoral veins).
Ascending (low veno-venous dump through insolvent perforating veins at a level of a shin or through a mouth of a small hypodermic vein prevails).
For an estimation of character and weight of displays of chronic venous insufficiency (CVI) in 1995 International classification (СЕАР) is accepted 

Clinical classification VIIB (Meeting of experts, Moscow, 2000)

The form of varicose illness:

I. Intracutaneous and segmental varicosity without pathological veno-venous dump.

II. Segmental varicosity with a reflux on superficial and-or  to perforating veins.

III. Widespread varicosity with a reflux on superficial and by perforating veins.

IV. Varicose dilation at presence of a reflux on deep veins.

Degrees of chronic venous insufficiency:
0 - is absent;
1 - a syndrome of " heavy legs";
2 - a passing hypostasis;
3 - a proof hypostasis,
4-hyper-or hypopigmentation, lipodermatosclerosis;
 5-healed venous ulcer
6-active venous trophic ulcer.

Clinical picture: the basic syndrome of varicose illness is chronic venous insufficiency of limb. Patients show complaints to presence of the varicose dilated veins, undue fatigability, weight in legs and hypostases in the field of an ankle joint, amplifying to the end of the working day. In a stage of indemnification can proceed without symptoms, in a stage of subcompensation of the complaint to changeable pains in the field of a shin, the passing hypostases arising at long standing and disappearing in horizontal position, in a stage of decompensation patients complain of constants heavy feeling, blunt pains in horizontal position, is especial during dream, quite often there are spasms in the muscles of shin, accompanying with short-term sharp pains, occurrence of trophic frustration is preceded frequently with a painful skin itch, mainly in the evenings. At gathering the anamnesis it is necessary to find out when and at what age first attributes of varicose dilatation of veins and what dynamics of occurrence of new dilatations of veins was have appeared. In such way find out the form of varicose illness (ascending or descending). Whether it is necessary to find out also was diseases of deep veins that could become the reason of dilatation of superficial veins. Among accompanying diseases frequently it is possible to reveal a lumbar osteochondrosis, flat-footedness (in 1 stage - 62 of %, in 2 stages - 87 of %, in 3 stages - 100 of %), infringements of activity of intestines as chronic locks at 60-70 % of patients. At gathering the hereditary anamnesis frequently reveal presence of varicose illness at close relatives.
At survey on character of varicose dilatation of veins can be judged localization insufficient communicative veins, by touching it is possible to estimate a condition of hypodermic veins, to define a blood-groove on a arteriovenous fistula and by auscultation to hear it. Similar symptoms meet at early stages of obliterating diseases of arteries, flat-footedness, the phenomena of a lumbar osteochondrosis. Diagnostics of varicose illness at presence of complaints and absence of attributes is carried out by means of retrograde phlebography where the initial degree of insufficiency of  the spinal valve of the big hypodermic vein comes to light, valves of deep veins of a hip and a shin. Dilatations of superficial veins meet at venous dysplasia and postthrombotic syndrome. Various kinds of angiodysplasia are distinguished on terms of their occurrence (usually at early children's age). Presence of artery-venous shunts leads to  the accelerated growth of the limb. The local skin temperature on a foot happens increased, on a skin of the limb frequently meet vascular a stain - capillary hemangioma. Dilatation of superficial veins at angiodysplasia occurs owing to shunting arterial blood in veins. For difference postthrombotic illness from varicose should resort to phlebography researches. Difficulty of recognition of postthrombotic illness consists that it frequently develops on a background varicose illness. Diagnostics facilitate anamnestic the data on the transferred thrombosis of deep veins which clinical displays are usually brightly expressed. At varicose illness on phlebography are determined dilatations of deep veins, but contours of them are equal, contrasting homogeneous. For postthrombotic illness are characteristic the widespread hypostases of the bottom limbs as most frequently there is a ileofemoral localization of occlusion deep veins. All attributes of infringements of venous outflow are more brightly expressed. Infiltration of hypodermic adipose tissue grasps considerably the big area on internal, and sometimes and an external surface of the bottom half of shin. The syndrome of the lower hollow vein, caused its local occlusion, can cause difficulties at diagnostics of varicose illness. Clinical displays of illness - moderate puffiness of distal departments of both bottom limbs dilatation of superficial veins, trophic changes of soft tissues same, as well as at varicose illness. For the benefit of a syndrome lower hollow vein testify simultaneous defeat of both limbs and approximately identical degree of decompensation venous outflow. Hyperpigmentation of integuments within the limits of the bottom half of shin meets after a bruise, hematomas, dermatitis, but absence of the basic attribute of varicos illness of the expanded veins excludes necessity of differential diagnostics.
