21Feb

Sclerotherapy with varicose veins

Table of contents:
  • What happens in the vein with sclerotherapy and ablation?
  • Sclerotherapy types
  • To whom is sclerotherapy and ablation indicated?
  • What about contraindications? Do we compare the effect with laser therapy?
  • What should I do before the procedure?
  • How is sclerotherapy applied to the legs?
  • What drugs are used for sclerotherapy
  • What special advice should a doctor follow after the procedure?
  • Disadvantages of sclerosing methods
  • Possible complications of sclerosing methods
  • Cost of procedures
  • Patient feedback

The opinion of doctors about the use in the treatment of varicose veins of limbs, hemorrhoids is ambiguous: there are pros and cons. The main advantage is considered the possibility of avoiding full-scale surgical intervention.

However, sclerotherapy is not available to all patients. It is necessary to take into account contra-indications and possible complications. For sclerotherapy, more modern techniques have appeared: laser therapy and radiofrequency ablation. Accumulated sufficient practical experience and long-term follow-up of patients. The use in emergency cases to eliminate bleeding from the esophagus of the veins helps to save the life of a seriously ill patient with cirrhosis of the liver.

What happens in the vein with sclerotherapy and ablation?

A substance injected into an affected vein( usually at least 1 ml), acts on the inner shell, causes aseptic inflammation, followed by the formation of a thrombus. Immediately the injection site( leg or arm) is compressed using an elastic bandage or linen. After a period of 6 weeks, the site will be scarred( sclerosed).The blood does not pass through it. This means that the vessel is excluded from the circulation and turns into a tight cord.

Laser and radiofrequency ablation also leads to scarring of an unnecessary vein. To use the laser is characterized by an internal burn of the mucosa, and by means of certain frequencies it is possible to cause the vein overlap without burning.

Sclerotherapy types

The main types of sclerotherapy therapy are conventionally divided into methods:

  • Microsclerotherapy - the drug is injected through a thin needle directly into the affected area. Usually used with a diameter of the vein not more than 2 mm.
  • Echosclerotherapy - the introduction of the drug is combined with ultrasonic duplex scanning. Allows the doctor to see on the screen the most vulnerable places, to determine the condition of the venous wall and the needle. It is used for sclerosing deep and large venous vessels.
  • Foam-form Foam-form is performed with the use of preparations including chemical detergents or foam substances. Can be mixed with other necessary means. Suitable for the treatment of large veins, increases the area of ​​contact of the sclerosant.

To whom is sclerotherapy and ablation indicated?

Read more: Surgical removal of varicose veins Surgical treatment of leg veins

The sclerotherapy method is indicated in the following vascular pathology:

  • with varicose veins, if there are vascular asterisks( the initial stage of the disease) on the skin, if there is a prolapse and thickening of convoluted surface vessels;
  • with vascular neoplasms( lymphangiomas and hemangiomas) on the body;
  • with hemorrhoids, enlargement of the external venous ring of the anal opening;
  • as an emergency aid for bleeding from the esophageal dilated veins.

Precise indications are determined by doctors phlebologists, proctologists, vascular surgeons. An important point in the effectiveness of treatment is the correctly established stage of the disease.

What about contraindications?

Procedure is contraindicated:

  • for pregnant and lactating women;
  • for allergies to drugs;
  • to patients with severe atherosclerosis of the arteries of the legs;
  • if there are signs of thrombophlebitis on the lower limbs;
  • with a tendency to vein thrombosis, previous thrombotic conditions;
  • if there is inflammatory skin disease in the sites of planned injections;
  • for decompensated heart diseases, congenital malformations, connecting the left and right chambers.

Performing sclerotherapy has technical differences. Apply 2 options.

Sclerotherapy of the "empty" vein

The method is called the Irish method - the physician hand compresses the upper and lower ends of the vein when injecting the drug, the blood flow is maximally reduced to the isolated site. The subsequent compression is necessary, that the thrombus has remained on a place, zarubtsevalsja. The method is applicable for the treatment of varicose veins of the lower extremities, hands.

But how to provide the necessary compression, if the venous vessel is in the groin, genitals, popliteal fossa, with the defeat of hemorrhoids? The effectiveness of compression is unlikely with obesity. In addition, some patients refuse to wear compression underwear on their feet due to inconvenience or the summer season.

In such cases in the lumen of the vessel there is a recanalization of the thrombus( a "window" for the passage of blood opens) and a recurrence of the varicose process is formed.

Laser treatment of veins
Laser beam causes burn of the inner layer of the vein

Tissue "burn" of the endothelial layer

The procedure differs from the previous method by repeated injections of a minimum amount of the sclerosant preparation that can cause a chemical burn of the vein inner vein. In this case, scarring does not occur due to the formation of a thrombus, but by thickening the walls of the vessel with a gradual closure and full sealing of the lumen( obliteration).

It can be used not only on the lower limbs, but also instead of the operation with varicose hemorrhoids, for the treatment of obese patients. Do we compare the effect with laser therapy?

In addition to sclerotherapy, there are other methods of non-surgical treatment of varicose limbs. The most widely used laser and radiofrequency ablation.

If sclerotherapy requires a syringe and a sclerosant, then these methods use special equipment. Accordingly, trained personnel, local anesthesia are required. This can not be done in a polyclinic, so ablation is performed in vascular specialized centers and departments.

In laser therapy, a catheter with a light guide is inserted into the vein. With the help of a two-hour action of the beam, a mucous burn is caused. Complete sclerosis occurs in a few days.

introduction of a conductor into a vessel
In the radiofrequency action, the possibility of certain frequencies to sclerose the vessel without the phenomenon of a burn is used.

