Treatment of varicose veins with laser: advantages, peculiarities of carrying out, subsequent treatment



One of the main symptoms of varicose veins of the lower extremities is the appearance of a highly visible vascular pattern on the skin of the legs. In addition to the aesthetic problem of this disease is dangerous and other manifestations. This is a constant pain during long walking, running, performing physical exertion or just a long stay in an upright position.

In addition, in elderly patients, this pathology often becomes the cause of thrombophlebitis, followed by the formation of blood clots. Through the venous system, blood clots can enter the lungs and cause a deadly syndrome - pulmonary thromboembolism.



Treatment of varicose veins with a laser (also called a similar technique endovasal laser coagulation, or in abbreviated form , EVLK ) is a new radical technology of surgical intervention that allows to get rid of the external manifestations of the disease and prevents the development of relapse. Phlebologists are still arguing about the causes of varicose veins.

Some experts associate this pathology of blood vessels with excessively intense physical exertion, overweight, and professional activity associated with prolonged standing. In women, the manifestation of varicose veins can trigger pregnancy. Genetically predetermined factors play a significant role.

The pathogenesis of the disease is associated with a disorder in the functioning of the valves of the venous bed, which provide normal active blood circulation. At the initial stage of the pathology, the venous outflow slows down. As a result, the rheological properties of blood change, which affects the structure of the vascular endothelium. Leukocytes “react” to the course of such processes, which rush to the lesion, stimulating the release of inflammatory mediators.

As a result, the shape of venous valves changes, the vessel wall thickens, and stagnation progresses. Part of the venous blood enters the bloodstream of the subcutaneous tissue, causing overdistension of small capillaries. This leads to the appearance of a venous pattern, "stars", and in the later stages of the disease - and nodes on the surface of the skin.

The main objective of the treatment of varicose veins is to block reflux - reflux of venous blood into the saphenous veins. In addition, it is necessary to remove the modified vessels that can not cope with its main task - the movement of venous blood towards the heart. Moreover, the achievement of a cosmetic effect is a secondary task.

The main thing is to “turn off” the pathologically developed veins from the systemic bloodstream, which provoke congestion, chronic venous insufficiency and varicotrombophlebitis. The treatment regimen for varicose veins of the lower extremities and the possible amount of surgical intervention is determined individually for each patient depending on the severity of the pathology, concomitant diseases and a number of other factors.

The main indications for laser surgery of the affected vessels are:

• high risk of trophic ulceration;
• external and general symptoms of varicose veins, regardless of their degree;
• pathological expansion and modification of the venous vessels;
• high probability of blood clots and the development of venous insufficiency.

 

Treatment of varicose veins with a laser has several advantages over other methods of invasive therapy:

• no incision is required, a vein is punctured under local anesthesia, and the position of the light guide is controlled by an ultrasound scanner;
• the almost complete absence of discomfort and pain;
• the procedure can be performed simultaneously on both legs;
• working capacity remains;
• there is no need for a long stay in the clinic;
• no traces of manipulation remain on the skin;
• minimal risk of undesirable consequences in comparison with open operation on vessels;
• short duration of the procedure, it rarely lasts longer than 1.5 hours.

The essence of this method of treatment of varicose veins with a laser is as follows. Using a special needle, a fiber is inserted into the vein to generate laser radiation pulses. This energy is absorbed by hemoglobin, resulting in the destruction of red blood cells.

In addition, vapor bubbles are formed, the temperature of which is close to 100ºС (in physics, this effect is called vaporization). Under the influence of these factors, the endothelial membrane of the vein is destroyed, which contributes, roughly speaking, to gluing. Also in the area of ​​production of laser radiation quickly formed a dense thrombus, which closes the lumen of the vein.

Previously, for the correction of varicose veins used devices that produce laser radiation with a wavelength of 940-980 nm. However, such impulses are more absorbed by the hemoglobin of the red blood cells, having a small effect on the vascular wall. Currently used devices that produce radiation with a wavelength of 1460 nm.

For manipulation, a radially emitting fiber is usually used, which contributes to a larger area of ​​laser radiation and less heating of the catheter tip. Regulation of power and exposure parameters occurs with the help of a sensor, and the device is turned on using a button located on the sterile part of the catheter.