In diagnostics of varicos illness great value have functional tests for an estimation of a condition of valve deep, perforant and superficial veins:
1. Test Brodey- Troyanovrendelenburg. In position of the patient laying lift researched limb for emptiness of superficial veins then area of a confluence of the big hypodermic vein of a hip press fingers and the patient passes in vertical position. Hypodermic veins all over again remain in a slept condition, however, in the subsequent 30 sec. are gradually filled with the blood acting from periphery. If immediately after the patient will rise on legs, to stop squeezing the big hypodermic vein varicously dilatated veins as return running pulse waves are filled by blood owing to insufficiency of valves.
4 variants of an estimation of results:
Positive (specifies insufficiency of valves of the big hypodermic vein at its fast filling).
Negative: superficial veins are quickly filled before elimination of squeezing the big hypodermic vein owing to an inconsistency of valves of perforant veins and filling of them does not increase at elimination of squeezing.
Double positive result: superficial veins are quickly filled before elimination of squeezing the big hypodermic vein, and after elimination of squeezing the pressure of walls of veins sharply grows.
Zero result: veins are filled slowly, and squeezing and elimination of the last on a degree and speed of this filling does not influence.
2. Symptom of Gakenbruch: at cough there is a formation of recurrent pulse waves in the basic trunk of the big hypodermic vein at insufficiency of the ostial  valve.
3. Test of Barrow - Scheinis: researched lays on a back, after the superficial veins is emptied in the lifted leg in this position on it impose three ropes, hypodermic veins squeezing only above oval fossa, above a knee joint, under a knee joint. Then the patient passes in vertical position. Fast swelling of units on any site of limbs specifies presence on the given piece of communicant veins with insufficient valves. Exact localization of perforant can be established, moving bottom rope.
4. Pratt's test allows to establish presence of insufficiency of valves of communicant veins and their level: in horizontal position of the patient lift researched limb and by vigorous stroking from periphery to the center empty hypodermic veins. Impose rubber bandage from the basis of fingers up to groin ligament for full squeezing only hypodermic veins. Then above bandage under oval fossa impose rubber rope for squeezing a hypodermic vein and elimination of a return flux on it. The patient passes in vertical position and investigating on one coil from above slowly removes rubber bandage as soon as between rope and bandage the interval in width in a palm opens, under rope apply the second rubber bandage which gradually twists finiteness from top to bottom is hardly imposed as the coil behind a coil is removed the first elastic bandage. Thus between bandage there should be an interval in 5-6 see., On which are marked by a solution of diamond greens filled varicos units (places of a confluence of communicant veins with insufficient valves. Such way surveys all finiteness.
5. " Mid-flight test " of Delbe-Pertes serves for definition of passableness of deep veins. In vertical position of the patient at as much as possible filled superficial veins on the bottom third of hip impose rubber rope or a cuff of a tonometer р=50-60 m.Hg. After that the patient is offered to move fast step during 5-10 minutes. At good passableness of deep veins, full value of their valves and valves of perforant veins the desertion of superficial veins occurs during one minute. If the filled superficial veins after "march" not went down, and, on the contrary, there is even more expressed pressure - that it testifies to impassability of deep veins.
Additional methods of research:
1. Phlebography is the most informative and objective method of research of varicos  illness. Phlebography can be made at intrabone, intravenous and even at intraarterial introduction of contrast. First of all stops are applied to studying passableness of deep veins of a shin and a hip, a condition of perforant and superficial veins ascending phlebography by means of a puncture of a back vein. Descending phlebography allows to reveal an inconsistency of valves femoral and big hypodermic veins. A contrast preparation enter in a femoral vein in groin areas through a thick needle at height of test of Valsalva. Vienna shins are contrasted by overskin punctures of a popliteal vein. Indications to phlebography:
Specification of localization and condition of valves in deep and superficial veins
Definition of character of pathological changes of deep veins and degrees of their passableness
Carrying out of differential diagnostics of diagnostics with postthrombotic illness and lymphostasis
Revealing atypical forms of varicos dilatation of superficial veins with presence of hemangyoms, or venous angiodysplasia
Revealing of postoperative relapses, and also attributes of disease without presence of varicos dilatation of superficial veins.
2. Haemodynamics methods of diagnostics
The basic
dopplerography (duplex scanning of veins)

