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Варикоз чем лечить лекарства

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17 августа 2019

Наиболее часто варикоз начинает проявляться после 30 лет, а иногда и раньше — при наличии наследственных и провоцирующих факторов.

Лечение варикоза требует ответственного подхода. Для снижения рисков появления тромбов необходимо восстановить кровообращение в венах и капиллярах, а также проводить терапию, направленную на снижение вязкости крови. Для нормализации работы венозных клапанов необходимо укреплять стенки вен и восстанавливать венозный тонус.

Флавоноиды — природные вещества-ангиопротекторы. Максимальное количество флавоноидов содержится в плодах, окрашенных в красные, бордовые и фиолетовые цвета, в особенности в ягодах шиповника, боярышника, винограда, черники, вишни, малины, голубики, клубники.

Варикозное расширение вен может проявляться по-разному в зависимости от образа жизни человека и его индивидуальных физических особенностей. У кого-то просто отекают ноги, а у кого-то налицо целый комплекс симптомов.

Варикоз — патология глубоких и поверхностных вен, которые по мере прогрессирования заболевания теряют свою эластичность и меняют форму, становясь извитыми и узловатыми.

АНГИОНОРМ ® — лекарственное средство для лечения варикозного расширения вен и симптомов хронической венозной недостаточности.

Узнать больше о препарате.

Если раньше хроническая венозная недостаточность (ХВН) и варикозное расширение вен относились к болезням пожилого возраста, то в наши дни они все больше «молодеют». Вызвано это малоподвижным «офисным» образом жизни современных горожан. Сидячая работа, неправильное питание, отсутствие физических нагрузок — только малая часть факторов, провоцирующих развитие этих неприятных заболеваний.

Какое лекарство для вен лучше?

Можно ли эффективно бороться с варикозной болезнью, называемой в народе просто «варикоз»? Особенно эта тема актуальна для молодых женщин, которые красоте и здоровью своих ног придают огромное значение. Варикозная болезнь и ХВН провоцируют частые судороги и отечность ног, ежевечернюю усталость и боли нижних конечностей. Вовремя начатое лечение позволяет предупредить развитие варикоза и возникновение осложнений — таких, например, как венозный тромбоз — справиться с которыми значительно сложнее, чем с начальной симптоматикой варикоза. Не менее важно не только начать лечение своевременно, при появлении даже незначительных симптомов, но и выбрать правильный подход к нему, позволяющий воздействовать на все нарушения системы венозного кровообращения, которые вызывает варикоз.

Неумолимая статистика утверждает: в нашей стране от патологий ХВН страдает примерно 30 миллионов человек [1] , при этом от 35 до 60% больных относятся к людям трудоспособного возраста [2] .

Часто потенциальные больные не придают значения первым симптомам-предвестникам болезни, поскольку на начальных стадиях они могут быть выражены незначительно. Какие это симптомы?

  1. Отеки лодыжек, стоп, нижней части голеней свидетельствуют о застойных явлениях в сосудах, из-за которых плазма крови попадает в ткани через стенки мелких капилляров. Отеки нередко сопровождаются чувством распирания и тяжести в голенях. Симптом чаще всего проявляется к вечеру.
  2. Сосудистые «сеточки» или «звездочки»телеангиоэктазии.
  3. Парестезии. Больной периодически ощущает онемение, жжение и покалывания в ногах — так называемые мурашки. Обычно это происходит после долгой и значительной статической нагрузки на нижние конечности.
  4. Ночные судороги — еще один предвестник заболевания. Они также могут возникать из-за застоя крови в венах ног. Такое непроизвольное и весьма болезненное сокращение мышц организму необходимо для того, чтобы протолкнуть кровь снизу-вверх по сосудам.

Кроме того, о развитии варикоза свидетельствует постоянное чувство усталости ног. Если к лечению варикоза не приступить на начальных стадиях, то позднее у пациента начинают выступать крупные вены, формируя узлы и извитые тяжи под поверхностью кожи. Трофические нарушения, сопровождающие варикоз и ХВН, приводят к сухости и гиперпигментации кожи ног, ее истончению и постоянному зуду. Осложнениями заболеваний могут стать трофические язвы, трофический дерматит, экземы, острый тромбофлебит и тромбоэмболия легочной артерии.

Терапия заболеваний вен направлена на устранение причин появления болезни, облегчение симптоматики и коррекцию осложнений на поздних стадиях развития заболевания.

Компрессионная терапия основана на действии специального лечебного трикотажа или бинтования эластичными бинтами. Они плотно и равномерно облегают бедро и голень пациента, сужая просветы поверхностных вен ноги, что облегчает нагрузку на стенки вен, снижает вероятность их растягивания и истончения, устраняет риск возникновения тромбов. Кроме того, компрессионные изделия облегчают физическое состояние больного, купируя распирающие боли и постоянное чувство тяжести в ногах.

