Phlebology. What diseases cure doctor phlebologist? Methods of diagnosis and treatment of venous disorders

Phlebology (from the Greek. "phlebos" (Vienna) and "logos" (knowledge)) is a branch of medicine that studies the structure and function of veins, and develops methods of diagnosis, treatment and prevention of venous diseases. Physicians phlebology can be divided into therapists use for the treatment of pills, injections and surgeons, phlebologists, resorting to radical surgical treatment. In General, the cardiovascular system of the person doing angiography, phlebologists, cardiologists, General practitioners. They all belong to the specialization of vascular surgery, the only difference is that the phlebologist deals exclusively with the diseases and abnormalities of the veins lower extremities, ie legs.

Indeed, unless one is faced with vein problems, he does not know who phlebologist and what's this medical specialist. Look at what is within the competence of the doctor, what illness is cured by phlebologist and when its consultation becomes necessary, and in some cases vital.

Флеболог - врач, который занимается диагностикой и лечением патологий венозных сосудов
Am a phlebologist, a doctor who deals with the diagnosis and treatment of pathologies of the venous vessels.

What does and what cures the doctor-phlebologist

Phlebology is one of the branches of medicine – the medical industry, dealing with various pathologies of the venous vessels of the man. This direction had to allocate a separate medical industry due to the wide prevalence of venous diseases.

Phlebologist studying the function and structure of the venous network of a person, the symptoms of venous insufficiency, and specializiruetsya for diagnosing the condition of the veins, the development of the scheme of treatment of venous pathologies, the prevention of their occurrence and prevention of relapses.

Please note! Specialization refers to a phlebologist, vascular surgery, the only difference is that phlebologists are engaged exclusively in venous pathology of the lower extremities.

The objectives of phlebologist is the timely detection of pathology of the venous system of acute and chronic nature and their treatment. In addition, the specialist can perform surgeries and provide emergency assistance in life threatening situations (for example, pulmonary embolism).

What pathology and disease cures phlebologist?

The main areas of specialization of the doctor-phlebologist is the treatment varicose veins as the most common practice, as well as acquired and congenital pathologies of the venous blood vessels on legs:

  • Venous dysplasia. Venous dysplasia, or labouriously – a developmental disorder of the veins which is laid down during fetal development. Venous dysplasia in children makes itself felt in the first year of a child's life or at the age of 8-10 years. If dysplasia veins affect tissues unrelated to the venous blood vessels, deep veins of the child compress the bundles of connective tissue (fibrous strands) or atypical are the muscles;
  • Varicose veins in the legs (including, complicated by venous bleeding and trophic ulcers);
  • Lymphedema. Lymphedema is a pathological condition accompanied by increasing edema of the soft tissues of the affected area (most commonly the lower extremities), (“sleevenote” legs);
  • Chronic venous insufficiency a complex of symptoms developing due to violation of the outflow of venous blood. This diagnosis occupies the first place among the vascular diseases of mankind. According to different studies and statistical sources, a violation of the outflow of venous blood from the legs, affecting up to 60% of people of working age, more dominate in that number women;
  • Phlebitis and thrombophlebitis. Phlebitis is an inflammation of the vein wall. Often phlebitis is accompanied by formation of thrombi in the lumen of the vessel. In such cases, the disease is called thrombophlebitis of the lower limbs he is most common;
  • Deep vein thrombosis of the lower extremities. Thrombosis deep vein (DVT) is a pathological condition which is characterized by the formation in the vessel lumen and thrombus, disrupts the normal blood flow. Occur most often in the veins of the lower extremities, other vessels rarely exposed to this disease. Pathology dangerous possibility of detachment of a blood clot at any point in time especially with loads, which, spreading through the blood, can cause blockage of smaller vessels, including the arteries of vital organs;
  • Reticular veins – mild forms of varicose veins, characterized by a manifestation of venous veins bluish color in the lower extremities. The disease mostly affects women, men rarely. It is also called cosmetic varicose veins;
  • Post-thrombotic pathologies. Post-thrombotic disease (PTD) is a pathology that causes obstruction of outflow of venous blood from the legs. It appears after the previous thrombosis of the lower extremities and beyond. Sometimes this happens a few years after suffering thrombosis of the legs. Sick at night strong convulsions he is experiencing a bursting sensation in the lower extremities;
  • Of phlebopathy. Phlebopaty is a disease that combines the whole complex of pathologies. It is characterized by symptoms of venous insufficiency in the absence of vascular lesions. Usually the disease affects the veins of the lower limb, as they often experience increased loads;
  • Venous ulcers. Trophic ulcer – a defect in the skin or mucous membranes that occurs after the rejection of nekrotizirovannah tissue and characterized by torpid course, little tendency to heal and a tendency to recur;
  • Valve insufficiency. Valvular insufficiency is a condition resulting from loss of anatomic integrity (destruction, detachment or tear of the valves, tendinous chords, etc.) of any valve, due to various reasons. In some cases valvular insufficiency develops as a result of increasing the diameter of the valve rings (annulate) to which are attached folds of the valve;
  • Telangiectasia. Telangiectasia is a persistent dilation of small blood vessels (arterioles, venules, capillaries) non-inflammatory nature, manifested by spider veins or spider veins visible to the naked eye. The diameter of the blood vessels is 0.5—1 mm. Distinguish between congenital and acquired types of telangiectasia.