-reovasography (a technique integrated reography bodies on Tischenko 1971)-pletysmography(venous occlusional pletysmography it is based on registration of change of volume of limb depending on fill of blood)
-phlebomanometery(vector phlebomanometery on Schvalbe determines a difference of pressure in each point depending on that measurement to a campaign or against a current of blood is made).

The earliest stages of development of varicos illness are difficult for diagnostics as there is no its basic attribute - varicos dilatation of superficial veins. Disease comes to light on the basis of the burdened family anamnesis and on constantly meeting undue fatiguability of finiteness, uncertain moderate painful sensations in shins when other reasons of such symptoms are absent.

Treatment of varicos illness.
There are two basic problems connected with varicos illness: cosmetic and functional. The basic external attribute of varicos illness is dilatationof hypodermic veins with formation of varicos units or fine intraskin vessels.
Conservative treatment is shown in the antenatal period, at refusal of the patient of operative treatment, at the local moderately expressed changes of hypodermic veins and at presence of serious contra-indications to operation. In these cases appoint carrying of elastic stocking, physiotherapy exercises, physiotherapeutic procedures and the medical products removing heavy feeling and pains and raising a tone of veins. The most effective means of conservative therapy are elastic bandages. The field of deservation of the varicously-dilatated veins is necessary to put on stockings the lifted limb, in the same position impose elastic bandage from finger-tips of foot.

The mechanism of action of an elastic compression at venous insufficiency:

1.  Squeezing intermuscular venous textures, superficial and perforant veins leads to to reduction of pathological venous "capacity" of the bottom limbs, and increase in pushing ability of a muscular-venous pomp.
2.  Reduction of diameter of a vein conducts to improvement of functioning concerning insufficient of valve and to increase of speed of venous return, reduction of viscosity of blood and decrease in risk of occurrence of a thrombosis.
3.  The increase in fabric pressure leads to to increase an absorb to an extracellular liquid in a venous knee of a capillary and conducts to recourse of a hypostasis.

 These actions can improve temporarily haemodynamics and to a certain extent interfere with fast progressing of pathological process. It is necessary to remember, that after 40 years at 90 % of women, with varicos dilatation of veins is present flat-footedness, thus correct selection of footwear, the basic requirements to which is important: a heel no more than 4 sm, steady, sole flexible, the footwear should be well nontight for air, at a boot and a boot presence of lacing is desirable to dose out a compression. High efficiency of zinc - gelatinous bandages for treatment varicos units was noted by B.V.Ognev in 1940г, but till now the method has not lost the value. The second old method of conservative therapy assumes the maximal stay of the patient in bed with raised position of limb
Complex conservative treatment

Complex conservative treatment of  VILL should include necessarily compression therapy by various kinds of bandages (bandage of a long, average, short extensibility) or medical jersey 1-4 compression a class depending on a stage of disease.