The procedure lasts 0.5 hours. After 7 days, you are allowed to go in for sports. This type of sclerosis is considered the least traumatic.

The choice of technique is determined by the location of the optimal access, the width of the affected vessel, and the sensitivity of the patient to the drugs.

What should I do before the procedure?

The doctor should talk about the medicines and nutritional supplements the patient is taking. Of particular importance are:

  • hormonal drugs;
  • anticoagulants( including those based on Aspirin);
  • pain relievers;
  • anti-inflammatory drugs.
Do not damage or irritate the skin on the limbs. Therefore, women are warned about the inability to use creams, ointments, shaving and hair removal before the upcoming manipulation.

Alcohol and smoking stop within 2-3 days. Directly in the morning you should take a hygienic shower, a light breakfast is enough. It is worthwhile to provide for wearing comfortable shoes in the coming days.

Ultrasound of the veins of the legs
The doctor draws a special marker on the extremity of the foot, determines the position of the foot for the introduction of

. How is sclerotherapy performed on the legs?

Sclerotherapy passes through several stages:

  1. Before the procedure, mandatory ultrasound examination of the venous channel is necessary. Its purpose: marking the veins by location and tendency to collapse, identifying places with the inability to create sufficient compression. If the vein does not fall off, it can be probed in the horizontal position of the patient, then the manipulations will be carried out lying down. Otherwise, the patient is seated on a chair or requires holding a vertical position.
  2. A needle is inserted intravenously into a predetermined location. Then the doctor squeezes the area 4-5 cm above and below the injection with the fingers and injects 1 ml of the sclerosant drug with a syringe. The patient may feel moderate burning along the veins. Usually, pain is not observed.
  3. It lasts for half a minute( exposure time).The needle is quickly removed, and a sterile cloth is applied to the injection site and the sterile tissue is pressed tightly to stop the bleeding.
  4. The patient is recommended to lie down for 10 minutes with active movements in the ankle and knee joints to connect to the work of the muscular pump. This ensures a reduction in pressure in the veins.
  5. An elastic bandage from the fingers to the inguinal fold is applied to the lower limb. Just take a walk for at least half an hour.

Repeated procedure is performed after 1-2 weeks. To achieve full obliteration, 3-4 sessions are required, rarely 6.

What drugs are used for sclerotherapy

Drugs for sclerotherapy correspond to all safety measures for sterility and provide it, as well as allergenic qualities. The most commonly used are:

  • Thrombovar, Fibro-vein;
  • Ethoxysclerol( 0.5% solution of polydacanol).

For one procedure, up to 1 ml of the drug is administered, with repeated injections, the dosage does not exceed the allowable dose.

The drug for sclerotherapy
Sclerosant on the basis of 0.25% solution of sodium tetradecyl sulfate

What special advice should a doctor follow after the procedure?

To consolidate the effect of sclerosing:

  • , the patient is recommended to walk daily for 5 km;
  • break in the exercise bike, gymnastics in fitness cents must be observed for at least three days;
  • 2 weeks to try to limit the long sitting and lying position;
  • 2 months should not visit the steam room and sauna, take a hot bath;
  • continue to wear elastic knee socks, stockings or hold bandages for 3-4 months.

Disadvantages of sclerosing

The main disadvantage is the temporary effect( reduction of swelling, pain in the legs).After sclerotherapy several years pass, and the disease becomes aggravated again due to other vessels, because the causes are not eliminated.

A patient with excess weight, "sitting" or "standing" work, heart failure remains high risks of varicose veins.

After the treatment, the patient will need to follow the diet, exercise, watch the wearing of comfortable shoes, take medication as directed by the doctor to support the effectiveness of the sclerotherapy.

Possible complications of sclerosing

Both chemical substances and other methods of action on the venous wall can lead to complications:

  • excessive burn of the inner surface of the venous wall delays the healing process, causes superficial scars and skin pigmentation;
  • thrombosis and thrombophlebitis - an inflammatory process in the venous wall with increased thrombus formation often accompanies cases of large-scale vein treatment, in the presence of untreated chronic foci of infection( caries teeth, nasopharyngeal diseases) if patients feel relieved to stop the doctor's recommendations;
  • allergic reactions to sclerosants are very rare.

Cost of procedures

To find out how much a certain procedure costs, it is necessary in a specific clinic. Since the price is not only the price of medicines, but also the depreciation of expensive equipment, the qualification of personnel, the rent for the premises.

Tentatively for Moscow clinics you can count on:

  • foam sclerotherapy of the main trunk of the large and small saphenous vein - for 15 thousand rubles;
  • sclerotherapy with the use of dopplerography - for 8 thousand rubles;
  • course repeated three times the introduction of the drug - 18 thousand rubles;
  • four-fold - 24 thousand rubles;
  • five-fold - 30 thousand rubles;
  • microsclerotherapy with different preparations on one limb in the shin area - 17,5 thousand rubles;
  • in the hip area - 22 thousand rubles;
  • radio frequency or laser ablation session - 59.5 thousand rubles.

Patient feedback

In many cases, patients' reviews are determined by the expectations or unrealized expectations of treatment.

Galina, 35 years old : "I performed 4 injections of a Thrombovar on a superficial vein of the tibia, I do not define any cords, the pains and puffiness have disappeared".

Nikolai, 44, : "I spent so much money on drugs, and as a result I had to perform laser treatment, only after it there was an improvement."

Lyudmila, 28 years old :" I used ointments only during pregnancy and while I was nursing, I was immediately advised by a doctor in a polyclinic after finishing feeding the child to go to a phlebologist. While she did penne sclerotherapy on one leg. The result is good. I'm going to repeat it on another. "