Unfortunately, vascular pathologies have a global status.People of different ages and genders are sensitive to it.Various reasons can contribute to the development of varicose veins of the lower extremities, and there are many of them.Therefore, statistics on the registration of vascular diseases are growing inexorably.At the same time, science and medicine do not stand still, and the number of treatment methods already represents an impressive list.
The choice of therapeutic regimen is up to the treating doctor.Its selection is determined by the stage at which vascular pathology is detected, the dynamics of the disease, the general health of the patient and other factors.At his discretion, the specialist may include conservative, surgical methods or their symbiosis in the treatment regimen.
Conservative methods include pharmacological and non-pharmacological therapy.These treatment methods may be the only ones in the initial stage of the disease, when the first signs appear, and in 100% of cases they constitute an addition to surgical methods.
Expert opinion
Surgical methods are used for advanced forms of vascular pathology.Surgical methods are divided into invasive and minimally invasive.They all have indications and contraindications, as well as their pros and cons.
One of the most popular modern therapeutic methods is the EVLT procedure (endovascular laser coagulation) of the veins of the lower extremities.It is difficult for an inexperienced person to understand medical terms.Therefore, the question arises: what is it and what is it for?
EVLT of the veins of the lower extremities: preparation, procedural technique, indications and contraindications
What is the EVLT treatment for varicose veins?Endovascular or intravenous laser coagulation of the veins of the lower extremities (EVLC) is a minimally invasive process for the elimination of varicose veins.
How is endovascular laser coagulation of varicose veins performed?This method has been practiced for about ten years, so the procedure has been improved to this day.EVLT is characterized by a highly technological and rather complex manipulation that requires not only high-quality equipment, but above all high professional training of medical personnel.
This is a percutaneous intravascular surgical procedure.This means that laser coagulation of varicose veins of the legs involves the introduction of a peripheral catheter into the venous bed.Through which a thin laser light guide penetrates to cauterize the veins.Under its influence, a thermal burn occurs and subsequent adhesion of the venous wall with obliteration of the lumen.The procedure will be performed under local anesthesia (a mixture of low concentration anesthetics), its effect should last 6-10 hours.Thanks to the addition of vasoconstrictors to the mixture, in addition to the anesthetic effect, a vasoconstrictor is also obtained.This reduces the risk of hematoma formation after EVLT.
All steps of the EVLT are performed using double-sided scanning.
Therefore, the specialist controls the laser and its location in the vein.Without taking into account the preliminary marking of the veins, laser treatment of varicose veins lasts about 40 minutes.If necessary, the next day, sclerotherapy or miniphlebectomy of the large varicose tributaries of the great and small saphenous veins is performed.This occurs because endovascular laser coagulation has limitations on the allowable expansion of the varicose tributaries of the great saphenous vein (GSV) and the small saphenous vein.For the procedure to be effective, the veins must have an expansion of up to 25 mm in diameter.Therefore, if some veins remain visible after EVLT treatment, there is no reason to worry.They can be eliminated by introducing sclerosing substances into the venous mouth or by making a puncture, then taking out the vein and physically removing it.As the research results show, in these cases, in the postoperative period, a good clinical and long-lasting cosmetic effect is observed, without signs of recurrence.Also, in general, the social rehabilitation of patients is accelerated (if medical recommendations begin to be followed immediately after surgery).
Laser coagulation of blood vessels on the legs: preparatory phase
What is the preparation for coagulation?Preparation is not difficult.In order to perform endovascular laser coagulation of the veins of the lower limb it is necessary:
- general screening of the patient's health status (general clinical blood and urine tests, blood test for RW, comprehensive analysis of blood coagulation indicators, blood tests for viral hepatitis B and C, AIDS, HIV and syphilis);
- examination of veins and blood vessels (USDS);
- therapist's conclusion on the absence of contraindications.
It is necessary to prepare medical compression stockings in advance.
You will need it immediately after laser varicose vein treatment (EVLT).As a rule, the doctor prescribes class II compression hosiery for this purpose.
EVLT of the veins of the lower extremities: indications and contraindications
If laser coagulation of the blood vessels of the legs is prescribed, the indications are few: presence of varicose veins (starting from stage 2 according to CEAP), trophic disorders of the lower leg, straight veins.
Removing veins in this way also has a number of contraindications:
- excess body weight (obesity);
- diseases of the arteries of the lower extremities, accompanied by the formation of atherosclerotic plaques on the internal walls of the blood vessels;
- limited movement of the patient due to diseases of the musculoskeletal system, stroke, etc.;
- infectious diseases;
- inflammatory processes of the skin and subcutaneous tissue;
- hypertension in the acute phase;
- some chronic diseases in the acute phase.
Can EVLT be performed if blood clots are present?A prerequisite for the operation is the absence of blood clots in the upper segment of the trunk of the saphenous vein.Therefore, the presence of blood clots is also a contraindication.