Хирургические методы применяются на поздних стадиях заболевания. Так, флебэктомия подразумевает удаление расширенных поверхностных вен в тех ситуациях, когда все прочие способы терапии оказались неэффективными. Склеротерапия схожа с флебэктомией, но вена в этом случае удаляется не с помощью хирургических инструментов, а путем введения специальных препаратов. После того, как такой препарат вводится в вену, он склеивает ее стенки и останавливает кровоток в вене.

Однако основой лечения и профилактики варикоза является все-таки медикаментозная терапия. Сочетание медикаментозной терапии с немедикаментозными методами (коррекция образа жизни, гимнастика, диета) и сопутствующей терапией (компрессионный трикотаж) позволяет обеспечить максимальное воздействие как на причину развития варикоза, так и на уменьшение его симптоматических проявлений (боли, тяжести, отеков, судорог в ногах).

Ведущую роль в современном медикаментозном лечении и профилактике варикоза играют системные венотонизирующие средства (венотоники), принимаемые перорально. Механизм их действия направлен на коррекцию нарушений в работе системы венозного кровообращения, которые являются причиной развития варикоза, а именно:

  • нарушения венозного тонуса (работы сосудистых клапанов, которые в норме препятствуют обратному току крови в ногах);
  • истончения и ослабевания стенок сосудов (под давлением крови в венах);
  • сгущения крови (повышения ее вязкости и склонности к образованию тромбов).

Лечебный эффект от применения венотоников в таблетках имеет системный характер — то есть способствует оздоровлению сосудов по всему организму, воздействуя на венозную систему в целом. Благодаря этому системные венотоники, как правило, обладают более выраженным и продолжительным действием на симптомы варикоза — в отличие, к примеру, от наружных венотоников в форме гелей, мазей, которые действуют непродолжительное время и исключительно в месте нанесения.

Системные венотоники — довольно большая группа препаратов. Как правило, большинство из них получено путем переработки лекарственного растительного сырья, ведь наиболее активными ангиопротекторами являются именно компоненты растительного происхождения: флавоноиды (диосмин, гесперидин, авикулярин, кверцетин, рутин и другие), экстракт конского каштана (содержащий эсцин), экстракт шиповника (содержащий витамин С) и другие. Исходя из количества активных ангиопротекторов в составе, все системные венотоники можно разделить на монопрепараты (например, содержащие только флавоноиды, только эсцин или только рутин) и комбинированные, состоящие из нескольких активных ангиопротекторов — например, флавоноиды, усиленные эсцином и витамином С. Преимуществом комбинированных венотоников является то, что они способны оказывать весь комплекс необходимых для лечения варикоза действий «в одной таблетке»: венотонизирующее, ангиопротекторное (укрепление стенок вен и капилляров) и антиагрегантное (снижение вязкости крови).

Активное изучение биофлавоноидов началось в конце 90-х годов прошлого века. Толчком к этому послужил «французский парадокс». Дело в том, что масштабное международное исследование показало, что среди французов смертность от атеросклероза значительно ниже, чем среди представителей других европейских наций. Это было связано с употреблением ими красного вина, в немалом количестве содержащего различные виды флавоноидов. Ученые доказали, что флавоноиды не только препятствуют развитию тромбов, но и оказывают венотонизирующее действие, а значит, способны эффективно применяться в терапии варикоза [3] .

В качестве вспомогательной (сопутствующей) терапии варикоза также могут использоваться и некоторые другие средства.

Нестероидные противовоспалительные препараты: на основе ацетилсалициловой кислоты, диклофенака, а также растения Гинкго Билоба. Их назначают для терапии сопутствующих воспалительных процессов или для симптоматического лечения, направленного на устранение болевых симптомов в ногах при варикозе.

Наружные венотонизирующие средства. К ним относятся мази, гели, кремы для наружного применения, которые помогают облегчить выраженность симптомов варикоза: усталости, тяжести, отечности ног. Самые популярные наружные венотоники — это обычные гели и мази на основе гепарина, троксерутина и др.

Далее в статье мы будем рассматривать системные венотонизирующие средства для лечения варикоза в виде таблеток.

Препараты для лечения сосудов: какие выбрать?

Разнообразие средств для лечения и профилактики варикозной болезни нередко приводит к тому, что человек теряется и не знает, какой именно препарат лучше выбрать. Без сомнения, любое лекарство должно быть назначено врачом, а в случае с варикозом консультация со специалистом просто необходима. При этом врача следует обязательно проинформировать обо всех принимаемых на момент обращения лекарственных средствах, чтобы он мог назначить адекватное лечение с учетом сохранения терапевтического эффекта всех одновременно принимаемых пациентом лекарств.

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Согласно российским и европейским флебологическим стандартам, для системной терапии варикоза обязательно необходим комплексный подход, о котором уже говорилось выше в статье.