To phlebologist also treated for traumatic pathologies of the venous vessels in occlusive disease, atherosclerosis of the vessels of the legs.

Most of these States, and of developing pathologies due to late presentation to the doctor. Therefore, if you encounter problems with the veins should not delay a visit to a phlebologist.

Important! Pediatrician phlebologist no. Due to the fact that cardiovascular diseases are more common in adults, pediatric phlebology does not happen. If you suspect problems with the veins in children and adolescents, they are referred for admission to an adult specialist.

To considering you are still looking for traumatic pathologies of the venous vessels, when occlusive disease and atherosclerosis of the vessels of the legs.

The doctor gives the examination of the patient, individual methods of treatment of venous pathologies, and observes the patient after the course of individual treatment. In addition, the competence of the specialist-phlebologist includes the prevention and prophylaxis of vascular diseases in individuals with a hereditary predisposition or included in a higher risk zone, which we describe next. Meantime, watch the video, which so well describes what disease cures phlebologist.

In the video, the doctor-phlebologist Maxim Filimonov, tells what diseases does phlebology:

When you need to go to the doctor

If you experience varicose veins blood circulation, and eventually develop inflammation in the blood vessels, which leads to the disease phlebitis. Slowing of blood flow and damage the vascular walls can result in the formation of blood clots. If the clot breaks off, it can enter the lungs and cause a blockage of the pulmonary artery, which can result in death.

На фото показаны 5 стадий варикоза нижних конечностей. 1 стадия - появление сосудистых звездочек, судороги в ногах. 2 стадия - выражены выступающие вены, боль и тяжесть в ногах. 3 стадия - поражение поверхностных и глубоких вен. 4 стадия - изменение кожи, образование трофических язв. 5 стадия - формирование венозных язв.
The photo shows the 5 stages of varicose veins of the lower extremities. Stage 1 – the emergence of spider veins, cramps in the legs. Stage 2 – expressed with protruding veins, pain and heaviness in the legs. Stage 3 – defeat the superficial and deep veins. Stage 4 – change the skin and the formation of trophic ulcers. Stage 5 is the formation of venous ulcers.

It is therefore important to enroll in will take to phlebologist, at the first sign of development of vascular pathologies such as:

  • Swelling of the legs (foot, leg);
  • The occurrence of fatigue in the legs when walking;
  • The burning and pain in the legs (at rest and during exercise);
  • Of heaviness in the legs;
Если беспокоит тяжесть в ногах, следует обратиться к флебологу
If worried about heavy legs, should consult a phlebologist.
  • Visual increase veins;
  • The darkening of the skin on legs;
  • The appearance of calf muscle cramps (usually manifested at night);
  • The emergence of “spider veins”;
  • The swelling and tenderness of the saphenous veins.

