Laser treatment of varicose veins - what is it, stages, prevention

laser vein removal

Varicose veins of the lower extremities are pathologies characterized by varicose veins, the formation of nodules. This is one of the very common diseases. Despite the active development of methods for treating varicose veins in our time, the increase in the number of people suffering from the disease is alarming.

The increase in the number of clinics with this pathology is due to the fact that many people are malnourished (passion for fast foods with fast carbohydrates and small amounts of plant fiber), with hormonal problems underlying thyroid dysfunction. , adrenal glands in the background of unfavorable environmental conditions.

healthy and diseased veins

Also very oftenvaricose veins occur during pregnancy, for persons who are forced to stand permanently due to the nature of their profession (risk group - hairdressers, salesmen).

In women, varicose veins can develop in the background of the stresses that are unusual for them when they play sports, such as lifting weights.

It is better not to delay the fight against varicose veins. And one of the most advanced treatments is laser treatment of veins.

Laser treatment of veins. Which?

Laser vein treatment is a minimally invasive treatment method. It is effective in overcoming dilated veins and trophic ulcers in the legs.

During laser treatment of veins, modern surgeons usually meanendovascular laser coagulation or obliteration (EVLK, EVLO), ablation. The point is that coagulation, obliteration, ablation are one and the same in medical practice. With the help of special devices, the reflux of blood in the perforating (i. e. connecting the superficial and deep blood vessels) and superficial veins is stopped, and then physically, due to the heat energy, blood leaves the veins.

Terminological aspects!

Turning to the terms, the word "cancellation" means closure, "ablation" - destruction, "coagulation" - coagulation. Saythese are different parts of the complex that combine the processes that occur in the veins of the patient during treatment.

But in practice, this is how the surgeon works with a laser, the procedure is often called "coagulation, " and the terms "obliteration, " "ablation, " are often used to treat the veins in radio frequency. In this case, a device with a radio frequency generator is used instead. there is no clear "connection" to the laser or radio frequency equipment for each of these terms. Therefore, patients planning laser venous treatment in different clinics may come across different names in the procedure.

  • Endogenous laser coagulation (EVLK).
  • Endovascular laser ablation (EVLA).
  • Endovenous laser thermal ablation.
  • Laser heat ablation.

Mechanism of removal of laser veins

The laser works from the inside through the lumen of the vein. The essence of the process is to create a completely controlled wall burn. "Boil", "seal" and then begin resorption, i. e. the process of removing the veins is gentle.

laser vein removal mechanism

EVLT can be used alone or in complex operationsin combination with sclerotherapy or miniphlebectomy.

In the first case, some of the veins are "precisely closed, some are glued together with a special preparation, in the second case, in addition to the seal, some of the veins are immediately pulled out with a hook and succeed.

Laser removal of veins helps save the patient from venous stagnation, trophic disorders, and edema.

The mechanism of use of the laser is based on the fact that with a targeted and effective effect on the venous wall, the surrounding tissues are virtually unheated.

This provides patients with the following benefits:

  • Surgery can be performed on an outpatient basis, no hospital care is required (unless the pathology is highly advanced and microflebectomy is required), and it is easy to perform without an incision, and no surgical intervention is required.
  • You can get back to your normal lifestyle quickly.
  • There are quite a few contraindications (we’ll talk about them below).

What veins can be removed with a laser?

Unfortunately, not all veins can be removed with a laser. Conservative surgery (scalpel) is used at an advanced stage and with certain anatomical features.

But which vein can be operated on with a laser?

It is important to pay attention to the specifics of the course of the vein.The laser only removes veins in a linear fashion. If the vessel is anatomically highly tortuous, it is difficult to predict how the laser beam will pass, and the main condition for successful completion of the procedure — taking over the artificial burning area — cannot be ensured.

As for the type of veins that respond well to laser treatment, thenThese include:

  • Big saphena is worth it.
  • Small saphenous vein.
  • Additional saphenous veins at least 5 mm deep from the skin surface;
  • Incompetent perforating veins (i. e. , veins with severely damaged venous outflow, most commonly the veins of the foot).

Indications and contraindications for EVLT

indications and contraindications of EVLK

The only indication for EVLK is varicose veins. Only EVLT can be used for the surgical treatment of open trophic ulcers.

What is typical of 1-4. stage varicose veins?

  1. Varicose veins.
  2. Venous malformations (arteriovenous malformations). Fistulas, abnormal fistulas between veins and arteries. They may be invisible to the eye and can only be detected by microscopic examination. Combines venous and lymphatic problems directly. Causes severe pain.

