VARICOSE VEINS
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.
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- Troyanov-Тrendelenburg. 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)
Additional
-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)
-termography
-polarography
-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.
Diet
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...
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.
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
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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.
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Large varicose veins on a hip and
in the field of a knee. 04.11.2006
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After 2 weeks after the ECHO -
sclerotherapy of fibrovain.
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Continuation follows
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Patient З. 29 years
Varicose illness
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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.
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Varicose units on a hip
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In 2 weeks after the ECHO -
sclerotherapy
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Continuation follows
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Patient Т. 31 year
Varicose illness, chronic venous insufficiency
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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.
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The image is absent
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04.10.06 Varicose veins on a shin
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Repeated survey in 2 weeks after
treatment
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Continuation follows
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Patient L. 36 years Varicose illness
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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.
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11.05.06 Varicose conglomerate on
the left shin
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25.05.06 In 2 weeks after FF
sclerotherapy
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18.07.06 A kind in 2 months after
treatment
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The patient in M. of 38 years Varicose illness
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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.
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Trunc varicose before the
echosclerotherapy bt fibrovain
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In 2 weeks after procedure
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Has passed 2 months after the
sclerotherapy
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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.
After procedure on leg it is put the compressive stocking, and the patient at once goes home.
Miniphlebectomy
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...
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...
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.)...
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.
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Huge trophic ulcer of the right
shin
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In 10 days after FF sclerotherapy the
ulcer was cleared and executed skin plastic
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Kind in 2 months after treatment -
the ulcer has completely begun to live
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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.