Medicamentous treatment includes:

•phlebotonics and angioprotectors(detralex, cyclo-3-fort); desagregations (prolonged pentoxyphylins, kurantil)
•antiphlogistic preparations (diclophenac sodium, nemisulides)

•preparations of local application (lioton 1000 gel, curiozin)
•anticoagulants (heparin, fraxiparin)

Principles of operative treatment of varicose  illness:
1. Operations on liquidation of veno-venous dumps.
Bandaging sapheno-femoral anastomosis
Bandaging popliteo-femoral anastomosis
-overfascial bandaging of perforated veins
-underfascial bandaging of perforated veins
2. Operations on liquidation of the varicose-changed superficial veins
-extraction of vein on probes (on Babcock)
-excision in parts (on Narat)
3. Liquidation of insufficiency of valves
-extravasal correction of valves by A.I.Vedenskogo's technique
4. Sclerosing and obturative methods of liquidation of a pathological current of blood - injection-sclerosing a method
-obturation of backcrural veins on A.I.Vedenskogo's method.
The postoperative period: the Active impellent mode already in the first days after operation (increase in duration of walking at 5-10 minutes in day), but loadings on an abdominal tension only in position on laying on a back.
To avoid water loading and locks. Anopirin 100 mg 1 time in day after meal. Elastic a compression within 6 months.

Modern methods of treatment of varicose illness:

Compressive sclerotherapy FOAM-FORM and sclerosurgical techniques in treatment of varicose illness
In 90th years has appeared and the new revolutionary method sclerotherapy with use of the foamy form sclerosing substances - Foam-Form began to develop. It in most cases is alternative to surgical treatment of varicose illnesses, not conceding it by results of. This method has received a wide circulation in the Western Europe. The combination of the minimal surgical influence and modern sclerotherapy guarantees successful treatment of varicose illnesses with the maximal comfort...

Technology Foam-Form sclerotherapy

Foam turns out directly ahead of carrying out of medical procedure. The volume of the received foam in some times exceeds initial volume of a preparation. At introduction in a vein foam fills in all volume, superseding blood, instead of mixs up with it. It allows to reduce a doze of a preparation, and to avoid undesirable collateral action. Foam is distributed to 10-20 sm from a place of an injection and only on changed (to the varicose-transformed veins). In healthy vessels foam is not distributed because of presence in them of valves. Right after introductions sclerosing foams there comes sharp narrowing varicose veins (spasm). After that it is put on special compressive a stocking which keeps varicose a vein in spasmodic a condition. In 3 days there comes pasting the varicose-expanded vein. Compressive  stocking is applied 4-6 more weeks, to formation of dense solderings.
Microsclerotherapy - so designate introduction of a preparation in the fineest veins, and " vascular asterisks ". Reticular varicose it is eliminated by introduction of microfoam on technology Foam-Form. Elimination of a venous grid should precede to microsclerotherapy " vascular asterisks ".

For removal of asterisks are used special catheters. After introduction of sclerosing  preparation the gleam of " a vascular asterisk " arises the specific reaction shown by reddening, a swelling of vessels. Low concentration of sclerosing preparations of 0,2 % a solution of fibrovain or 0,5 % a solution of ethoxysclerol are used.

The cosmetic effect is shown in 3-6 weeks. Application of microsclerotherapy, as a rule, leads to to full disappearance of a venous grid.

Results of sclerotherapy

Patient Ш. 44 years. Large varicose units on a hip and shins
Operative treatment (phlebectomy) from which she categorically was offered to the patient has refused. Taking into account the expressed venous insufficiency method Foam-Form of sclerotherapy under the control of ultrasound is offered. 
The image is absent

Large varicose veins on a hip and in the field of a knee. 04.11.2006
After 2 weeks after the ECHO - sclerotherapy of fibrovain.
Continuation follows

Patient З. 29 years Varicose illness
 Varicose illness has appeared after sorts since 26 years. At duplex scanning it is revealed the varicose expansion of inflow of big hypodermic vein (BHV) on a hip. Valves itself BHV are not changed. It is executed the ECHO - sclerotherapy by technology Foam-Form.  
The image is absent

Varicose units on a hip
In 2 weeks after the ECHO - sclerotherapy
Continuation follows

Patient Т. 31 year Varicose illness, chronic venous insufficiency
Age 31 year. Suffers by varicose expansion of veins from 16 years. In the last some months disturb weight in legs, hypostases by the evening, night spasmes in calfs. It is carried out the sclerotherapy Foam-Form under the control of ultrasonic duplex scanning. 
The image is absent

04.10.06 Varicose veins on a shin
Repeated survey in 2 weeks after treatment
Continuation follows

Patient L. 36 years Varicose illness
Has addressed in clinic with complaints to weight in legs, hypostases in the field of anklebones by the evening, on presence of varicose units on the left shin. Expansion of inflows of the big hypodermic vein on a shin, with formation of a conglomerate of varicose units is marked. Zones of pigmentation and inflammatory processes (dermatitis) in the bottom third of shin.

