What is the disease "varicose veins"?

Varicose veins of the lower limbs suffer about 40% of women and 20% of men. Veins are blood vessels that return blood to the heart. They have a very fine formations of venous wall, called venous valves that help blood to court to move only in one direction - from the periphery to the heart. Varicose veins occur when those infected venous valves. Then in the normal upright posture of man leads to stagnation or pendulum movement of venous blood into the affected vessel. Without adequate medical intervention leads to the onset of pain, feelings of tension, fatigue, appearance of swelling around the ankles and up, and later changes in the skin and subcutaneous, frequent inflammatory processes and the emergence of non-healing venous ulcers. The disease can be extended to the deep venous system (so-called "vein") and the occurrence of complications can be significantly impaired quality of life of affected by the disease. In already developed deep vein thrombosis, the condition can be life-threatening. Therefore the treatment of varicose veins should start as early.
If, after review and then angiologichen respectively ultrasound with Doppler apparatus. It was proven poor function of the venous valves you. This venous segment should be removed.

Principle of treatment with a laser probe

In the laser method (ELVeS = Endo Laser Vein System) leads to blockage (obliteration) of the great saphenous vein (Vena saphena magna) and the small saphenous vein (Vena saphena parva).
The light energy of the laser beam is absorbed by hemoglobin in the blood and is converted into heat. Thus the temperature inside the vein is increased to about 60-70 degrees Celsius. In the vein wall changes occur that lead to blood clotting in this section of the court. In other words - the vein is "sealed" by this temperature. Before this manipulation about extensions vein is injected with a fine needle dilute local anesthetic, which aims to completely obezboli treated area and secondly as a buffer to prevent thermal damage surrounding tissue.

Manner of manipulation

Laser treatment of varicose veins is an ambulatory method, but is done in a surgery room in strict compliance with the rules of aseptic and antiseptic. All supplies are off. It works with a kind of local anesthesia, so-called tumestsentna anesthesia. According to body weight and the length of the bed in the treated area around the vein under continuous ultrasound guidance is injected using one pump between 500 and 1500 ml of dilute local anesthetic - eg. lidocaine. This methodology has a significant advantage over general anesthesia because the patient (patient) remains flexible and thus reducing the risk of thrombosis of other vessels. This applies with even greater force for patients with underlying cardiovascular and asthmatic complaints, where general anesthesia is a very high risk.

Originally reviewed by an ultrasonic probe. Extended vein is marked on the skin. Where is the lowest point is inadequate, punctured with a needle (diameter 1.2 mm). Treatment with a laser probe as a rule this prick is the only place from which penetrates into the vein taka that this treatment scars. The needle is introduced in court thin catheter. After it carefully introduces thin laser fiber to the level of the groin. This whole process is controlled by a second doctor with ultrasound equipment.

Follows the introduction of the analgesic solution in bed around the vein. The end of the laser fiber associated with a laser generator that produces a laser beam having a wavelength of about 980 nanometers (that is, infrared rays). The surgeon begins to slowly withdraw the catheter with the laser fiber, the rate is about 3-5 seconds. centimeter. The speed is directly dependent on the size of the enlarged vein. The display of the device constant visual control of the operator the amount of energy introduced - an average of about 100 joules per linear centimeter. There are two methods of treating a varix laser fiber - with continuous slow download or certain pulses. Either way always leads to wrinkling of the venous wall and its blockage. Already dysfunctional vein without any problem can be left in the patient's limb and not having been uprooted as the traditional method - stripping. Activated by enzymatic processes it will be slow "decomposed" in the coming weeks and turned into connective tissue. At the request of the patients in the same procedure can be treated and the side branches of the main vein, and if they are extended. However, experience shows that in 60% of cases these side branches obliterating themselves through applications after the laser treatment outer elastic compression. If you still remain single node without any problem can be sclerosing method of foam sclerotherapy. Not a problem in patients with bilateral varicose be processed and both legs, but it is recommended to be at least one month during the time between the two procedures.

After the complete removal of the catheter and laser optics should impose external elastic compression and elastic medical bandage or medical elastic compression sock second class. It remains of the limb 5 days, after which it carries out only during the day. As prophylaxis against deep vein thrombosis besides physical activity, patients must five days in a row to make subcutaneous injections of low molecular weight heparin - one per day (that are prepared pharmaceutical forms).

After leaving the operating room, you will be preserved performance in the coming days. You will necessarily get a phone number for feedback to the operator, as well as instructions and recommendations for checkups - they are all free.

General recommendations

Laser treatment of varicose veins is fully ambulatory method. The patient stays in the hospital a few hours. After discharge is recommended to stay in the circle of his family or close friends for at least another 12 hours. In the first 24 hours after the operation should not move alone on the street, to drive himself to use public transport, and to work with dangerous machinery. These precautions are not associated with the manipulation of the vein, and with local anesthesia.