  1. Венотонизирующее действие. Дает возможность бороться с несостоятельностью клапанного аппарата сосудов. В норме кровь движется по сосудам ног снизу-вверх — против действия силы земного притяжения. Это происходит благодаря сокращению икроножных мышц в процессе движения и физических нагрузок, а также благодаря наличию специальных клапанов на внутренней поверхности стенки вены, которые препятствуют обратному току крови. Однако под влиянием разного рода провоцирующих факторов клапаны ослабевают и начинают пропускать кровь в обратном направлении. В результате в поверхностных венах скапливается избыточный объем крови, что приводит к постепенному растяжению их стенок.
  2. Ангиопротекторное действие. Направлено на укрепление растянувшихся стенок сосудов — восстановление их упругости и эластичности. Под давлением венозного рефлюкса (патологического сброса крови сверху-вниз) кровь застаивается в венах, стенки сосудов истончаются и жидкость получает возможность проникать в соседние ткани. Возникают отеки, которые, в свою очередь, приводят к нарушению трофики.
  3. Антиагрегантное действие. Направлено на борьбу с трофическими нарушениями и на восстановление реологических показателей крови (снижение ее вязкости и риска образования тромбов). Так называемая густая кровь — это очень частый спутник заболевания, ведь не столько опасен сам варикоз, сколько венозный тромбоз, появляющийся на его фоне. Нарушение тока крови способствует накоплению в мелких кровеносных сосудах продуктов метаболизма, это вызывает сгущение крови и провоцирует появление свободных радикалов и медиаторов воспалительной реакции. Все эти факторы в комплексе ухудшают текучесть крови и приводят к ее сгущению.

В идеале системный венотонизирующий препарат должен работать одновременно во всех направлениях, чтобы достичь наилучшего эффекта без приема дополнительных препаратов. Как правило, это преимущество также обеспечивает более компактный курс лечения (поскольку действует сразу на все аспекты проблемы варикоза) и хорошую экономию средств.

Топ-5 препаратов для лечения варикоза (для внутреннего применения)

В наш список вошли только наиболее известные среди потребителей безрецептурные венотонизирующие препараты, тогда как фактически их, конечно, намного больше.

Монопрепараты, содержащие в своем составе только один вид активных ангиопротекторов:

  • «Детралекс». Препарат на основе флавоноидов диосмина и гесперидина, которые являются производными из плодов цитрусовых [4] . «Детралекс» обладает венотонизирующим действием. Производится в форме таблеток по 500 мг или 1000 мг, а также в виде суспензии 1000 мг/10 мл. При венозно-лимфатической недостаточности препарат принимают во время еды: 2 таблетки по 500 мг в сутки (1 таблетка днем и 1 таблетка вечером) или 1 таблетка/саше по 1000 мг в сутки (утром). Длительность курса определяет врач, но обычно терапия длится от 2 до 12 месяцев, а, значит, лечение «Детралексом» будет стоить от 2200 рублей за курс. Среди противопоказаний — повышенная чувствительность к активным компонентам препарата и грудное вскармливание. К побочным действиям относятся: часто — диарея, тошнота, рвота, диспепсия; редко — колиты, головокружение, головная боль, общее недомогание, сыпь, крапивница, зуд; неуточненной частоты — изолированный отек лица, губ, век, боль в животе; очень редко — ангионевротический отек.
    (Регистрационное удостоверение препарата: № ЛП-003635 от 17.05.2016 г. в Государственном реестре лекарственных средств) [5] .
  • «Венарус» — основными действующими веществами являются диосмин и гесперидин [6] . Препарат выпускается в форме таблеток по 500 мг или 1000 мг, в одной упаковке их может содержаться 30 или 60 штук. Принимают «Венарус» по 1 таблетке 1000 мг или 2 таблетки по 500 мг в сутки во время еды, курс длится от 2 до 12 месяцев. Стоимость упаковки на 30 таблеток по 500 мг — около 500 рублей. Стоимость курса обойдется примерно от 2000 до 12 000 рублей. Противопоказания: повышенная чувствительность к активным компонентам или вспомогательным веществам, входящим в состав препарата, а также не рекомендуется применение в период грудного вскармливания. Побочные явления: редко — головокружение, головная боль, общее недомогание, сыпь, крапивница, зуд, колит; часто — возможно появление диареи, тошноты, рвоты, диспепсии; частота неизвестна — боль в животе, изолированный отек лица, губ, век; очень редко — ангионевротический отек.
    (Регистрационное удостоверение № ЛП-003561 от 21.11.2016 г. в Государственном реестре лекарственных средств) [7] .
  • «Флебодиа 600». Выпускается в форме таблеток. В его составе тот же флавоноид диосмин [8] . Спектр действия аналогичен «Детралексу». Преимуществом препарата «Флебодиа 600» является компактный прием: один раз в день по одной таблетке утром натощак, но при более низкой суточной дозировке флавоноидов (600 мг). Курс приема обычно длится 2 месяца. В одной упаковке препарата находится от 15 до 90 таблеток [9] , стоимость — примерно 500 рублей за упаковку 15 штук. На один двухмесячный курс, следовательно, потребуется потратить около 2000 рублей.
    (Регистрационное удостоверение № П N016081/01 от 10.04.2017 г. в Государственном реестре лекарственных средств) [10] .
  • «Троксевазин» — лекарственный препарат из группы ангиопротекторов. Основное действующее вещество — троксерутин [11] . Выпускается в форме капсул по 300 мг. «Троксевазин» принимают внутрь во время еды по одной капсуле 3 раза в день. Курс лечения 3-4 недели. Стоимость упаковки на 50 капсул — приблизительно 300 рублей. Стоимость курса в среднем колеблется от 500 до 800 рублей. Противопоказан при язвенной болезни желудка и двенадцатиперстной кишки, хроническом гастрите в фазе обострения, при непереносимости компонентов препарата, в первом триместре беременности. С осторожностью следует применять (длительное применение) при почечной недостаточности, а также детям до 15 лет. Препарат не рекомендуется применять во втором и третьем триместре беременности и при грудном вскармливании; исключение — случаи, когда ожидаемая польза для матери преобладает над возможным риском для плода и ребенка. Побочные действия — аллергические реакции, головная боль, эрозивно-язвенные поражения ЖКТ, тошнота, изжога, диарея, а также «приливы» крови к лицу.
    (Регистрационное удостоверение № П N012713/02 от 01.08.2017 г. в Государственном реестре лекарственных средств) [12] .

