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 VARICOSE DISEASE AND VENOUS INSUFFICIENCY – PROFESSIONAL ADVICES 
Tristan Peradze, Medical Doctor, Academician
Head of the angiology and Reconstructive Surgery Clinic of
National Surgery Center named K. Eristavi
 
  
Coresp. Mr. Tristan, can you please specify what have conditioned such a high prevalence of these diseases? Bases on the data the number of people with venous insufficiency is increasing. According to widespread information every 4th woman and every 10th man suffer from one of the forms of this disease. Dose this information correspond to reality? 
 
T.P. This is a many-sided problem. First of all we should acknowledge that this is purely “human” disease, contributed vertical position of our body. Yes, you should not be astonished; this disease does not meet in animals. Their bodies align horizontally and venous blood flows towards the heart without   any resistance. In contrast, human venous blood from the lower extremities should pass through the vertically aligned inferior vena cava, before it reaches the heart. The lower extremity venous valves have to bear weight of this whole column of blood; but as these valves are not foreseen for such pressure, they become incompetent because of dilatation of vein. If valves permit blood to move to only one direction in the health vein, incompetent valve permits backflow of the venous blood which accumulates in the lower extremity and leads to “bouquet” of complications.
 
coresp.  If the venouse insufficiency is the disease of vertical walk why do not all of us suffer from it? Correspondingly, what is the contributing  factor for its development?
 
T.P.  I do not think there is any man or woman, who has not experienced heaviness in legs after long standing or sitting position.   This feeling of heaviness is caused by impeding venous blood flow in the vertical position. However several factors should be coincide to form the disease.
First – is inherited predisposition, specifically, congenital weakness of venous valves. This is the only causative factor, which does not depend on the lifestyle of the patient. Frequently there are some other persons suffering from this disease among the relatives of the patient.
The predisposing factors are:
Pregnancy – again if we refer our attention to our “friends” with four legs, it is obvious that fetus compress the anterior wall of the abdomen and practically does not make any problem to the venous flow. In contrast, fetus compresses the pelvic cavity and hampers the venous flow from the lower extremities. This is the reason for higher prevalence of variocous disease in women compared to men.
Obesity – due to compromising venous flow
Prolonged standing and sitting without movement – contraction of lower extremity muscles is the main factor aiding in expulsion of blood from the legs. During prolonged standing or sitting without movement, when the muscles do not contract the venous congestion deepens.  
Hot bath, influence of warmth and sun on the extremities – widens veins.   
Some medications – contraceptive pills for example.
 
corresp. I have often met people with legs overloaded with venous nodules. They do not complain of pain, only of   heaviness. My friend also suffers from this disease but she considers it to be a cosmetic problem only, but you speak about dangerous complication.
 
T.P. Venous insufficiency is manifested by feeling of heaviness, which worsens with prolonged standing and/or sitting, sharp, abrupt pain develops lately, with skin itching and burning sensation and night muscle cramps. It is important that number and size of venous varices does not represent the severity of the disease. Small varices and mild swelling may lead to severe complications. This is one of the most perfidious diseases. Its perfidy is represented in its “not bothering” nature. 
Even in the advanced disease, when the serious complications are unavoidable, patient may not concern any discomfort or pain. Also, in the consequence of our Georgian careless nature, we do not refer to physician, before the disease does not bother us too much, and frequently this “too much” is already too late; and complications of venous insufficiency are sorrowful: 
Tropic ulcer: this is a non-healing lesion on the internal side of the leg in the area of malleolus. Skin darkens and pigment spots appear first and in the center of this spots ulcer forms at last.
I have heard many “folk” methods of ulcer treatment. I even have met a quite strange “receipts” of medications. The wide spreading of such “magic ointments” is due again to the perfidious nature of the disease – ulcers periodically heal themselves even without treatment and this fact is awarded to these ointments.   I can tell you, that healing of the ulcer is stimulated not by the ointment but by tight bandage of the leg. However, without adequate treatment, ulcer will inevitably remit with the bigger size and complicated form. 
Insufficiency of deep veins, thrombosis and post-thrombotic syndrome – people call this syndrome as transmission of the disease into the deep veins. This expression is quite near to the reality. Deep veins cannot bear blood returned by the superficial veins, they become overloaded and their valves damaged.   
For this time, legs become swollen and cramps and pain become more severe. Sever insufficiency of deep veins may also be caused by thrombophlebitis. This disease begins with elevation of temperature and leg swelling. Skin may take purple color. The reason of this condition is venous inflammation of infectious etiology and obliteration of the vessel lumen by masses of thrombi, which leads to impeding venous blood flow. The unfavorable result of this complication is that even after the adequate treatment the severe venous insufficiency remains with constant leg swelling, skin darkening and ulcer formation. To say in other words, deep vein insufficiency and deep vein thrombophlebitis are the complications development of which we should not wait. Because, if there is good treatment outcome before the complications development, outcome worsens after they form.   
The most dangerous complication is thromboembolism. We often hear “he had thromb attack”. This thrombi may originate and torn away from venous wall during thrombophlebitis and as it does not meet any resistance on its way it will flow to the pulmonary artery and obliterate it. This is so called “shock producing zone” and if the thrombus is large enough it will cause abrupt stopping of heart beat and breathing. It sounds very scary, but thromboembolism is the one of the leading cause of sudden death along with myocardial infarction.  
 