Possible side effects

After resolution of local anesthesia in the course of the vein may occur very weak pain in the next 10 hours, but they are temporary in nature. As a rule, around the treated vein receive minor bruising. They disappear by itself after about 10 days. More stubborn bruises remain for several weeks. Local cooling and heparin gels help their faster delivery. Some patients may be treated with laser fiber vein be palpated as hard and painful stretch, but this is very rare and resolved within two weeks. This is due to the progress aseptic inflammation, which is the purpose of healing manipulation. The application of non-steroidal anti-inflammatory ointments and cooling quickly normalize the condition. Some patients feel a wrinkle vein as a constant withdrawal limb, this is completely harmless and disappears 1 to 2 weeks after treatment. Globally, the possibility of failure of manipulation is below 1%.

Risks and possible complications

• Although responsible and careful treatment of the vein in the laser method may be some complications that require further attention:
• Infection - very rarely because they work under sterile conditions in surgical operating. Yet if any - is necessary antibiotics and topical medication by your doctor.
• Larger than usual bleeding which must be treated further including surgically.

In very rare cases, described the appearance of skin hardening (keloids), which are not desirable from a cosmetic point of view.

• There may be brownish along the treated vein to subside after a few months.
• Allergic reactions to local anesthetics also have been possible. They consist of itching, rash or other, which would require more serious treatment, but generally are extremely rare - casuistry.
• Abnormal skin sensations along the treated vein - tingling or numbness. As a rule violation that is transient in nature. Very rarely can be maintained for a longer period of time.
• Also very rare complication is the emergence limfostazi swelling of the treated limb, which requires prolonged use of the outer elastic compression.
• As with any intravenous manipulations and here the risk of deep vein thrombosis is large, if not can prevent. So after the laser treatment administered subcutaneously niskomolekularni heparins is required. A very rare side effect in heparin treatment HIT (heparin induced thrombocytopenia) leading to alarming hemorrhage.
• Complication, such as a jam of the laser fiber or a part thereof or a part of the catheter into the vein, it is also casuistry. If it happens, resorting to surgical removal.

Statistical dangerous complications (such as deep vein thrombosis, pulmonary embolism, severe infections) are extremely rare. They are mainly seen in patients with accompanying diabetes, overweight, or very neglected varicose veins. In comparison with the operating method - the stripping - these complications are significantly less frequent.

The reason for this is that treatment with the laser probe is extremely friendly method and that mobility of the patient is completely preserved.

Generally this treatment is performed in the operating room hirurgicheska but ambulatory. In the United States and in the European Union, the process is introduced by 1998, and thousands of patients are cured by the above-described manner. Statistical treatment of early and late results of this treatment gives a significant advantage over standard surgical treatment - stripping. Here are the most significant advantages:

• Cosmetic - the best possible result - there is only one puncture of a vein
• Many small bleeding
• Mobility of patients immediately after the procedure
• Lovely performance for the next days
• Ideal for all who do not want general anesthesia

Prophylaxis

• Move your feet at every opportunity. When your job requires prolonged sitting or standing upright, take short breaks, like walk or perform circular footwork. Moving the legs and short walks at regular intervals are necessary and on long journeys by car, train or plane.
• Select appropriate sports. Carried out regularly and with appropriate shoes, walking is the best exercise for facilitating the movement of blood in the veins. Exercise swimming, running, cycling, dancing. Sports such as tennis, handball and basketball are not recommended because they lead to a widening of the veins.
• Avoid prolonged exposure to heat because it causes enlargement of the veins. Therefore, prolonged sun exposure, use hot car mask, hot tubs and saunas should be avoided.
• Finish your evening with a cold shower toilet feet upwards. It improves venous function and reduces the feeling of pain and heaviness.
• Overcome constipation and reduce excess weight. Constipation and obesity cause increased venous pressure and can be prevented with a high fiber diet (fruits, vegetables, wholemeal bread) increased fluid intake (about 1.5 liters of water per day) and limited intake of fat, fatty meat, coffee, alcohol.
• Wear loose clothing. Too-tight pants, corsets, belts, etc. Compress the veins and prevent venous drainage.
• Choose shoes with appropriate height. Avoid Equal soles and heels higher than 5 cm. Try to wear shoes with a current between 3 and 5 cm.
• Sleep with legs raised high. Lifting them to a height of 10-15 cm during sleep reduces venous stasis, it favors the venous drainage to the heart.
• Massage your feet as often as possible. Start of feet and continue upward.
• If you feel pain, heaviness, swelling of the ankles or leg veins become visible, visit your GP to chronic venous disease can be diagnosed early and promptly will be offered preventive measures and treatment. Tell your doctor if you are pregnant or using hormonal therapy because in both cases venous symptoms may worsen.

Special exercises

Prone
1. Take vigorous movements with the legs while riding a bike (15-20 times).
2. Perform cross and uncross of lower limbs outstretched, like scissors (1015 times).
3. Describe small circles with straight legs (10 times)
4. Folding and unfolding the fingers of feet in slightly raised and stretched lower limbs (20 times).

In the upright position
5. Walk the fifth 30 seconds.
6. Lift on fingers (10-15 times).
7. Begin of the fifth fingers and back (10-15 times)
8. When collected dilute fifth aside and place the feet (10-15 times).