Sclerotherapy (sclerobliteration) of the veins of the lower extremities in Moscow
Sclerotherapy (sclerotherapy) of veins is a modern method of treating varicose veins, based on the introduction of special chemicals (sclerosants) into the lumen of the vessel, which cause gluing of the walls and subsequent resorption of the vein. The technique is aesthetic, as without incisions and scars it allows to combat various manifestations of varicose veins.
The history of sclerotherapy (sclerobliteration) of veins
The first mention refers to the period of antiquity. In the works of Hippocrates, a method for obliteration of a vein with the help of a metal rod is described. An artificial inflammation was caused, then the vein was punctured by the thorn of the eastern plane tree. The first, documented, experiments on the introduction of solutions into the vein were carried out by Christopher Wren (mathematician and architect from Oxford) in 1656. The pioneer of sclerotherapy in 1682 was D. Zollikofer (Swiss doctor). Using acid, he tried to cause a vein thrombosis.
Dr. C. Pravaz is the inventor of a syringe
In 1851, C. Pravaz (French surgeon) invented a syringe, sclerized with his help arterial aneurysms. About the first procedure in a form close to modern (injected iron perchloride), reported Debu and Chassenyak in 1853 year. Due to the large number of complications associated with sclerotherapy at the Congress of Surgeons, a negative evaluation of the method was given in Lyon at 1893. At the beginning of the XX century, Jean Sica injected sodium salicylate into the veins, later - sodium carbonate and founded the "French" technique of sclerotherapy.
The discovery in 1930-x years of detergents (the effect is based on damage to the proteins of the inner wall of the vein) was the beginning of a new chapter in the history of sclerotherapy. In 1946, tetradecyl sulfate was invented, in 1950, polydocanol. Their introduction into practice allowed the technique to get mass distribution. In the middle of the 1950, K. Sigg proposed an "ascending" technique (Swedish). In 1960, D. Fegan published a work based on successful treatment in 13 thousand patients. In it he formulated the basic postulates of modern sclerotherapy.
System of syringes for performing foam sclerotherapy according to L. Tissari
The technique of the foam block proposed by K. Sigg in 1949 was widely distributed in 2000 after the presentation of the three-way valve by L. Tessary (obtaining fine-grained foam of high quality). Widespread introduction of ultrasound diagnosis allowed the introduction of echo-assisted interventions, which allowed for the implementation of stem sclerotherapy, sclerobliteration of perforating veins.
Sclerotherapy (sclerobliteration) of veins - what is it?
The essence of the technique consists in the action of a special chemical substance (sclerosant) on the inner wall of the vein (intima), which eventually leads to its gluing and complete elimination.
Sclerosants are subject to the following requirements:
- The effect should be only in a certain concentration, below which the drug does not work.
- The effect of the drug on the venous wall only after prolonged contact with it (zones with stagnation of blood, healthy veins are not damaged).
- The drug should be strong enough to sclerosis even large veins, but do not damage the tissues surrounding the vessels.
- Do not induce allergies.
- Do not induce pain upon administration, do not cause pigmentation and scarring of the skin.
- Be readily soluble in physiological saline.
Types of sclerosants
Currently, the following groups of drugs are used in the world for the purpose of sclerotherapy:
- Detergents, which are fatty (carboxylic) acids and fats. These include: sodium morruate, ethanolamine oleate, tetradecyl sulfate, polidocanol, glycerin.
- Hypertonic and ionic solutions: hypertonic sodium chloride solution (20 and 23,4%); sclerodex - a mixture of 25% dextrose; 10% NaCl with a small amount of 2-phenylethanol; ionized iodine (variglobin).
- Cellular toxins.
The most widely used preparations of the detergent group.
