Myths about varicose veins. Myth 4: varicose veins can only be cured with injections

Beginning of a cycle of articles about varicose veins:
Myths about varicose veins. Myth 1: it will pass
Myths about varicose veins. Myth 2: you can coexist with varicose veins all your life
Myths about varicose veins. Myth 3: varicose veins can be cured only surgically
Myths about varicose veins. Myth 3: Varicose veins can only be cured surgically (continued)

In two previous articles, we considered the methods of treating varicose veins at the initial stage and at the stage when changes in blood vessels begin to appear on the surface of the legs. In this article, we will dwell in more detail on the method of sclerotherapy in the treatment of varicose veins at the stage when patients notice the appearance of large veins on the legs.

Sclerotherapy is an effective treatment for varicose veins

Unfortunately, until now, no method has been invented to cure varicose veins once and for all. This disease is genetically determined, that is, with a hereditary tendency to "weakness" of veins, to a greater extent - veins of the lower extremities. Modern ideas about this disease force us to treat it like any other chronic disease, the same as coronary heart disease, hypertension, peptic ulcer disease, periodontitis, arthrosis, osteochondrosis, etc. Varicose veins require constant monitoring by a specialist, periodic courses of treatment. There is a period of exacerbation, when the doctor conducts an examination and diagnosis to clarify the nature of the lesion and selects the most effective treatment method for the given moment. Indeed, the most effective methods of treating varicose veins are surgical - sclerotherapy and various operations.

Sclerotherapy is as old a method as compression therapy. In recent years, there have been drastic changes in the approaches and rules for performing this procedure, a new generation of safe sclerosants has appeared, the old ones have been modernized, and high-tech new methods and technologies of sclerotherapy have been developed. This was facilitated by the development of modern ultrasound equipment, which allows diagnosing vein damage in the early stages and using various types of sclerotherapy effectively and safely.

Who is indicated for the sclerotherapy method?

This method is used at the stage of the disease, when the patient notices already quite large, dilated, varicose veins on the legs. When contacting a phlebologist, a patient with varicose veins will be required to undergo an ultrasound examination of the veins, which will provide absolutely accurate information about the form and stage of the disease, as well as allow choosing the most effective method of treatment individually. If this examination does not reveal damage to the main (main) superficial veins, the phlebologist will suggest sclerotherapy.

How is sclerotherapy performed?

At the moment, several varieties of this procedure are widely used, which allow in various situations to effectively treat affected veins without surgical interventions. The drugs (sclerosants) used for this procedure are absolutely safe for the body, they act only on the wall of the vein at the injection site, they are not absorbed anywhere and do not affect anything else. Qualified phlebologists use only modern, safe and extremely effective sclerosants of the new generation in their work.

Sclerotherapy is performed on an outpatient basis, the procedure is practically painless, it is performed with very thin needles, and the injection feels like a mosquito bite. Several sessions may be required, the breaks between them are selected individually. Sclerotherapy, regardless of the type, is always compression, that is, after the procedure, a bandage made of an elastic bandage or a compression stocking must be applied to the leg. The period of such compression is individual depending on the type of sclerotherapy. The side effects of such treatment are insignificant, unexpressed, superficial in nature, and complications are very rare and few. There are certain rules for performing the procedure, such as the specifics of the drug used in one or another situation, the mode of compression therapy, and the method of performing it in certain situations. Therefore, the patient always needs to find out all the subtleties of the future procedure from the specialist, which will confirm his competence and level of training, as well as provide the patient with the desired result.

Types of sclerotherapy:

So, at the moment, the following types of sclerotherapy are known:

1. Microsclerotherapy – used for the treatment of small skin vessels and capillaries. Often, auxiliary devices, magnification and additional visualization are used to perform the procedure. It can be performed both with a liquid sclerosant and with a foam form of the drug.
2. Foam sclerotherapy is a treatment method in which the drug is transformed from liquid into microfoam. This form of sclerosant is more effective, as it displaces blood from the vessel and allows the maximum effect on the vein wall, as well as the use of lower concentrations of drugs, which dramatically reduces the likelihood and severity of side effects. This type of sclerotherapy is preferred in most cases.
3. Echo-sclerotherapy is a sclerotherapy performed under ultrasound control, most often used to "glue" perforating (connecting superficial and deep) veins, which are the cause of the expansion of superficial veins. This procedure is also performed on an outpatient basis, but it uses different needles and may require local anesthesia. In addition, this procedure is carried out exclusively with a foam form of sclerosants and with visual control by ultrasound. Such a procedure is more complicated, requiring certain skills and professional qualifications, quite delicate, sometimes filigree. It can lead to the development of serious complications, so it is important for the patient to inquire about the experience of the specialist who performs the procedure. The specialist must choose the drug and its concentration as accurately as possible, and must perfectly master the method of ultrasound diagnostics.
4. Catheter trunk scleroobliteration is a type of sclerotherapy using different catheters that are inserted into a vein. This technique is used in various situations both as an independent method and in combination with other methods during surgery. Options for performing this procedure are as follows:
   - monocatheter (using one catheter) - as a separate method used for the treatment of main veins, performed as an operation under local anesthesia. It is also performed as a component of combined surgical treatment, for example, in the presence of pronounced trophic changes in the skin of the lower leg and the impossibility of using other methods due to technical complications or limitations;
   - multicatheter (with the simultaneous use of several catheters) - used in elderly patients, in case of technical difficulties and in certain situations during operative treatment. It can be used both in outpatient settings and as a component of surgery.
5. Laser-assisted foam sclerotherapy (LAFOS) is a method of treating varicose veins, which consists in sequentially affecting the vein first with a certain laser, and then with a sclerosant injected into its lumen. The idea of ​​this method is that the laser causes the vein to shrink and its diameter to decrease, after which it is much more susceptible to sclerosing. After laser treatment, even large veins can be sclerosed, so-called trunk sclerotherapy can be performed. The method is quite ambiguous, which raises a lot of questions among specialists.
6. Mechano-chemical sclerotherapy (ClariVein) is the most modern type of trunk sclerotherapy, which is still undergoing research and is not used in our country. It can be used only with a small diameter of the vein, as a rule, up to 7-8 mm, its efficiency is up to 70%.
7. Sclerotherapy based on the use of cyanoacrylate bioglue (VenaSeal) - the method is still at the approval stage. A very expensive, but promising procedure due to the lack of need for anesthesia and compression therapy. Variations of sclerotherapy are also possible, such as cryosclerotherapy - the introduction of a sclerosant with simultaneous cooling of the skin with a stream of cold air to reduce pain and spasm of blood vessels. The method is good, effective, but expensive, requiring the use of expensive and bulky equipment.
8. Cryolaser + cryosclerotherapy is a technique that is a combination of laser and sclerotherapy treatment of varicose veins with the use of 75% glucose as a sclerosant. Allows treatment of veins at any time of the year, with minimal compression. It is not used in our country yet.

It should be noted that at a certain stage of varicose veins, with strict adherence to the recommendations and competent professional selection of the technique, sclerotherapy is effective and allows you to stop the disease for a long time, sometimes forever. It is necessary to remember that a visit to a phlebologist will be a mandatory condition in the future to control the disease and the result of treatment.

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