Contraindications

Unfortunately, laser venous treatment has contraindications:

  • Ischemic manifestations in the legsin the background of obliterative diseases of the peripheral arteries (chronic ischemia) and acute ischemia of the lower extremities. Most commonly in patients with atherosclerosis. Laser removal of the veins may be ineffective in this case. This is due to the fact that the need for compression cannot be avoided after treatment and is at the root of ischemia - a serious risk for the latter to progress.
  • Breast-feeding. The risks are associated with an increase in hormone production in women who are breast-feeding. Experts recommend that you wait for breastfeeding to stop and then use laser treatment.
  • Pregnancy.
  • Oncological diseases.
  • Any pathology in the acute stage. How critical a particular exacerbation is in a given case is determined by the physician, taking into account the disease and the individual characteristics of the patient.
  • occlusion of the arteriesblood clots.
  • Impossibility of maintaining real estate and an active imagethe patient's life after surgery.
  • Inflammatory process in the upcoming surgical areainterventions (except for chronic trophic ulcers). Inflammation can lead to the spread of infection and then sepsis during surgery.

Stages of endovenous laser coagulation

Section 1. Medical examination, consultation

It is important that these are not only performed by a surgeon but also by a surgeonvascular surgeon, phlebologist. The phlebologist is most familiar with the characteristics of the anatomy of the lower extremities, the physiology of venous outflow, the pathogenesis of venous transformation of the veins, and the peculiarities of the condition of the valves at different stages of varicose veins.

Phlebologists are purposefully trained in methods for treating abnormal reflux in the veins. These physicians are the most competent in making decisions about the treatment of vascular disorders.Phlebologists, not just "general" surgeonsThey also give the most complete recommendations for recovery.

Section 2. Diagnostics. Analyzes and functional testing

What does the preoperative examination contain?

  • Functional tests. There are several types: perforation of perforating veins, valve failure, condition analysis, deep vein permeability.
  • Blood test. Haematological examination, general and biochemical blood tests (detailed) The doctor pays special attention to the following aspects: whether the patient has latent inflammatory processes based on the results of the analysis, glucose levels, sugar provokes the progression of their infection), D-dimer levels (this indicator is directly related to assessing the risk of blood clots), APTT - thromboplastin time (although this is a minimally invasive procedure, this indicator is important for the surgeon when manipulating veins). As with other vein surgeries, Rh factor and blood type are determined, HIV test, RW (syphilis), HB (hepatitis B), HCV (hepatitis C) are performed.
  • General urine analysis. It is important to rule out hidden pathologies that could adversely affect the overall outcome.
  • Electrocardiogram. If necessary, cardiac ultrasound. Unfortunately, when someone has problems with the veins in their legs, the heart often doesn’t work properly. It is both part of the cardiovascular system. Therefore, it is extremely important for the doctor to assess the condition of the heart.
  • For women - gynecological examination. In some cases, varicose veins in the perineum, vulva, and varicose veins develop in the background of the syndrome of venous plurality of pelvic organs.
  • Ultrasound of veins and arteries(with duplex) One of the basic tests, the results of which are used in treatment. The structure and diameter of the veins and arteries and the speed of blood circulation are important to the doctor. Both the treatment and rehabilitation regimen depend on the ultrasound image. It is a complete picture of the blood vessels and arteries that will help develop a competent package of measures to prevent the risks to a given patient.

Because people with varicose veins often have comorbidities, ultrasound diagnosis of the abdominal cavity and pelvic organs is also often prescribed.

Section 3. Preparation the day before surgery and the day of surgery

  1. Depilation of legs the previous day.
  2. The patient can eat the day before surgerylight breakfast. If a person is taking any medication, it is usually not deleted. But it is important to discuss this with your doctor. Especially if the side effects of the drug are bleeding.
  3. Take it to the clinic with youcompression stockings.
  4. Vein marking. A special surgical marker is used to mark the vein. contains gentian dye, dries quickly. Most markers used in surgery have bactericidal properties. They draw the full projection of the vein. Marking is performed under ultrasound control. The result of the perforation reset depends on how professionally the marking is performed. The professionalism of marking also influences aesthetics. The emphasis is not only on medical but also on cosmetic outcomes. It is important that manipulations are performed strictly in the area of localization of defective, pathologically affected vessels.
  5. Dark anesthesia. Cold local anesthetic solution is used. An anesthetic "coupling" occurs near the vein.
  6. Thrust.
  7. Inserting a light guide into a vein.
  8. EVLO directly. The doctor turns on the device and activates the light guide. The laser radiation turns on and the light guide travels along the vein.
  9. Create a compression. After the procedure, a compression bandage is used (special rollers are attached to the vein, compression stockings to the foot).

