Varicose Veins: which treatment to choose?
New techniques of treatment of varicose veins have emerged and are increasingly used. Sclerotherapy, laser, Chiva, What are the results of these interventions lighter than surgery? A report of Anaes an update on the issue.
Varicose veins and tired legs are very frequent diseases. It is estimated that three out of four people have varicose veins during their lives and for one in four symptoms are bothersome enough to warrant medical treatment or surgery. In recent years, techniques have improved and new methods have emerged, promising treatments lighter and in theory less traumatic. But what are their real benefits? The answer with experts from the National Agency for Accreditation and Health Evaluation (Anaes).
Shoo reflux
To understand the techniques employed, some anatomical details are needed. The blood flow in the legs in a deep venous network, located in the heart muscle, and in a superficial network, under the skin. This superficial network is affected by varicose veins. It comprises two main veins, both large and small saphenous, who bring a game of blood into the deep network, and secondary veins, smaller. To prevent the stagnant blood in the superficial veins, antireflux valves are distributed throughout their journey. In case of failure of these valves, reflux occurs and the vein is dilated, forming a varicose vein visible under the skin.
Varicose veins legs
First, the balance
The veinotonic relieve symptoms and may, for some, help heal an ulcer, but they have no effect on the development of varicose veins. By the elastic stockings or strips is effective when it is paid. But it is a palliative, symptomatic, which has no effect on the anomalies already installed.
Different interventions may, however, to remove varicose veins. They may be considered:
* To relieve the symptoms become too painful;
* To prevent complications of venous stasis (venous ulcers, skin lesions or, more rarely, phlebitis and embolism);
* Or simply for aesthetic reasons.
A detailed assessment will be completed before any intervention, including an echo-Doppler. This painless examination can clarify the status of the valves and the mechanism responsible for reflux.
Surgery for reflux the most important
Varicose traitement surgery is the treatment of choice for varicose veins most important. Several techniques exist. One of the most classic is the stripping of removing the main vein of the legs (saphenous vein) by making two small incisions at the ankle and the groin. The operation is completed by the removal of all small varicose veins that could develop from the saphenous vein.
After removal of superficial veins, the blood return is through deep veins. The only cons Absolute contraindication to surgical stripping is clogging the network with deep venous phlebitis.
The operation is performed in the operating room under general or epidural anesthesia. Hospitalizations are increasingly brief, often within hours, and generally do not exceed two days. In the aftermath of the intervention of the hematomas and bruises appear sensitive, which will fade in two to three weeks. The march was resumed immediately after surgery, but a work stoppage of three weeks is usually required.
The surgery can be performed at any age, except during pregnancy, and in any season. But be aware that the wearing of stockings is necessary for two to four weeks after surgery and that it is necessarily more difficult during periods of high heat.
Sclerotherapy in other cases
To treat smaller varicose veins, the choice was discussed between the stripping and sclerotherapy. Sclerotherapy has the advantage of being a much more lightweight, made of firm and does not require anesthesia. It is injected into the varicose vein with a fine needle, a substance that will induce shrinkage and hardening of the vein patient, who will butcher (se “sclerosis”). The activities can be resumed immediately, a work stoppage is not necessary. The procedure seems so simple, but it does require a good experience for injection is accurate. There is a low risk, but serious, accidental injection into an artery. Using ultrasound guidance can be sure that the product is properly injected into the vein.
Varicules
Often varicose veins secondary concern. They can then be removed either by sclerotherapy, either surgically, by phlebectomy. This is a minor surgery, performed under local anesthetic. Some practice in firm, even if experts consider it preferable to intervene in the operating room for reasons of asepsis. Small portions of veins are removed with a hook through tiny incisions.
Sclerotherapy has the advantage of being lighter and better supported than the surgery. It does not scar. Its main disadvantage is the risk of recanalization of the vein. The choice depends mainly on the characteristics of varicose veins to be treated and the physician’s experience.