There are veins (veins) that carry the dirty blood in our body to the heart and lungs for cleaning. Since the leg veins perform these functions from the bottom up, that is, against gravity, there are valves inside them that work in one direction. The deterioration and retraction of these valves is called venous insufficiency. Symptoms of venous insufficiency are also called varicose veins.

Sedentary lifestyle can lead to varicose veins …

During the pandemic, people had to restrict their movements preferably or necessarily. When the remote working system, curfews and the natural lifestyle of the winter months come together, people spend most of their time in closed areas. This can lead to venous insufficiency. When immobile, the function of the valves in the veins in the legs (veins) can be disrupted, the massage effect of the calf muscle on the veins may decrease, and weight gain in addition to this can lead to venous insufficiency and varicose veins.

How is venous insufficiency recognized?

It is very important for individuals to be conscious about this issue in the diagnosis of venous insufficiency. The first symptoms are swelling in the ankles or sock rubber marks, noticing the veins that may have different diameters from capillary to thick in the legs, feeling uneasy. In such cases, complaints should be shared with a cardiovascular surgeon, the leg should be examined and a very detailed leg ultrasound examination called venous doppler should be performed.

Venous insufficiency can occur at any age.

Venous insufficiency is not a problem of old age and can be encountered at any age. Although the hereditary aspect is important, someone in his family who has not been diagnosed with venous insufficiency before may also show symptoms. There is a possibility of developing the disease in those who have occupational, vital or health reasons that will prepare the ground for the formation of the disease we mentioned earlier. Various studies have shown that the incidence of varicose veins in women is 70-80% and in men 30-40%.

If venous insufficiency is not treated, there is a risk of pulmonary embolism.

When venous insufficiency is not treated, it may predispose to clot formation in the leg veins. If such a clot breaks out of its location, whether in the main veins (deep venous thrombus-DVT) located in the innermost parts of our legs, or in more superficial veins, the first target to reach is the lungs. This is called a pulmonary embolism (clot in the lung). Pulmonary embolism is a very serious picture and creates a vital risk.

There are different treatment methods according to the condition of varicose veins.

While ‘superficial foam sclerotherapy (VFS)’ is used for the treatment of capillary varicose veins, varicose veins with a diameter of more than 5mm, which can be defined as ‘spaghetti-like veins’, are removed by ‘ambulatory phlebectomy (AP)’ method under local anesthesia through 1mm incisions. Laser applications in the superficial treatment of capillary varicose veins should be applied in addition to superficial foam sclerotherapy, when necessary, and should not be used as a first choice, since it is painful and causes burn marks if the vessel diameter is large.

Under general or epidural anesthesia, EVTA has replaced the surgery called ‘stripping’, which aims to remove the vein throughout the incisions that require stitches. “Endovenous Truncal Ablation (EVTA)” is the injection of high energy or an adhesive into the vein that causes venous insufficiency by slipping the valves back.

In the EVTA method, in the awake patient, under local anesthesia, a 1mm diameter catheter (thin plastic tube) is given high energy or an adhesive is injected into the relevant vein. Radiofrequency or laser is often preferred as a high energy source. Adhesive injection is a recently described and promising method. Although the short-term results are known, the long-term results are not known and the number of cases is low, so radiofrequency and laser technologies have not become common. As a result, no matter what form it takes, the vessel that is closed and canceled from the inside is absorbed and destroyed by the body within 8-12 months, and instead, the side and healthy veins are immediately activated. Since the deep veins that carry the blood back to the heart are not touched, there is no problem arising from the absence of the canceled vein.

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