Tetradecyl sulfate (Fibro-vein)
Their action is based on the extraction and denaturation of the endothelial wall proteins of the venous wall. This leads to delayed cell death and obliteration of the vein. The detergent affects only the pathologically altered vein, since the natural flow of blood dissolves it to a safe concentration. Thus, only varicose veins with delayed blood flow undergo chemical treatment, healthy ones are not damaged. Unlike other sclerosants, detergents do not cause destruction of blood cells (hemolysis) and intravascular coagulation aggregation (coagulation). These qualities determined the leading position of these drugs in sclerotherapy.
In Russia only preparations of the detergent group have been approved: polydocanol (ethoxysclerol) and tetradecyl sulfate (fibrovein). Another plus of these sclerosants is the possibility of using the foam form of the drug.
Basic principles of sclerotherapy (sclerobliteration) of veins
- First of all, the reflux is eliminated in the proximal parts.
- First, larger veins are eliminated.
- A conglomerate of interconnected veins should be eliminated in one session.
- Immediately after the procedure, it is necessary to provide adequate compression and start walking.
Types of sclerotherapy (sclerobliteration) of veins
- Microsclerotherapy of telangiectasias. In vessels with a diameter of up to 1mm, the drug is administered in a liquid form: polydocanol (concentration 0,25-0,75%), tetradecyl sulfate (0,1-0,2%).
- Microsclerotherapy and foam-shaped sclerotherapy of venulectasia (1-2 mm) and reticular veins (2-4 mm). The foam form of the preparation is used: polydocanol (0,5-1%), tetradecyl sulfate (0,25-0,4%).
Foam-form of small veins and spider veins
- Echo-controlled sclerotherapy: large and small subcutaneous veins, tributaries of the main veins, perforating veins. Only the foam form of the sclerosant is used in a high concentration of 3% for polydocanol and 1-3% for tetradecyl sulfate.
Foam sclerotherapy (sclerobliteration) of veins under ultrasound control
Indications for sclerotherapy (sclerobliteration) of veins
Endovenous chemical obliteration can be successfully subjected to any varicose veins. The appearance and availability of modern minimally invasive methods of thermaloblattering (EVLO, RCHO) somewhat narrowed the scope of sclerotherapy (sclerobliteration) of veins in Moscow. But it remains still relevant, and sometimes irreplaceable.
Most often the indications are as follows:
- The presence of reticular varicose veins and telangiectasias, often an aesthetic problem, sometimes the indication is the bleeding from these vessels.
- Isolated varicose inflows of small or large subcutaneous veins.
- The presence of pathological reflux in the perforating veins, after its elimination in the main veins.
- If patients with a trunk form of varicose veins are contraindicated other methods of treatment. It is proved that the intervention is effective even with the diameter of the osteal valve of the large saphenous vein up to 30 mm.
Contraindications for sclerotherapy (sclerobliteration) of veins
As with each treatment technique, sclerotherapy has contraindications.
- Cardiopulmonary insufficiency.
- Allergy to sclerosant.
- Thrombosis of deep and superficial veins.
- Pregnancy and lactation.
- Inflammatory processes in the procedure area.
- Inactive patients.
- An open oval window in the heart (for a foamy shape).
- If varicose veins are the only way out of the lower limbs (10% PTFB).
- Hormonal therapy.
- Proximity of long flights.
- Ischemia of the lower extremities.
- Obesity and lymphostasis.
Procedure Technique sclerotherapy (sclerotherapy)
The technique of sclerotherapy is non-traumatic and does not require hospitalization and changes in the usual rhythm of life, is well tolerated by patients.
Technique of sclerotherapy with one hand
The session is performed in a horizontal position. Sometimes it is necessary to create an elevated position of the limb. Injections are performed by the thinnest needles 27 - 30G, therefore practically are not felt by patients. After treatment of the skin with a solution of antiseptic, sclerosant is introduced into the lumen of the veins. Depending on the caliber of the vessels and their localization, a liquid or foam form, of one or another concentration, is used. The introduction is carried out slowly, to exclude the extension and rupture of the vessel. For additional visualization, an ultrasound scan or a vein monitor can be used.