Комбинированные венотоники, содержащие в составе сразу несколько активных ангиопротекторов и благодаря этому обладающие комплексом действий на все звенья проблемы варикоза:

  • «АНГИОНОРМ» — в настоящий момент единственный лекарственный комплекс, сочетающий венотонизирующую, ангиопротекторную и антиагрегантную активность для лечения варикоза. «АНГИОНОРМ» — это разработка отечественных ученых (НИИ «ФармВИЛАР») с уникальным запатентованным составом: флавоноиды, усиленные экстрактом шиповника (который содержит витамин С и уменьшает проницаемость и хрупкость кровеносных сосудов), боярышника, солодки, конского каштана (который содержит эсцин) [13] . «АНГИОНОРМ» также проявляет стресс-протективную активность, способствует повышению физической работоспособности и проявляет умеренный противоболевой эффект. Из противопоказаний — индивидуальная непереносимость веществ, входящих в состав препарата, тяжелые хронические заболевания почек, печени и ЖКТ с нарушением их функций, не рекомендуется при беременности и в период грудного вскармливания, детям до 18 лет. Удобной упаковки «АНГИОНОРМ» на 100 таблеток хватит на рекомендуемый курс лечения до трех недель, а ее стоимость — всего около 450 рублей. Розничная стоимость курса лечения препаратом «АНГИОНОРМ» — одна из самых низких на отечественном рынке венотоников в таблетках.
    (Регистрационное удостоверение № ЛС-001137 от 15.03.2017 г. в Государственном реестре лекарственных средств).

Если вы уже в группе риска по развитию варикозной болезни, по возможности откажитесь от длительного пребывания на солнце, не сидите по несколько часов в одном положении — даже в офисе постарайтесь найти пару минут на разминку. Обязательно почаще ходите пешком, а если живете на верхнем этаже, откажитесь от лифта и пользуйтесь лестницей — при подъеме кровь хорошо прокачивается по сосудам. Помните, что снизить опасность развития варикозной болезни можно, только изменив образ жизни.

Информация о работе и расписание

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Стационар одной ночи: полное лечение варикоза менее чем за 24 часа.
Вся подробная информация на http://www.surgery-future.ru/hirurgiya-sosudov/flebologiya

Лечение заболеваний вен


В Центре проводится ДИАГНОСТИКА И ЛЕЧЕНИЕ

  • Хронической венозной недостаточности
  • Острых венозных тромбозов (в т.ч. варикотромбофлебита)
  • Варикозной болезни
  • Посттромботической болезни
  • Трофических язв

Комплекс диагностических мероприятий
включает осмотр специалистом-флебологом, выполнение лабораторных исследований, а также инструментальные исследования на комплексе современных высокоинформативных аппаратах (ультразвуковая допплерография, дуплексное ангиосканирование, рентгеноконтрастная флебография, компьютерная томография, магнитно-резонансная томография, по показаниям – ангиографическое исследование).

Ультразвуковое ангиосканирование выявляет зоны патологического рефлюкса и варикозной трансформации, обеспечивает прицельную хирургическую коррекцию


ЛЕЧЕНИЕ ХРОНИЧЕСКОЙ ВЕНОЗНОЙ НЕДОСТАТОЧНОСТИ

БОЛЬ, ТЯЖЕСТЬ, ОТЁКИ ног – первые и наиболее распространённые симптомы такого серьёзного заболевания как хроническая венозная недостаточность (ХВН).
Нарушение венозного кровообращения в нижних конечностях возникает при различных заболеваниях (варикозная болезнь, посттромботическая болезнь, тромбозы, тромбофлебиты, врождённые пороки развития венозной системы), а также при длительных статических нагрузках (положение стоя или сидя), избыточной массе тела, беременности, во время занятий тяжёлыми видами спорта (теннис, футбол, борьба, тяжёлая атлетика). Во время длительных переездов в автомобиле, автобусе, поезде, перелётов в самолёте венозное кровообращение также существенно ухудшается.