Is laser venous coagulation allowed during pregnancy and for how long?
Expert opinion
EVLT surgery is prohibited during pregnancy and after childbirth, during breastfeeding.Non-drug methods of conservative therapy are recommended for pregnant and breastfeeding women, because... it is necessary to exclude all possible risks to intrauterine development and the health of the already born baby.
Rehabilitation after laser coagulation of the veins of the lower extremities
Those who are prescribed EVLT (laser subcutaneous coagulation) of the veins of the lower extremities wonder whether it is necessary to open a sick leave certificate?To eliminate varicose veins with this method, it is not necessary to stay in the hospital for a long time.The procedure is performed on an outpatient basis and does not require bed rest.You can return to your usual lifestyle and work responsibilities the next day.The only thing that will take time is rehabilitation.Recovery after EVLT of the veins can take up to a month and a half.During this period of time, it is important to responsibly follow all recommendations received from your doctor.
Daily routine after the procedure
The daily routine in the postoperative period requires regularity.A proper balance between wakefulness and sleep, activity and rest, as well as food intake, healthcare procedures, etc.To help your body recover and reduce the risk of relapse, you need to make some lifestyle changes.Daily routine and routine will have to be brought to a certain extent closer to compliance with the rules of a healthy lifestyle.
What should you not do after the procedure?
There are some contraindications and restrictions after the procedure to remove varicose veins.First of all, you need to get rid of bad habits.After laser coagulation, alcohol and smoking are prohibited, at least for the rehabilitation period.Nutrition should also be balanced and correct to control weight.
For several weeks after EVLT, you should avoid taking hot baths, as well as visiting baths, saunas, and swimming pools.
Tanning salons, loved by the fair sex, and body care procedures in beauty salons are prohibited.Women will also need to change their high heels for more comfortable shoes with low, stable heels.
Practice after the procedure
Fearing complications and relapses, some patients wonder whether sports and running are allowed after EVLT?Let's start with the fact that after laser coagulation of veins and miniphlebectomy it is necessary to immediately start moving, this will reduce the risk of blood clots.Starting from the day after surgery, daily walking should last at least 1.5-2 hours.There is one peculiarity: during the first days the patient must remain in compression stockings around the clock. In addition, it is allowed to wear medical underwear only during the day and for a maximum period of six months, then the doctor will select the compression class of the hosiery during a review.
Sport is allowed and even necessary!But not all its types are acceptable during the rehabilitation period.It is important to exclude significant physical activity, such as weight lifting, strength training in gyms, etc.Is it possible to run after laser coagulation of veins?Experts prohibit fast running as a form of shock loading.These also include jumping and jerking.Such loads after surgery are extremely undesirable.
Complications after EVLT
Like any other operation, laser coagulation of the veins of the lower extremities has potential complications.Undesirable consequences of laser coagulation in the postoperative period are rare and some even extremely rare (1:10,000).Therefore, the method is considered the most effective.However, you should be aware of the following complications after EVLT surgery:
- thrombophlebitis;
- deep vein thrombosis;
- pulmonary embolism;
- burns;
- paresthesia;
- hyperthermia.
Is there normal pain after EVLT and how long does it last?What to do if the leg is pulled and swelling occurs?Which of the following can be considered a complication after EVLT?
Expert opinion
A large vein after coagulation forms a dense cord with redness.As a rule, such compaction at the puncture site and redness occurs 7-10 days after endovascular laser coagulation (EVLC).This phenomenon is normal, but it is temporary.Furthermore, it regresses quickly when applied topically.
Some patients notice that the leg hurts and becomes numb during the first two days after laser vein coagulation.These unpleasant sensations are more likely associated with the unusual wearing of medical hosiery than with the treatment procedure itself.Rarely are annoying pains and tensions felt along the venous bed.They last no more than a month and a half and go away on their own.Interestingly, on the first day, in response to coagulation of vascular wall proteins, a temperature no higher than 38°C may occur.After EVLT, the doctor will inform the patient about all possible complications and give recommendations on how to behave in a particular case.
Pregnancy after EVLT
EVLT of pregnancy veins cannot interfere with pregnancy in any way.On the contrary, when planning a pregnancy, the absolutely right step would be to solve the problem of varicose veins.Therefore, to the question of whether to perform laser coagulation or not, the answer is obvious.Because during pregnancy the load on the vessels will increase and the disease will worsen by 100%.Pregnancy excludes surgery.Only in difficult situations, when the situation is critical, the attending physician can prescribe a radical method of treating varicose veins to a pregnant woman.
When pregnancy occurs after EVLT, measures should be taken to prevent relapse.
For this purpose it is recommended to wear medical compression stockings, perform gymnastic exercises, self-massage of the limbs and apply venotonic creams.A foot cream with chestnut and ginkgo biloba extracts is ideal for its properties during pregnancy.Its composition is natural, which means that the product is safe for the health of the expectant mother and baby.