Corresp. You really described fate of patient suffering from varicous disease in black colors. I cannot believe there is not any treatment from the sight of modern medical sciences.
 
T.P.  unfortunately, surgery remains the only proved effective treatment method. If we repeat the words of one famous advertisement “all other are compromise”. The conservative treatment only represents the subsidiary list of methods.
 
 
 
corresp.  You mean, if someone has the varicous disease, surgery is unavoidable
 
T.P.  yes, this is true. However, after so much scaring I want to introduce some positive in our conversation. Surgery is equivalent to some disaster for obvious Georgian citizen. Related to this fact, it should be mentioned that some medication treatment is hundred times more damaging for the body. In our situation, surgery does not even have an alternation. Besides this, with the modern conditions of developed medicine, surgery techniques are so perfect that this procedure hardly can be called “surgery”. Aimed with modern equipment and techniques surgeon radically cures the patient, making only minimal incisions. Complications in the pre- and postoperative periods are minimal – patients are able to walk already on the second day of the surgery, rehabilitation period is decreased and so on.     
 
Corresp.  But what if the mentioned complications are already developed, what way out does the surgeon have? 
 
T.P.  I want to repeat, that it is better not to wait for complications, because as there is good outcome after the surgical treatment of uncomplicated varicose, as ticklish is treatment of complications. According to earlier methods, physician had to treat ulcers during period of many tiring month and they was able to make surgery only after healing of the ulcer. In the modern conditions, it is possible to conduct radical surgery in the presence of active ulcer. It is interesting patient’s amazement when ulcer, which did not heal during the years, heals in several days after surgery.  
Nevertheless, if deep venous insufficiency forms, surgery has little benefit in its treatment. The whole life of such patient becomes one continuing treatment. Patient has to wear elastic bandages or specific stockings practically continuously.
In addition, thrombophlebitis, as I have already mentioned, may become a cause of fatal thromboembolism. That is why it is indicated urgent hospitalization and surgical treatment in case of inflammation of varicous nodules, redness, hardness, acute leg swelling and temperature elevation. 
 
Corresp.  Mr. Tristan, you have convinced us of the importance of surgery. However, what can you tell us about alternative treatment methods for example about lazerotherapy, sclerotherapy?
 
T.P.  Youhear the word “guideline” everywhere. Changes of attitude to treatment rules always follow integration process in the civilized word. Guidelines are methods of disease treatment, formulated by international science organizations after many years’ of difficult researches. Not to follow guidelines or make some corrections in them is to say softly is uncivilized action from the side of the physician. There are gathered all methods that leads to highest percent of cure in these guidelines. Accordingly, there will not be included methods effectivity and safety of which are questionable or not proved.
The guidelines of varicouse treatment requests conductance of appropriate surgical treatment, after which may be used sclerotherapy or laser therapy, purely in the cosmetic view. Sclerotherapy without surgery is not proved to be effective, due to higher recurrence and complication rate. 
 
corresp. And finally, what can you advice, what actions can we take, before refer to physician? 
 
T.P. Prophylactic measures have the big significance in the early stages of the disease, when the only complaint is feeling of heaviness. For the patient with venous insufficiency the main is life style – wearing the loose clothes, control of body weight, exercises, swimming, minimizing prolonged standing and sitting, avoiding hot bath and sun tanning. The shower should be finished with cold-water exposured from the lower part of extremities upward. Patient may need to wear elastic bandages and special stocking along with receiving vein tonic preparations. Here I want to mention the role of venous tonic preparations in the prophylaxis and treatment of varicous disease and Chronic Venous Insufficiency.
Preparations that affect venous system take the main part in my practice, because they are unchangeable in the preventing progression of the disease and for decreasing pre- and postoperative rehabilitation periods, decreasing clinical complaints, such as swelling and feeling of heaviness.   
There are many preparations, which become the main component of angiologic practice nowadays. From this view, it is worth to mention venotonic and angioprotecting preparation Venodiol. It has anti-inflammation and swelling decreasing effects, has venotonic and angioprotecting properties. I use Venodiol for the treatment of Chronic Venous insufficiency and venous varicous diseases already for ten month. I want to mention, that venodiol introduction in the postoperative treatment causes acute improvement of patient condition, swelling and pain are decreased, venous and lymph drainage are improved and rehabilitation process is shortened.
Such effectiveness of Venodiol, from my point of view, is caused by interesting combination of its component. It represents combination of micronized purified fraction of flavonoids (diosmin 450mg, hesperidin 50 mg) and ascorbic acid 100 mg. this is the combination of flavonoids and vitamin C which determines maximal expression of their activity. Venodiol can be used for prolonged period with the minimal course is 2-3 months (tow tablets a day, treatment course depends on the severity of disease. It is safe for prolonged usage, periodically repeating course therapies and does not have any addictive or allergic reactions. 
So, let us take care of ourselves, let us refer to certified physician timely, trust him and always remember - our health is in our hands.