Постепенно развиваясь без соответствующего лечения, хроническая венозная недостаточность приводит к развитию трофических язв, однако наиболее грозным осложнением этого заболевания является тромбоз глубоких вен нижних конечностей зачастую приводящий к развитию тромбоэмболии лёгочной артерии, что может привести к смерти пациента.

При появлении первых признаков хронической венозной недостаточности (боль, тяжесть, отёки ног) следует обратиться к специалисту – флебологу!

В нашем Центре возможно проведение любого вида лечения по поводу хронических и острых заболеваний вен.

Консервативное лечение хронической венозной недостаточности:

  • медикаментозная терапия, компрессионное лечение, местное хирургическое лечение (при язвах),
  • физиотерапия и восстановительное лечение (совместно со специалистами Восстановительного медицинского центра),
  • ультразвуковая диагностика и малоинвазивная коррекция патологического венозного рефлюкса

ЛЕЧЕНИЕ ВАРИКОЗНОЙ БОЛЕЗНИ

Варикозная болезнь – одно из самых распространённых заболеваний. По разным данным ей страдают от 25% до 50% взрослого населения России. Заболевание чаще всего проявляется видимыми расширенными подкожными венами, но это лишь «вершина айсберга». Такие симптомы как боль и тяжесть в ногах (особенно в вечернее время), отёки, судороги также могут свидетельствовать о начинающемся заболевании. Предрасполагающих к появлению варикозной болезни факторов очень много. В первую очередь это наследственная предрасположенность, интенсивные физические нагрузки, длительные статические нагрузки (длительное положение стоя или сидя без движений – сидячий образ жизни, работы). Беременность и роды, в особенности неоднократные, длительный приём гормональных контрацептивов также являются существенным фактором риска развития варикозной болезни. Часто заболевание начинает проявлять себя лишь незначительной вечерней усталостью ног. Потом постепенно эти ощущения усиливаются, появляются вечерние боли, отёки, исчезающие с утра и вновь появляющиеся к вечеру. Постепенно симптомы нарастают, начинают беспокоить вечерние и ночные судороги мышц ног. И всё это время болезнь может никак не проявлять себя внешне – нет никаких варикозно расширенных вен, лишь несколько небольших сосудистых звёздочек.

Суть заболевания заключается в расширении подкожных вен и нарушении работы их клапанов, в результате чего сильно затрудняется отток крови от нижних конечностей, увеличивается венозное давление, возникает застой крови и жидкости в ногах. Эти нарушения кровообращения со временем приводят к развитию осложнений варикозной болезни, таким как трофические язвы и тромбофлебиты подкожных вен. Тромбофлебит подкожных вен (образование тромбов в варикозных венах ног) самое грозное осложнение варикозной болезни. При его распространении на глубокие вены ног фрагменты тромба могут отрываться и приводить к тромбоэмболии лёгочной артерии – летальность (смертность) после таких осложнений крайне высокая. Лечение острых тромбофлебитов в большинстве случаев хирургическое и проводится в экстренном порядке. Образование тромбов в венах процесс достаточно быстрый и практически непредсказуемый, способный создать множество проблем человеку, страдающему варикозной болезнью, а порой привести и к прискорбным последствиям. Трофические язвы – длительно не заживающая рана, обычно в нижней трети голени по внутренней поверхности – крайне неприятное осложнение варикозного расширения вен, сопровождающееся выраженными болями и неприятным запахом. Причиной их также является нарушение кровообращения в нижних конечностях – венозного стаза и нарушения микроциркуляции (кровообращения в мелких сосудах и капиллярах). Их лечение обычно достаточно длительное и затратное.

Диагностика варикозного расширения вен и его осложнений в настоящее время возможна только при выполнении соответствующего ультразвукового исследования (ультразвуковое ангиосканирование сосудов нижних конечностей) так как визуально можно выявить лишь часть изменений, а для планирования и проведения адекватного лечения требуется всеобъемлющая информация.

Лечение варикозной болезни на данном этапе развития хирургии многообразно. В настоящее время уже успели хорошо себя зарекомендовать современные малоинвазивные и малотравматичные методы – такие как ЭНДОВЕНОЗНАЯ ЛАЗЕРНАЯ КОАГУЛЯЦИЯ и РАДИОЧАСТОТНАЯ ОККЛЮЗИЯ. Это методики принцип которых заключается в том, что вместо удаления варикозно расширенных вен в их просвет через прокол кожи вводится специальный катетер, при помощи которого лазерным или радиочастотным излучением вена «заваривается» без удаления. Эти методики не требуют общей и даже спинальной анестезии – выполняются под местным обезболиванием. Они отличаются крайне малой степенью травматизации – практически отсутствуют болевые ощущения как в процессе выполнения манипуляции, так и в постманипуляционном периоде. Травма настолько мала, что в день выполнения манипуляции пациент может быть отпущен домой и даже выйти на работу.

