PHLEBOLOGY

Shank varicose veins manifest themselves in various ways. Legs discomfort and pain are effects of blood circulation system problems. It passes while doing exercises and increases while standing or sitting. In leisure time pain extends abnormally.

Varicose veins pain is dull, and difficult to describe. It allocates in the middle parts of the legs and seems to be rather a feeling of tension and pain of infirm veins. Sharp, or dull and limited pain of outer side of legs never comes from pathologically changed veins. Patients usually fell stretching groin pain, which source is located at tibia veins.

Typical symptoms are:

	Heavy legs that passes by when you walk
	Pain behind varicose veins, when you stand,
	Pre-menstrual pains around visible, even small varicose veins,
	Inclination to ankle swelling at the end of a day,
	Symptoms escalation with raising warmness

Main reasons of varicose veins pain
Varicose veins pain is not associated with extended valves incapacity e.g. spider veins neither multiplied varicose veins, but it origins from vein paries stimulation. Hormonal changes before menstruation, broadening of vein light, and rising blood pressure can also exaggerate painfulness accompanying varicose veins. If varicose veins are large, the feeling of massiveness and heaviness of legs are effects of blood blocking all over in veins. High vein blood pressure gets low during walking for example, when leg muscles make blood circuit. The massiveness feeling increases when a patient suffers from lasting valve incapacity. Patients also suffer from swelling ankles pain. Pain can also reveal as painful muscle contractions.

How to diagnose it correctly?
To diverse vascular veins from other medical problems the doctor has to examine a patient carefully. There are later medical surveys carried out in standing and sitting positions.

Types of varicose veins:

	Spider varicose veins Spider varicose veins are only first symptoms of veins problems. They are broad middle skin veins, located usually at middle tight filled with large amount of blood. Sometimes they are of a circular shape, especially those on leg's surface. There is quite a variety of spiders. Isolated, short and thin changes can be accompanied by condensed varicose veins or tiny vessels spread radial from a central vein. Such varicose veins are various to Corona Phlebectatica, which is a wreath of changed vessel similar to a crown placed around the ankle and the back part of a foot. It is a reason of lasting valves incapacity.
	Multiplied vascular veins Multiplied vascular veins come from single broaden veins or sets of veins branches creating various configurations. They can be placed all over leg area, especially on muscles at their flexor and rectifier, and also on side areas.
	Vena saphena magna They are vascular veins starting from groin and heading downwards. They can be invisible between thighs and tibia veins connections and knee. They usually show up in the middle leg area. Vascular veins changes and vein branches are the effects of blood pressing to tibia vein from deep veins system (upstream.) It is easy to examine invisible part of tibia vein when the patient is standing. Patients with expanded changes can have a bump under the groin, which is the connection between the thigh and tibia veins.
	Åderbrock i vena saphena parva syns strax under skinnet på patienten i närheten av fotknölen och orsakas av att blodkärlen vidgas och bryter in i huden.
	Vena saphena parva This kind of vascular veins place themselves on the skin over a muscle and close the ankle's side. They are pathologically broad veins and circulation perturbations of skin placed over an ankle.

Calf bone vein perforates fascia under the knee (the place of perforation is a hand width below the area). It is easy to find it when a patient coughs.

Vascular veins with inefficient perforators It is a very seldom health complication: perforators' inefficiency of surface and deep veins. According to Cockett, perforators of middle and surface shank area are classified in three groups. Perforators under knee are called Boyd veins, and those over knee are Dodd veins. The problem can reveal as vascular veins, as well as oval veins' knob when a patient is standing, and as an oval hole in fascia when a patient twists their leg outside (in that position the knob disappears).

Treatment possibilities
There are five options after medical examination:

The vascular veins treatment depends on their size and kinds, on the illness progress and the patient's expectations.

Spider veins and small vascular veins can be cured with:

	Sclerotherapy
	Laser therapy

Sclerotherapy is a vascular veins and spider veins treatment consisting of injecting mixtures into veins. The injected substances react with vein paries swelling and vessel's closure. The therapy:

	Usually requires several sessions
	Is not very invasive, there is no need for anesthesia
	Does not require of hospitalization,
	There are not many of side effects

You should have sclerotherapy if you have:

	Side vascular veins
	Net vascular veins, mainly twisted, with little knobs, small and medium spider veins

Surgery treatment should be considered when a patient has problems with tibia or fibula vascular veins, incapacity of perforators and vein connections. Spider veins oblitery are more a cosmetic than a surgical problem. Generally, oblitery improves blood circulation in veins and prevents the valves incapacity, inflammable coagulation of veins, vein coagulation and anthrax vascular veins.