11.05.06 Varicose conglomerate on the left shin
25.05.06 In 2 weeks after FF sclerotherapy
18.07.06 A kind in 2 months after treatment

The patient in M. of 38 years Varicose illness
Weight in legs by the evening, night spasmes has addressed in clinic with complaints to presence of varicose expanded veins on the left hip and a shin. At survey it is marked the varicose expansion of a trunk of the big hypodermic vein to 1 sm from an average third of hip up to the top third of shin.

Trunc varicose before the echosclerotherapy bt fibrovain
In 2 weeks after procedure
Has passed 2 months after the sclerotherapy
Intravascular  laser obliteration of varicose veins

The essence of a method will consist in an irradiation of an internal surface of varicose veins a beam of the laser. Through a small puncture of a wall of a vein the special optical path through which the laser beam is carried out is entered...

For many years infra-red lasers (neodymium, carboxylic, holmium) are used in coagulation and are sharp soft fabrics. With occurrence of diode lasers with length of a wave 940 nanometers, became possible removal of the expanded venous vessels by lesser traumatic way.
Intravascular laser coagulation (IVLC) with the help of laser QuadroStar+940 - a modern method of treatment of varicose illness in which basis ability of hemoglobin selectively lays to absorb energy of laser radiation with the subsequent coagulation of a vascular wall.
The length of a wave of laser QuadroStar+940 lays in infra-red region of spectrum. This radiation will penetrate more deeply into a biofabric in comparison with green radiation that promotes deep coagulation of various types of a fabric.
The technique of treatment of varicose expansions of veins by this way is lesser traumatic and also is maximum safe for the patient. Under local anesthesia by a special needle the changed vein is pierced. Through a needle, under the control of the ultrasonic scanner, over a gleam of varicose veins the thin laser optical path is entered. In process of movement of an optical path in a cavity of a vessel the laser pulse, which coagulate a vessel moves.
After procedure on  leg it is put the compressive stocking, and the patient at once goes home.

Surgical treatment of varicose illness has more than hundred years, however, only last decade it began to meet the requirements of ambulance, painlessnesses and cosmetics. Modern lesser invasive technologies have radically changed the person of surgery of varicose illnesses and have made its more affable for patients.
Complications of varicose illness
Venous thromboses and thrombophlebitises


Thrombophlebitis - an inflammation of a venous wall with formation in a gleam of a vein of blood clots. As a rule, this term designate an inflammation of superficial, hypodermic veins. Very much frequently the thrombophlebitis develops on a background varicose illnesses and chronic venous insufficiency. Superficial thrombophlebitises at varicose are inclined to repeat, and as are capable to progress and cause heavy complications.
The basic complaints at a thrombophlebitis is condensation in the field of a vein, reddening and a pain. The body temperature sometimes raises. The thrombophlebitis is declined to migrate and will be distributed upwards and down, at times penetrating in deep veins. The thrombophlebitis dangerous disease and without correct treatment quite often leads to to complications (thromboembolism of pulmonary artery, a sepsis, a thrombosis of deep veins).
It is important to differentiate a thrombophlebitis from other diseases. It is the most difficult to distinguish a thrombophlebitis from an erysipelatous inflammation.