Преимущества этих методик заключаются в их высокой эффективности (не ниже чем у хирургических вмешательств), крайне малой травматичности и выполнения под местной анестезией, что делает возможным амбулаторное, то есть без госпитализации, их выполнение и практически не меняет привычного образа жизни пациента (исключение составляют длительные физические нагрузки и высокотемпературные процедуры – бани, сауны, горячие ванны). Осложнения после такого рода вмешательств крайне редки, а рецидивы встречаются не чаще, чем после классических хирургических операций. Не стоит забывать и о косметической привлекательности данных вмешательств. Манипуляции выполняются пункционно, то есть без разрезов, что позволяет ликвидировать варикозные вены практически не оставив на коже никаких следов проведенного лечения (нет разрезов – нет шрамов).

Единственными ограничениями в использовании этих методик являются слишком большие варикозные вены и сильно извитые вены. В первом случае лечение можно проводить лишь с использованием современных модификаций флебэктомии (удаление вен), техника выполнения которых отработана для максимального снижения операционной травмы при сохранении полного объёма удаления варикозных вен, а во втором на помощь флебологу приходит современная модификация склеротерапии, так называемая пенная (foam-form) склеротерапия, при которой в варикозные вены под контролем ультразвука вводится специальный препарат (склерозант) в пенной форме, который вытесняет из вены кровь и «заклеивает её».
Ещё одним важным преимуществом современных эндовенозных вмешательств является и то, что все они выполняются под контролем ультразвука – хирург полностью контролирует ход и объём выполняемой манипуляции, что существенно снижает риски возможных осложнений лечения и рецидива заболевания.

Для лечения варикозной болезни нижних конечностей в нашем Центре также применяются следующие методы:

Компрессионная склеротерапия – метод лечения телеангиэктазий («сосудистых звёздочек»), так же широко применяемый в качестве альтернативного хирургическому методу лечения варикозной болезни. Не требует анестезии, практически безболезненен, выполняется амбулаторно. Максимально эффективен при использовании на ранних стадиях варикозной болезни.
Метод склеротерапии заключается в введении в вену лекарственного препарата – склерозанта (фибро-вейн, этоксисклерол) в виде жидкого раствора или микродисперстной пены, который «пломбирует» вену, склеивая её изнутри. Кровоток по вене прекращается. С течением времени вена замещается соединительной тканью – рассасывается (склерозируется).
Для лечения варикозной болезни используется, так называемая, ЭХО-склеротерапия. Т.е. введение препарата в варикозно изменённые вены производится под контролем ультразвукового исследования, что обеспечивает максимально точное выполнение манипуляции, а следовательно позволяет добиться хороших результатов при минимальном количестве осложнений и рецидивов заболевания.

ЭВЛК – метод лечения варикозной болезни обладающий высокой эффективностью и крайне малой травматичностью, также следует отметить и высокую косметичность метода.

Суть ЭВЛК заключается в том, что под ультразвуковым контролем и местной анестезией (обычно расствором лидокаина) пункционным способом или через мини разрез в вену вводится специальный катетер и световод, после чего включается лазерное излучение при помощи которого вена «коагулируется» (заваривается) изнутри, кровоток по вене прекращается. В течение последующих 2-3 дней отмечается появление экхимозов (синяков), плотного шнуровидного тяжа (коагулированной вены) в области поведения операции.

РЧО (радиочастотная окклюзия) — метод лечения варикозной болезни обладающий высокой эффективностью и крайне малой травматичностью, также следует отметить и высокую косметичность метода.
Суть РЧО заключается в том, что под ультразвуковым контролем и местной анестезией (обычно расствором лидокаина) пункционным способом или через мини-разрез в вену вводится специальный катетер (РЧО-электрод), при помощи которого вена «сваривается» изнутри, кровоток по вене прекращается.

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Считается наиболее надёжным и стандартизованным среди всех малоинвазивных эндовенозных методов лечения варикозной болезни.

Флебэктомия – классическая методика оперативного лечения варикозной болезни при которой варикозно расширенные вены удаляются из отдельных разрезов и проколов кожи с использованием специализированного хирургического инструментария.

Минифлебэктомия – методика при которой удаление варикозно расширенных вен выполняется через отдельные проколы кожи (в некоторых случаях возможно её выполнение через проколы кожи иглой 18G – 1 мм в диаметре)

Криофлебэкстракция – метод флебэктомии «минус разрез», при котором после выделения вены из разреза в неё вводится криозонд, дистальный (дальний) конец вены примораживается к зонду, после чего вена удаляется.

Аппаратная флебэктомия системой TriVex – используется для малоинвазивного и косметичного удаления больших конгломератов варикозно изменённых вен.