The EVLK procedure itself takes place in several stages:

1. Ultrasonic marking of varicose veins.
2. Installation of the fiber under the control of ultrasound.
3. Anesthesia (this procedure is also called the formation of a protective coupling). When the doctor makes sure that the light guide is inserted correctly, a solution of novocaine, which surrounds the venous vessel from all sides and prevents the damage of neighboring tissues by the laser thermal radiation, is injected into the area of ​​laser irradiation.
4. Immediate coagulation of the pathological vessel. The parameters of laser radiation are selected depending on the diameter of the treated vein and the severity of varicose veins.
5. If necessary, smaller vessels are additionally removed using pulses of electric current (this technique is called radiofrequency ablation or obliteration), punctures, or the introduction of a medicinal solution that promotes adhesion of vessel walls.
6. Elastic compression. At the place of introduction of the fiber have a small gauze or cotton ball, which is pressed compression underwear.

The advantage of laser varicose vein treatment is not only a quick and pronounced result, but also a short rehabilitation period.

On average, the EVLC procedure lasts from 60 to 90 minutes, after which the patient can go home and return to an almost normal lifestyle. Hypodynamia is contraindicated - on the contrary, the patient is recommended to move as much as possible, to make long walks. The only restriction is the prohibition of carrying weights.

Laser treatment of varicose veins: contraindications, possible complications, cost and reviews

There is no doubt that this method of getting rid of varicose veins has several advantages, the main of which is safety.

However, this method of treatment of the disease has certain contraindications, it is:

• circulatory pathology;
• increased blood clotting;
• the specific structure of the vessels, preventing the introduction and proper placement of the fiber;
• the diameter of the diseased vein is greater than 10 mm, which adversely affects the final result of laser therapy;
• acute infectious diseases;
• exacerbations of chronic pathologies;
• increased body temperature;
• sedentary lifestyle of the patient (for health reasons or other reasons);
• lower limb ischemia;
• severe cardiovascular lesions occurring with hypertension, tachycardia.

The vast majority of patients suffer EVLK well and return to their normal lifestyle immediately after the procedure. Of the “advantages”, a quick result is noted - most of the symptoms disappear after 7-14 days.

But in some cases may occur:

• low-grade fever, which is associated with the systemic response of the body to the performance of manipulation;
• hematoma and slight swelling in the area of ​​the introduction of the fiber;
• slight discomfort in the area of ​​the main veins of the lower extremities, aggravated by movement;
• bruises along the laser-treated veins;
• the appearance of areas of impaired pigmentation.

The result, which brought the laser treatment of varicose veins, is controlled in several stages. The first visit to the doctor is planned 14 days after the EVLK session.

The doctor conducts an external examination of the extremities and makes an ultrasound with Doppler. In the absence of symptoms of complications, the patient is given appropriate recommendations and allowed to go home. The next consultation is prescribed in six months, and the last - in 12 months.

If during this period there are no signs of relapse, laser treatment of varicose veins is considered successful. The cost of the procedure depends on the complexity of the manipulation and the amount of work. The price varies between $ 200 and $ 650, sometimes it includes preliminary and follow-up observation by a phlebologist, diagnostic examinations.

Reviews

Irina, 45 years old. “Varicose veins appeared in the last months of pregnancy. I thought that after giving birth everything would return to normal, but this did not happen. The disease continued and pain was added to the ugly veins on the legs, a constant feeling of heaviness. At the end of the day, I literally could not move. I was terribly afraid of the operation, the pills and ointments did not help. Laser treatment of blood vessels has become a real salvation. More than a year has passed, and I forgot to think about my varicosity. ”

Korneev Andrei Stepanovich, phlebologist. “I have been treating varicose veins for many years. Previously used surgical methods of therapy often caused recurrences, were poorly tolerated by patients, were accompanied by a long period of rehabilitation. The spread of laser treatment allowed to solve almost all these problems. The procedure is quick, does not require serious general anesthesia. The patient leaves the clinic almost immediately, and there have not yet been any cases of relapse or complications in my practice. ”

Laser treatment of varicose veins in comparison with other methods of therapy

Alternative methods of surgical treatment of varicose veins of the lower extremities are:

• Phlebectomy. This is a traditional surgical intervention, which is carried out to remove the affected vessel. The disadvantages of the procedure include invasiveness, long-term recovery, the need for serious pain relief, a high risk of complications. The indication for this kind of surgery is the lack of effectiveness and the impossibility of conducting minimally invasive interventions.
• Stripping During this manipulation, the affected segment of the vein is removed using a thin probe.
• Cryostriping The destruction of the pathological vessel is due to the action of low temperatures.
• Microflebectomy. This method is designed to remove vessels of small diameter and length through small punctures on the skin surface.

Laser treatment of varicose veins entered clinical practice only in 2000. However, the data available to date allow us to conclude that this method is significantly superior to other methods of varicose vein therapy in terms of efficacy, safety and cosmetic results. But unfortunately, it is not applicable in the later stages of the disease, so the doctor should be consulted when the first symptoms of pathology appear.