If only laser removal is performed, each manipulation takes about 40 minutes.

When laser treatment is combined with a miniflebectomy, the treatment time increases: some short sections of the veins are removed by a thin puncture. The combination of laser treatment and microflebectomy is an excellent opportunity to achieve remarkable aesthetic results for very large varicose veins.

If it is important to supplement laser treatment with sclerotherapy, a number of special medications are injected into a vein. This combination of surgical techniques is relevant for telangiectasia (pronounced expansion of small blood vessels), reticular varicose veins ("vascular network").

Section 4. Restorative

At this stage, the most important thing is to wear compression stockings, to prevent relapses.

It is important to know the possible complications before planning laser treatment.

Complications

They are cosmetic and more global.

complications of varicose veins

Minor complications

  • Pain. Many patients do not feel pain immediately after the procedure, but after 5-6 dayspain 5-6 after medical manipulations. on the sun. This usually happens when patients ignore the rules of physical activity and immediately switch to an active lifestyle, or in the background of other pathologies.
  • Seals.It can be formed in the area of the tributaries of the "soldered" vein. The seals are not aesthetic and cause mental discomfort, however, if you immediately take control of the seals,in a month and a half the problem can be easily remedied. To do this, doctors set the compression scheme in this zone. With properly selected compression stockings, the seals will dissolve.
  • Pigmentation.It occurs during the resorption of a vein. The problem does not occur in all patients unless the vein is close to the skin. In this case, no special treatment is required.After a while, the skin regains its natural tone in most cases.. If this does not happen, the pigmentation is removed by cosmetic methods. Sufficiently extensive areas of pigmentation may occur in patients with seals along the "soldered vein. "In this case, they can become "provocateurs" of hyperpigmentation.
  • Decreased leg mobility.The appearance of a "string feeling". There is no pain, but when the leg is stretched, it seems that a string of rope has been tied to it, and this interferes with the usual actions in the usual "mode".A few weeks after laser coagulation, the discomfort disappearsalone.
  • Edema. More often - in the ankle, in the leg. As with seals, the problem can be effectively solved by correcting and replacing the wear pattern of the compression stocking.
  • Subcutaneous haemorrhages (hematomas).If you use absorbable gels, you can forget about bruises in a few weeks.

Great complications

  • Inflammatory processes in tissues.In severe cases, medication may be needed. But more often, the problem is solved by changing the way you wear compression stockings.
  • Phlebitise of tributaries.There is a lot of tension in the legs. The skin will be very red (usually streaked). The skin temperature rises locally. Phlebitis -a rare complication of minimally invasive procedures, but if stated, ultrasound dopplerography, angioscanning, blood sampling is recommended. Based on these results, the doctor decides what medications (anti-inflammatory drugs, blood thinners) to prescribe to the patient, whether physiotherapy is needed, and changes the compression garment to narrower or less skin. Everything is defined in one complex, but at the same time quite individually.

Prevention of complications

Patients should wear compression stockings. Usually two pairs of knitwear provide the best effect. The tightest - immediately after the procedure and knit - with less pressure to maintain the effect of the treatment.

prevention of varicose veins

When choosing a compression stocking, it is important to consider not only brand awareness, but also two conditions:

Compression stockings must comply with the RAL standard. In this case, the products are carefully analyzed and evaluated for compaction level, pressure distribution.

The assessment of the optimal level of compression should only be performed by a physician. Choosing a compression stocking on your own and prescribing one or another compression level is a huge mistake that is fraught with pain and squeezing. In self-assessment, the patient often relies on subjective feelings (some stockings are narrower, others less tight). But only a doctor can objectively assess which anatomical incision and which compression is optimal for a particular patient.

If you need to work dynamically or statically, but only in a stationary position,after coagulation of the veins, it is important to avoid heavy loading, they often change the position of their legs during the day.

They give a correction for fitness and sports. The best form of exercise is swimming and walking. Alternating walking around the heel and toes is helpful.

But stretching is what can cause the most damage for the first time after the procedure. It is also worth refraining from jumping and running - especially with acceleration and weight training.