Современные малоинвазивные методики лечения варикозной болезни позволяют комплексно подходить к решению проблем каждого конкретного пациента в индивидуальном порядке, а использующаяся в процессе манипуляции ультразвуковая навигация ещё более способствует улучшению результатов лечения.
Лечение варикозной болезни на ранних стадиях гораздо более эффективное и гораздо менее травматичное с высоким эстетическим результатом.

До После

ЛЕЧЕНИЕ ВЕНОЗНОГО ТРОМБОЗА

Варикозное расширение вен требует тщательного лечения. Связано это с тем, что заболевание опасно не косметическими дефектами, а своими последствиями в виде тромбозов или трофическими нарушениями. Лечение варикоза вен на ногах мед препаратами используется в качестве комбинированной терапии заболевания. Медикаментозные средства широко применимы в качестве профилактики варикоза, а также при предоперационной подготовке и в послеоперационном периоде. Лекарственные препараты, применяемые при заболевании, разнообразны и оказывают различные влияния на организм человека.

Когда применяются мед препараты

Лечение варикозного расширения вен – проблема №1 для тех, кто страдает данным заболеванием. Лучшая терапия варикоза – радикальное лечение, которое заключается в удалении пораженных сосудов следующими методами:

Лечение варикоза мед препаратами – терапия профилактическая или вторичная. Если варикоз уже появился, то лекарственные средства помогут замедлить его распространение или применяться в качестве дальнейшей профилактики заболевания после радикального лечения. В качестве комбинированного лечения, медикаментозные препараты незаменимы.

Группы мед препаратов, применяемых при лечении варикозного расширения вен:

  • флеботоники;
  • венотоники;
  • антикоагулянты;
  • нестероидные противовоспалительные мед препараты;
  • дезагреганты;
  • фибринолитики;
  • антиоксиданты.

Флеботоники — венотонизирующие средства от варикоза

Флеботоники – фармакологическая группа препаратов для лечения варикозной болезни на ногах. Фармакологическое действие данных лекарств направлено на улучшение венозного оттока путем воздействия на микроциркуляторное русло. Мед препараты данной группы могут применяться в виде таблеток, гелей, мазей.

Флеботоники применяются для:

  • улучшения кровообращения;
  • улучшения лимфооттока;
  • противовоспалительного эффекта;
  • повышения эластичности сосудов;
  • разжижения крови;
  • профилактики хронической венозной недостаточности;
  • предоперационная подготовка;
  • реабилитационный период после оперативного лечения.

Показания при назначении флеботоников:

  • варикозное расширение вен;
  • венозный тромбоз;
  • ХВН, или хроническая венозная недостаточность;
  • флебопатия;
  • посттромбофлебический синдром.

Противопоказания для назначения флеботоников:

  • заболевания пищеварительной системы в стадии декомпенсации;
  • аллергические реакции на компоненты мед препарата;
  • почечная недостаточность;
  • хронические заболевания сердечно-сосудистой и почечной систем;
  • острые инфекционные процессы;
  • новообразования различной локализации;
  • ограничено в период беременности и лактации.

Наиболее часто применяемые флеботоники:

Наибольшее распространение получил Детралекс, так как возможно его применение у беременных женщин для лечения ног, а из противопоказаний отмечается индивидуальная непереносимость. Мед препарат оказывает улучшение венозного кровообращения, улучшает ток лимфы и повышает тонус сосудистой стенки.

О видах флеботоников и наиболее эффективных представителях в виде таблеток и мазей говорится в этой статье.

Венотоники при варикозном расширении

Венотоники при варикозе вен ног помогают нормализовать кровенаполнение сосудов за счет улучшения тонуса сосудов. Венотоники могут применяться в виде таблеток, мазей, гелей, бальзамов, кремов.

Показания к применению:

  • варикозное расширение вен;
  • хроническая венозная недостаточность;
  • предоперационная подготовка;
  • послеоперационный период;
  • купирование симптомов заболевания в виде отеков, тяжести в ногах, болей в нижних конечностях.

Механизм действия мед препаратов для лечения ног данной группы основан на поливалентном действии. При этом нормализуется кровоток и происходит улучшение оттока лимфы. Эффекты достигаются за счет повышения сосудистого напряжения и снижении проницаемости стенок сосудов.

По механизму выраженности действия венотоники подразделяются на:

  1. Препараты, воздействующие на сосудистый тонус. В основе данной группы лежит иглица шиповатая;
  2. Препараты, улучшающие кровоток. В основе данной группы лежит экстракт конского каштана.

Наиболее распространенные венотоники для лечения варикоза на ногах:

Об особенностях применения этой группы лекарств, классификации и наиболее эффективных в лечении представителей можете узнать из этой статьи.

Антикоагулянты — кроворазжижающие средства

Широко при мед лечении варикоза вен ног применяются антикоагулянты, или лекарственные препараты, изменяющие вязкость крови путем угнетения свертываемости ее.

Выделяют 2 группы антикоагулянтов:

  1. Прямого действия;
  2. Непрямого действия.