Treatment of a classical thrombophlebitis of the big hypodermic vein begins with conducting direct anticoagulants, not steroid anti-inflammatory means, the preparations improving venous outflow and rheological parameters of blood, ointment compresses locally and elastic bandagings of finiteness. As soon as proximal  site of hyperemia or infiltration reaches the border of the top and average third of hip, to the patient operation - bandaging of the big hypodermic vein at a level of sapheno-femoral anastomosis for preventive maintenance of thromboembolism of pulmonary artery. During such operation it is impossible to delete the thrombosed trunk and the varicose-expanded veins. In an organism process of an active inflammation proceeds, and the probability of purulent complications is very high, not speaking that in the sharp period will be impossible to achieve a cosmetic effect. The patients who have transferred bandaging of sapheno-femoral anastomosis concerning a sharp thrombophlebitis of the big hypodermic vein, are subject to phlebectomy through 2 - 3 mon, in the cold period for the prevention of repeated thrombophlebitises.
The concept submitted above about a level of distribution of the process demanding surgical intervention, has been reconsidered after introduction in practice of duplex scanning. Appeared, that frequently at visual and palpation estimation of height of a thrombosis on a hip as low, according to ultrasonic research there is a thrombosis of sapheno-femoral anastomosis or even floatable in the general femoral vein a blood clot. Now any patient with suspicion on a sharp thrombophlebitis of the big hypodermic vein should pass duplex scanning for definition of risk of development of thromboembolism of pulmonary artery. At an opportunity of distribution of a blood clot in deep venous system the volume of operation extends for audit of the general femoral vein. And operation is necessary for carrying out in conditions of statement of the time kava-filter.

Trophic ulcers
What is the venous trophic ulcer
Varicose illness, badly cured thromboses of deep veins in due course result in the second illness which refers to as chronic venous insufficiency. Outflow of blood from the bottom finitenesses that leads to to deterioration of a alimentation of tissues of legs is broken. If illness began with a thrombophlebitis of deep veins, occurs varicose secondary expansion of superficial veins, in the beginning it improves blood circulation a little, but then a alimentation of fabrics suffers even more.
Early attributes of chronic venous insufficiency are the feeling of weight and a pain in a sick leg or both legs which amplify at long walking or standing. Quite often disturb spasmes in calfs, especially at night. The leg starts to swell, in the beginning hypostases disappear at raised position of a leg, but then become constants. Fabrics of a leg in its bottom third because of constant hypostases become dense, change the color. Irrespective of the reason of venous insufficiency (varicose or postthrombophlebitic illness) in a basis of development of ulcers lays stagnation of venous blood, is especial in the lowermost sites of the bottom finitenesses. It is formed, figuratively speaking venous "bog" where blood practically does not move, however gives all oxygen, and receives from fabrics harmful waste products of ability to live of cells. Thus, fabrics not receiving a sufficient nutrition accumulate poisonous substances. The skin accepts brown or dark brown painting, there is a skin itch, the phenomena eczema and dermatitis. In result the slightest scratch does not heal, and starts to increase, turning to a trophic ulcer.
Long current (at times during many months and years) a trophic ulcer, inevitably leads to to development of varicose eczema. This is promoted by application of various "ultrafashionable" ointments, creams, gels. The skin in which there are developments of stagnation, is extremely sensitive to any local influences and allergens, therefore to be engaged in self-treatment at a trophic ulcer is fraught with heavy complications.
One of terrible complications of a trophic ulcer of the bottom finitenesses should be counted malignant regeneration which meets in 1,6 - 3,5 % of cases, but it is diagnosed quite often in far come stage. Attributes of regeneration of trophic ulcers are increase in a ulcer in sizes, aggravation of pain and burnings in a place of its arrangement, occurrence of elation of edges as a shaft, increase a quantity of secrete with a putrefactive smell.
Often relapses of an inflammation in the field of ulcers, long current of disease cause distribution of process deep into, involving in it hypodermic cellular tissue, muscles, sinews, and even bones. In due course these changes lead to to infringement of mobility and arthrosis of an ankle joint. In due time started treatment of a trophic ulcer and observance of a special medical mode in early stages of a ulcer leads to to its fast closing.

The trophic ulcer has some phases of current:

1.  Occurrence and progressing;
2.  Clarification (purulent separated);
3.  Scarrings or granulations;
4.  Epithelization - coverings a young skin.

