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Golden rules in the treatment of varicoses

Venous insufficiency, which is the basic mechanism in the development of varicose, is the one-way only valve that carries the blood flow to the heart, which is inside the veins carrying dirty blood from the leg, and the blood flows backwards.

This leak in the valves; It can develop depending on reasons such as genetics, lifestyle, pregnancy, obesity. While structural disorders develop in the tissue of the valve due to genetic and hormonal reasons, there is an increase in intra-abdominal pressure due to obesity and weakness of the muscles around the vessels.

In addition, people in the profession group, who require standing for a long time, have blood on the leg, vein expand, and valves flap the blood back. This leak expands the vein more and the leak increases even more. Accordingly, varicose, edema and skin changes develop in the following process.

In addition to the appearance disorder, varicose veins cause problems such as pain, swelling, cramping and intravascular coagulation. The quality of life of those who depend on varicose veins also decreases considerably. Especially during standing, an intolerance develops due to blood ponding in the leg.

Our venous insufficiency and varicose veins must be treated in terms of our quality of life and health. However, there are rules to be followed that increase the success rate during treatment. An important part of varicose treatments performed without following these rules can do more harm than good.


  1. Leaks causing varicose veins should be revealed before treatment.

Patients presenting with venous insufficiency complaints such as varicose veins, pain and edema should be evaluated with Doppler ultrasonography before treatment. Whether the vein are clogged, leaks in the valves, and their degree should be determined.

This evaluation should be done by the physician who will perform the treatment, and if any intervention is planned, a Doppler examination should be performed by a radiologist experienced in venous Doppler evaluation. In complicated cases where sometimes Doppler ultrasound is insufficient, further investigations should be performed with tomography or MR angiography.

  1. In deciding on treatment in children or adolescents, further investigations should be made for the intra-abdominal area, as well as doppler examination.
  2. The treatment method to be applied should not be limited to the skills of the doctor.

Surgical treatments for varicose veins have been removed for about a hundred years, and the part of the vessel with a leak is removed. However, since a large number of complications can develop due to this method, less invasive new techniques have been developed. Among these techniques are intravenous laser, radiofrequency and adhesive applications. Today, intravenous laser and adhesive applications have started to replace surgical treatments all over the world.

  1. The patient should be able to return to normal life in a very short time.

In recent years, endovenous treatments (laser, adhesive), which are applied under local anesthesia, patients can return to their normal daily life in a shorter time. There are fewer complications after treatment and the long-term success rate is quite high.

  1. After the leak is eliminated, varicose veins should be eliminated with microsurgery or foam treatment.

After the procedures to eliminate the leakage that is the cause of these varices, small varicose veins in the leg may disappear between 6 and 12 months due to pressure drop. However, 30% of heirs can remain unchanged. Therefore, after laser treatment for leakage in the lids, varicose veins should be removed with microsurgical interventions in the same session. With this technique, varicose veins are removed with 1mm incisions and there is no trace left after the procedure. With this application, venous insufficiency and varicose vein treatment should be provided in a very short time.

  1. Very large heirs should be treated even if they do not cause a complaint

The common cause of large varicose veins is severe valve insufficiency. Depending on this, the blood will pond in the leg and cause clotting. In these patients, pulmonary embolism, a blood clot and a fatal complication associated with it, may develop following travel, operations, or procedures that require its immobility.

  1. If varicose veins in the leg are accompanied by varicose veins, research should also be carried out in the abdomen for the source of the leak.

Often, varicose veins in the genital area are accompanied, especially in patients who develop varicose veins due to birth. It will not be the right approach to treat these patients only by looking for leaks in the leg veins. In these cases, advanced examinations such as MR angiography should be performed in the abdomen, and leaks and varices in the abdomen should be detected.

  1. Treatment methods should be combined for an effective approach.

In a patient with superficial capillary varices, the varices will recur in a short time if we apply foam treatment to the leak without laser. In other words, the patient's leakage will be eliminated first, large varicose veins will be removed with microsurgery in the same session and foam treatment will be applied to small or capillary varices after approximately 1.5-2 months.

  1. In patients with varicose veins accompanied by venous ulcers, after the leaks are removed, they must wear varicose stockings until the wounds disappear completely.
  2. Lifestyle arrangements for new venous insufficiency must be made to reduce relapses after treatment. Sports and nutrition habits are the leading ones.

ANTALYA Varicose Veins /Dr.İlhan Gölbaşı

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