Simple superficial varicose veins of lower limbs refer to lesions confined to superficial veins of lower limbs, including great saphenous vein, small saphenous vein and their branches. Most patients occurred in the great saphenous vein, which was clinically diagnosed as varicose veins. The superficial vein of the lesion is elongated, dilated and winding, which mostly occurs in people who have been engaged in standing work and manual labor for a long time. Simple varicose veins of lower limbs are generally mild, and surgical treatment can often achieve better results.

Etiology: The first pair of superficial vein valves (femoral saphenous vein valves) are mostly incomplete, and the blood flow of superficial veins is reversed due to the increase of venous pressure in lower limbs. Secondly, the weak congenital vein wall is also an important reason. Patients often have systemic or localized venous wall defects. When the venous pressure increases, the veins will dilate in a tortuous way. Finally, long-term standing, obesity, abdominal pressure and other factors can increase venous pressure and increase the possibility of varicose veins.

Treatment:

1. Traditional surgical treatment

(1) The treatment of varicose veins of great saphenous vein is mainly high ligation and stripping.

(2) If the great saphenous vein is nonfunctional and the communicating branches and deep veins are normal, high ligation can be performed to cut off the great saphenous vein and its branches.

(3) For patients with valve insufficiency of great saphenous vein and communicating branch valve insufficiency, besides the above operations, the abnormal communicating branch should be ligated and cut off, or the great saphenous vein should be stripped.

(4) If there is reflux when saphenous vein enters popliteal vein, the entrance section can be ligated and removed, and the distal section can be stripped or injected with sclerosing agent.

2. The following situations can be treated by wearing elastic socks.

(1) Systemic diseases, such as active hepatitis, progressive tuberculosis, uncontrolled diabetes, serious heart or kidney diseases, etc.

(2) Local diseases, such as deep vein occlusion, pelvic or abdominal tumor, acute phlebitis, leg ulcer complicated with cellulitis.

(3) Patients who are too old during pregnancy and then start venous fistula.

3. Minimally invasive treatment

Traditional surgical methods are radical, but there are many shortcomings, such as many surgical incisions, great trauma, time-consuming recovery, and aesthetic impact. Therefore, in recent ten years, there have been a lot of new methods to treat minor trauma, such as sclerosing agent, laser sealing, radiofrequency ablation, transparent rotary cutting with cold light source, microwave therapy, catheter electrocoagulation, etc., which have achieved good results and provided patients with more choices that meet individual needs.

(1) sclerotherapy

Principle: The contact between sclerosing agent and vein endothelium leads to local inflammation and adhesion of blood vessels and occlusion of filling veins.

Commonly used hardeners are: 5% sodium morrhuate, 5% sodium oleate-ethoxide and 1% ~ 3% sodium tetradecyl sulfate.

Suitable for: small-scale localized varicose veins, or only communicating branch valve insufficiency, or partial varicose veins left after operation, or local recurrence after operation, and sclerosing agent injection therapy is suitable.

Operation method: the patient stands to make varicose veins full. At the predetermined injection site, the short inclined needle is used to pierce the blood vessel, and then the patient is instructed to lie flat, and the affected limb is slowly raised, and the injection needle is fixed to make it motionless. After the blood in the varicose vein is completely driven out, press the upper and lower ends of the vein tightly with your fingers, then slowly inject sclerosing agent, massage the injection site with gauze, and wrap it with elastic bandage from toe to knee for 2-3 weeks. The patient is required to walk as usual after the injection.

(2) endovenous laser closure

Principle: The laser fiber is placed in the main cavity of superficial vein, and its end touches the vein wall and blood, resulting in photothermal effect. On the one hand, it causes damage to the inner wall of vein and structural destruction, on the other hand, it causes local thrombosis, which leads to venous fibrosis and thromboembolism, and then leads to venous closure.

Applicability: For mild to moderate varicose veins, the effect is not good for severe varicose veins (some scholars suggest that the diameter of varicose veins is 8mm).

Main steps: puncture the vein above the medial malleolus, place the sheath tube, place the catheter tip below the intersection of the saphenous strands, place the laser fiber in a proper position through the catheter, extract the fiber tip of the catheter line, set the laser to a continuous emission state, slowly extract the fiber and catheter, and stop the laser emission before puncture.

(3) radiofrequency closure of vein

Principle: Basically the same as laser sealing, this method generates heat energy by radio frequency, which leads to thermal coagulation and structural destruction of protein fibers in vein wall, and then fibrosis, degeneration and contracture.

The application scope and operation steps are basically the same as laser sealing.

Features: the penetration distance of heat energy is shorter than that of laser, and the attenuation speed of heat energy is faster than that of laser, which can greatly avoid the side effects brought by high temperature, such as nerve injury and vein rupture.

Note: Patients with devices such as pacemakers should use this method with caution.