Механизм работы антикоагулянтов прямого действия основан на торможении выработки тромбина путем инактивации факторов свертываемости крови и каллекреина. Применение данной мед группы препаратов при лечении ног требует тщательного контроля за коагулограммой, что позволяет избежать развития кровотечения.

Механизм работы антикоагулянтов непрямого действия основан на инактивации синтеза протромбина. При этом инактивируются побочные ферменты, не затрагивая непосредственно тромбин.

Классифицируют антикоагулянты следующим образом:

Антикоагулянты Прямого действия Непрямого действия
Группа Представители Группа Представители
Гепарины Гепарин Монокумарины Варфарин
Низкомолекулярные гепарины Эноксапарин:Клексан, Новопарин, Фленокс

Бемипарин: Цибор

Индандионы Фениндион Гирудин Фондапаринукс: Арикстра

Дикумарины Неодикумарин

ФепромаронСинкумар

Натрий гидроцитрат Натрий гидроцитрат Лепирудин Рекомбинантное производное гирудина Данапароид Смесь аминогликозидов

Показания к назначению антикоагулянтов:

  • варикозное расширение вен;
  • повышенный риск тромбообразования;
  • сопутствующие заболевания сердечно-сосудистой системы;
  • наличие заменных сердечных клапанов;
  • инфаркт миокарда;
  • тромбофлебит нижних конечностей;
  • предоперационная подготовка;
  • послеоперационный период.

Противопоказаниями для назначения антикоагулянтов является:

  • аневризма внутримозговая;
  • язвенная болезнь желудка или двенадцатиперстной кишки;
  • тромбоцитопении;
  • новообразования любой локализации;
  • гиповитаминоз К;
  • лейкозы;
  • почечная и печеночная недостаточности;
  • артериальная или почечная гипертензии;
  • болезнь Крона.

Нестероидные противовоспалительные мед препараты

В мед терапии варикоза вен на ногах применяются нестероидные противовоспалительные мед препараты.

Механизм их лечения заключается в:

  • противовоспалительном эффекте на стенки пораженных сосудов;
  • обезболивающем действии;
  • снижении отеков нижних конечностей;
  • снижении тромбообразования.

Среди НПВС наибольшее распространение получили:

  • Диклофенак в виде таблеток, мази, геля или раствора для инъекций;
  • Индометацин в виде геля, таблеток или раствора для инъекций.

Дезагреганты в лечении варикоза вен

Дезагреганты при варикозном расширении вен способны оказывать снижение агрегации тромбоцитов, что ведет к снижению риска образования тромбов в венах ног и других частей тела. Наиболее часто используемый для лечения мед препарат из данной группы – Аспирин, или Ацетилсалициловая кислота.

Кроме того, группа дезагрегантов включает в себя:

  • противоподагрические лекарственные средства;
  • сосудорасширяющие;
  • спазмолитические;
  • реополиглюкин, являющийся заменителем крови.

Из препаратов следует выделить:

  • Аспирин, Кардиомагнил, которые нарушают метаболизм арахидоновой кислоты;
  • Тиклопиридин, Клопидогрель, изменяющие агрегацию тромбоцитов;
  • Тирофибан, который является ингибитором гликопротеидов;
  • Дипиридамол, оказывающий сосудорасширяющее действие;
  • Абциксимаб, образующий антитела к гликопротеидам;
  • Эптифибатит, нарушающий агрегацию тромбоцитов.

Данная лечебная мед группа применяется в совокупности с другими лекарствами в качестве вспомогательной терапии. Особенность данной группы препаратов заключается в более позднем начале действия, которое сохраняется длительное время после отмены препарата.

Фибринолитики при варикозе на ногах

При варикозе на ногах применяются фибринолитические препараты. Механизм их действия направлен на то, чтобы снизить риск развития тромбоза вен, а также оказать разрушительное действие на уже образовавшиеся тромбы. В результате приема фибринолитиков происходит растворение фибринового тромба различной локализации.

Прием фибринолитиков показан при:

  • остром периоде инфаркта миокарда;
  • ТЭЛА, или тромбоэмболии легочной артерии;
  • тромбозе крупных артерий;
  • тромбоз глубоких вен нижних конечностей.

При явлениях наружного или внутреннего кровотечения прием данной группы препаратов противопоказан, так как это ведет к массивной кровопотери из-за отсутствия образования тромбов.

Из наиболее распространенных используются следующие препараты:

Антиоксиданты для лечения варикозного расширения вен

В лечении варикоза вен на ногах мед препаратами особую нишу занимают антиоксиданты. Данная группа препаратов оказывает сосудоукрепляющее действие, что позволяет оказать противоотечный и противовоспалительный эффекты. Применяются антиоксиданты в комплексной терапии варикозной болезни.

Из препаратов применяется:

Выбор лекарства для эффективного лечение — задача врача. Обязательно обратитесь к специалисту за назначением. Только в этом случае возможно быстрое избавление от недуга.

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