Laser removal is a treatment done with a modern Photoderm Vasculight device. That piece of equipment unites intensive and high-energy broad spectrum light with an impulse of Nd:YAG laser. Thanks to that combination the light, which wave is 1064 nanometer long, can remove various vessel changes: benign, vested and natural ones from total body area. The emitted light generates warmth, which warms up a morbid change up to a high temperature that destroys and removes it from the tissues. In case of vein changes, the removed tissues are blood vessels. Red blood pigment, hemoglobin, absorbs the light energy and changes it into warmth that raises the blood temperature. When blood's temperature is high enough, blood coagulates and destroys vessel parieses, which are removed from the organism in a time. Effective therapy includes one to dozen and so sessions within a few months; it depends on the size and the depth of a change, which later spontaneously disappears from the body. The effects may be expected in a few months time.

Medium and large vascular veins treatment These kinds of vein changes can be removed in the ambulatory using methods called "crochet", VARADY's method, or phlebotomy. It is done with local anesthesia. With micro-cuts 1 millimeter long all vascular veins are removed. Later, a stretchy bandage is placed on the calf. The patient wears it for about seven days. After the treatment bruises can appear, but they are not serious complication and disappear within a few weeks.

Large vascular veins
The best treatment for large vascular veins is surgery. It is done with line anesthesia (e.g. extrameningeal) and joins a treatment consisting removing (stripping) tibia (VSM) or fibula (VSP) vein with side vascular veins removal with VARADY's method described above.

VSM stripping is removing the main vein with two cuts, in the middle of the ankle, 1 centimeter long, and on the groin 3 to 4 centimeters long. Treatment lasts for about 45 minutes to 3 hours, its time depends on the amount and size of vascular veins. The patient stays in the clinic for about 12 hours and returns to full physical activity within 7 to14 days.
We recommend walking since the first day after the treatment and wearing stretchy bandage or antivascular tights for about 4 weeks.
During first the 5 to 7 days since surgery the patient takes painkillers, e.g. Paracetamol or Ketonal.

After-surgery discomfort is minimal. We recommend that our patients to take medicines diminishing blood coagulation of Heparyna micro-molecular type.
After the treatment the patient can have bruises and a small swelling, but these symptoms pass within a few weeks.
Surgery gives a great cosmetic result and completely removes vascular veins problems.

Preparing to treatment
If a patient has small vascular veins, we apply ambulatory treatment. Before the treatment there are preparations and an initial diagnosis, including an enquiry that proofs whether the patient is healthy and does not suffer from other sicknesses.

Medium size vascular veins

	To achieve efficient and long lasting effect you should have ultrasonography, where a doctor will carefully estimate anatomy and pathology of vein system.
	Basic blood tests describing its coagulation are also required.

In our dermatology clinic the doctors' team performs treatments described above using the most progressive methods.

You should not undergo these treatments if you have problems with deep blood veins system. Sclerosis therapy drastically diminishes vein blood back flow, it excludes surface vein system and that is why it is not recommended when a patient has coagulation of deep veins. Besides, patients with artery adhesions, circuit incapacity, cancer changes and severe illness cannot have sclerosis treatments. People with veins coagulation or those who had them during the last 6 months, should not have those treatments.

You should also not have the treatments if you have:

	Sharp and chronic vein inflammatory
	Illness with high fever, including cold and allergies

You should avoid that method when planning physical effort and traveling to another climate zone, or if you have inflammatory skin exudation and vascular veins anthraxes. Veins sclerosis, which is ground for anthraxes, can be healed if they are not infected, just like anthrax inflammation of small vessels.

Menstruation and contraceptives do not complicate the sclerosis treatment. You should not undergo it during first three moths and the last six weeks of pregnancy. During the rest of the pregnancy there are no the obstacles against having the therapy, unless the patient has to stay in bed.

Vascular veins appearing during pregnancy disappear after childbirth, which is why there is no reason to treat them.

If a patient has active immunization, they should postpone treatment for about 3 weeks.