Using modern methods of visualization of veins
After injections, peloid dressings are applied to the skin along the veins, the compressive jersey of the 1 or 2 class is worn
After the procedure of sclerotherapy (sclerobliteration) of veins
Terms for wearing knitwear are determined by the diameter of the sclerosed veins. At the end of the session, the patient is shown a walking tour of 15-20 mines and subsequently every day patients must perform certain exercises for the lower extremities. Walking, cycling and aerobics with a light load are ideal after sclerotherapy.
In the course of treatment there are limitations, namely:
- visiting baths, saunas;
- long static loads;
- long flights (a week after the session);
- hair removal (a week after the session).
Complications sclerotherapy (sclerotherapy)
- Hyperpigmentation - is due to the deposition of hemosiderin in the surface layers of the skin, is an infrequent side effect of sclerotherapy, as a rule, independently passes during 6-12 months.
- Local edema - occurs due to the introduction of significant doses of the drug in a small area, regress itself.
- Transient neurological complications: migraine, loss of visual fields - can arise when using a foam form of sclerosant. Self-stop within 10-15 min.
- Metting (secondary, recurrent telangiectasias) - frequency of occurrence up to 15%.
In most cases, spontaneously disappear within a few months.
- Nerve damage is a fairly rare complication, due to the close arrangement of the branches of the nerves with the trunk of the BPV, MPV. Often passes independently.
- Skin necrosis - may occur due to the ingestion of the substance into paravasal fiber or small arteries. This complication is extremely rare.
- Thrombotic complications (thrombophlebitis, deep vein thrombosis, PE) - are extremely rare.
- Allergy, anaphylaxis. As with any drug, a reaction is possible. Fortunately, they are quite rare.
In the overwhelming majority of cases, the only thing that worries patients is small hematomas at the injection sites. They dissolve in a week.
Aesthetic sclerotherapy sclerotherapy (sclerotherapy)
Convenience and effectiveness allowed sclerotherapy to become not only a curative, but also a cosmetic procedure. The method is the most effective for the treatment of telangiectasias and the only one for eliminating reticular varicose. In recent years in Russia there has been a peculiar boom in aesthetic phlebology.
Many of the fair sex dream of beautiful, cleaned from the vascular asterisks, mesh legs. Sclerotherapy of the veins of the lower limbs perfectly copes with this task. Since the main restriction is the wearing of compression linen, it is optimal to treat in late autumn or winter. Elimination of telangiectasias and reticular veins pursues cosmetic goals, but patients at the same time have symptoms of venous congestion, so that the effect of treatment is often pleasantly surprised by improvement in well-being.
Sclerotherapy of the hands (removal of ugly veins on the hands) in Moscow
It's no secret that with age, the skin of women's hands becomes more delicate, the liquid is lost, the turgor of tissues decreases. Against the backdrop of these changes are often manifested well-marked unaesthetic veins of the rear of the hand and forearm. With these veins, dermal lasers can not cope with the diameter of these vessels. Sclerotherapy can easily eliminate them.
The results of removal of ugly veins on the hands in our clinic
Before the session of sclerotherapy on the hands
After a session of sclerotherapy on the hands
Until recently, patients had to travel to Europe with similar problems. Now sclerotherapy of the hands is available in Moscow, in our clinic. Dr. Semenov Artem Yuryevich, one of the first in Russia, applied this technique, and his results are in no way inferior to foreign colleagues. To date, he has the greatest experience of sclerosing veins in the hands of our country.
Advantages of sclerotherapy on lower extremities
Sclerotherapy (sclerotherapy) of veins is an amazingly well tolerated non-surgical procedure that allows to eliminate both small and large varicose veins. Phlebologists, who own the technique, practically do not encounter any complications. That is why sclerotherapy has become firmly in the arsenal of modern specialists and continues to improve. In our phlebology center "MIFTS", phlebology doctors have one of the largest experience of treating varicose veins with sclerotherapy. Tens of thousands of successfully treated patients passed through their hands!