Radical treatment of venous trophic ulcers

Treatment with use of sclerotherapy FOAM-FORM
Application of sclerotherapy, is especial under the control of ultrasound, helps "to stick" the basic pathological venous dumps and leads to to fast healing of a ulcer. Sclerotherapy it is possible to carry out not waiting closings of a trophic ulcer. Aim "pasting" of pathological dumps after the sclerotherapy leads to to fast clarification and closing trophic ulcers...

Surgical treatment
Surgical treatment of heavy venous insufficiency is expedient for carrying out after closing a trophic ulcer. In a basis of surgical operation elimination of principal causes of infringement trophism of a skin - high and low veno-venous dumps lays. In cases when long therapy does not lead to to closing of a ulcer, performance of surgical intervention with use videoimage-endoscopic or lesser invasive technical equipment is possible...

Skin plastic, it is applied after elimination of venous stagnation at huge trophic ulcers and promotes the fastest healing of the big skin defects. The international experience testifies, that at the overwhelming majority of patients after elimination of high and low veno-venous dumps trophic ulcers are reliably closed and not recur irrespective of their initial sizes.

Into a complex of treatment of a trophic ulcer necessarily enter:

Clarification of a trophic ulcer
It is necessary to provide clarification of a trophic ulcer from pus and microbes that is achieved by ointments with enzymes. In 7-10 days of such treatment, as a rule, the ulcer becomes pure, brightly red, starts to decrease. At this time ointments stimulating healing (such are applied as olasol, curosin, bandages with sea-buckthorn oil), are accepted preparations improving venous outflow (detralex, escusan etc.)...

Results of treatment of trophic ulcers

In this section results of treatment of venous trophic ulcers by method Foam-Form of sclerotherapy and lesser invasive surgical techniques are submitted. Results are submitted, as is. You can observe of dynamics in real time.

Huge trophic ulcer of the right shin
In 10 days after FF sclerotherapy the ulcer was cleared and executed skin plastic
Kind in 2 months after treatment - the ulcer has completely begun to live
Bleeding from varicose expanded vein

Treatment - imposing of a pressing bandage for 2-3 days.

Preventive maintenance of varicose illness
Drink enough of water.
- Do not suppose locks. Products with a plenty of cellulose should make the basic share of your diet.
- Exclude hot baths. Take a shower.
- Finish water procedures by douche of legs by cool water.
- Limit stay in conditions of heat and the increased humidity.
- Conduct an active way of life. Regular two-hour walks in comfortable rate - is excellent training for vessels. Are very useful aquaaerobics and navigation - employment in water prevent venous stagnation. And the power loadings are inadmissible.
- Carry convenient footwear on a heel not above 3-4 see.
- Carry the convenient specialized clothes. Too narrow trousers (even in the first trimester of pregnancy), stockings and linen with hard elastic bands complicate blood circulation.
- Do not stand and do not sit long - do not assign to legs superfluous static loading.
- Sit correctly - not stoop, do not cross a leg under a chair and do not put a leg on a leg;
- At all do not lift weight!
- Do not make epilation by wax and do not use an electrodepilator.
- Give legs a  rest periodically within day (or even in the evening), having put them on a pillow is higher than a level of heart. In such position 15-20 minutes are necessary to be approximately.
- Use external gels with vesseltonic effect. Your doctor will help to pick up a safe preparation.

If at you is though the slightest attribute of varicose expansions of veins or predisposition to this, it is necessary, not postponing to address in the clinic specializing on disease of veins to the doctor - phlebologist. In clinic " Center of Phlebology " the special program which allows pregnant women to be under constant supervision of the doctor in the beginning of pregnancy, before sorts and after them is developed. On consultations of phlebologist diagnostics is carried out, recommendations on preventive maintenance of varicose are given, is selected compressive jersey . If there will be a necessity for treatment you will begin it after sorts at the doctor who is already well familiar with your specific features.

1.  Duly professional support is very important. In fact any woman would like to carry by not simply pregnancy on healthy legs, but also to be beautiful after sorts.

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