What is varicose disease?
It consists of permanent pathological dilation of a vein.
This pathology is caused by the loss of functionality of the walls of the vessel and its valves, causing a countercurrent blood reflux, thus tending to accumulate in the veins of the superficial venous system. The veins in this way lose their elasticity progressively, they dilate and disappear.
What are the main risk factors?
We can distinguish between modifiable and non-modifiable factors.
Among the non-modifiable risk factors are female sex and familiarity; Among the editable ones are: prolonged erect station, obesity, sedentary, hormone replacement therapy (contraceptive pill), incorrect plantar support.
Are there protective factors?
An active lifestyle, a balanced diet, proper hydration, and regular physical activity are correlated with a lower incidence of the disease.
How many people are affected by this disease?
This disease is very common in the general population, affecting about 10-33% of women and 10-22% of men. Recent estimates show how there is an increase in incidence with age advancement. In Italy they are affected: 7-35% of men between 35-40 years and 15-55% of those over 60, 20-60% of women between 35-40 years and 40-78% Of patients over 60 years of age.
How does it affect the disease?
The veins do not have a very well developed internal muscle layer, so they tend to dilate when the wall begins to release due to excess transfusional blood flow or a slowing down. All this results in a permanent dilation of the veins of the circular surface that take on a dilated and serpentine appearance. In the most advanced stages, a higher blood stasis occurs in the sloping areas, resulting in fluid accumulation (edema), red blood cell extravasation that causes pigmentation of the skin until the appearance of skin swelling injuries (ulcers).
What are the signs and what are the symptoms?
Fatigue, nocturnal cramps, restless legs, heaviness, tension and turbid trophies of venous origin: pigmentation, eczema, hypodermitis, white atrophy.
Venous stasis ulcer is a chronic skin lesion that does not tend to spontaneous healing, which does not re-epiteliate before 6 weeks and which recurs with high frequency.
What are the instrumental examinations needed for proper diagnosis?
Recalling that any instrumental diagnostic research should always be preceded by a specialist visit, the following examinations are available to the specialist to diagnose the disease and to plan for any surgical intervention:
- Venous EcocolorDoppler
What treatments are available today?
Minivasive surgical treatment of varicose veins.
The invasive treatment of venous reflux and superficial varicose veins improves the quality of life with respect to compressive conservative treatment. Conventional surgical treatment of the large incontinence vein vein has been represented for years by crossectomy (vein ligament and deep venous junction) and stripping (combined with local flebectomy (removal with microchips of varicose veins) .
Over the last decade, mini-invasive techniques, including eco-guided sclerotherapy and intravenous laser ablation have gained popularity in the treatment of varicose veins, and have largely replaced surgery. These new techniques are less invasive than conventional surgery, and are associated with post-operative recovery with faster recovery, less pain, and minor complications such as hematomas, inguinal wound infections, and nerve damage.
What is laser thermoablation?
Laser thermoablative techniques are minivasive procedures performed by endovascular, that is, carried out by navigating inside the venous vessels to be treated (an undercurrent method).
These procedures are aimed at the occlusion of incontinent venous trunk (eg truncated safenicus) using thermoablative methods. In fact, laser energy is converted into thermal energy, which causes inflammation of the venous walls and eventually fibrosis, resulting in obliteration of the vessel.
How does the laser act?
Laser is an acronym that stands for “light amplification by stimulated radiation emission”.
The lasers emit light of very specific features. First, it is a monochromatic light that is generated by a specific wavelength. Specifically, intravenous laser ablation (EVLA) is commonly performed using a wavelength between 810 nm and 1500 nm. Laser light is unique as it is consistent (with all the waves in phase, allowing high energy transfer) and collimated (conveyed to a divergent beam rather than spreading in many directions like light from a light bulb).
Some substances inside the vein, called chromophores, absorb laser photons. Photon absorption induces excitation and molecular dehumidification of the chromophores and thus produces thermal energy from photothermolysis. This thermal energy causes inflammation of the vein walls associated with a permanent occlusion of the vein, which through a complex remodeling process gradually transforms into a fibrous scar.