Please note! Women are encouraged to visit phlebologist in the preventive purposes once a year, because of venous disease they are much more common than in men.

To whom and how often you need to visit a phlebologist?

At least once a year to visit phlebologist needs patients within the risk zone:

  • Individuals who are overweight;
  • Elderly;
  • Persons whose activity is connected with increased load on the legs;
  • Having a genetic predisposition to diseases of the venous vessels;
  • Women are constantly wearing tight clothing on the legs and high-heeled shoes.
  • Abusing alcohol, Smoking, prone to gluttony and overeating;
  • For people leading a sedentary lifestyle;
  • Women with many children;
  • Patients undergoing any surgery on the legs.

Prevention of varicose disease of the lower extremities, visit phlebologist should be at least once a year, especially after 40 years. Also preventive examinations shown to pregnant women who are prone to weight gain and swelling in the legs.

How to make an appointment to phlebologist for free?

To get an appointment to phlebologist in two ways: free of charge (under the policy), received a referral to a specialist from a local therapist and on a paid basis by contacting a private clinic, at the place of residence.

Specialists phlebologists are receiving specialized in phlebology clinics, equipped with modern systems of visual diagnostics and treatment of venous and vascular diseases.

How much is a consultation fee, consultation with a doctor-phlebologist?

Pay a consultation with a phlebologist will cost an average of 1,800 rubles (in clinics of Moscow and St. Petersburg). Admission price will depend on the popularity of clinics and doctors, as well as the region. In addition, you need to consider that the cost of the consultation does not include additional studies that will be administered by a physician.

Paid phlebologist is not cheap, so when choosing a specialist, you should pay attention to the following factors:

  • Qualification whether it's been doctor residency (internship) in cardiovascular surgery whether specialization for ultrasound;
  • The experience of the doctor phlebologist – advantage specialist will be 15-20 years of experience, development and implementation of own methods of treatment and diagnostics in phlebology.
  • The receive location from the available equipment of medical institutions, depends on the quality of treatment and informative in the diagnosis of the patient.

To make an appointment to phlebologist in private clinic by phone or on the website of the medical facility, or call a phlebologist to the house, if a person is lying and can't get up. When you call to the patient, the doctor will examine the patient, put the preliminary diagnosis and prescribe diagnostic tests.

How is the consultation, an appointment with a phlebologist, methods of diagnosis

A consultation with a phlebologist is carried out in stages:

  • History taking and patient interviews;
  • External examination of the patient (assessed skin condition, its elasticity, color);
  • Palpation — examines the state of the veins of the patient (the doctor brings out all the knots, bumps, seal veins).

After that, phlebologist can conduct a preliminary diagnosis, using special techniques (sample a Delta of Peters, alloy Pretta, trial of Chania or Troyanova-Trendelenburg). On the limbs of the patient is placed in an elastic bandage or a tourniquet, after which the patient is the team physician performs a certain movement either remains stationary.

To establish an accurate diagnosis are hardware methods and means of diagnostics of venous diseases of the legs:

  • Venography is a diagnostic method of the study of the human vascular system, with radiopaque substance injected into a vein. Also called a venography;
  • UZDG (Doppler ultrasound of vessels) is a highly informative non-invasive study of the arteries and veins to diagnose and detect various diseases. Method UZDG is a joint Ultrasound of the lower extremities and Doppler study;
УЗИ сосудов - информативный метод диагностики заболеваний вен
Vascular ultrasound – informative method of the diagnostics of venous diseases.
  • Angiography. Angiography is a class of methods of contrast study of the blood vessels of the legs used in the radiographic, fluoroscopic studies, computed tomography, magnetic resonance imaging used in a hybrid operating room. Angiography demonstrates the functional vascular condition, roundabout blood flow and length of pathologic process;
  • CT or MRT. Magnetic resonance imaging (MRI) and CT scan (CT) pursue the same goal – to study it and "scan" the internal organs and system of human internal structure;
  • Duplex scanning of vessels of the legs (USDS) is a method based on the use of color Doppler echography. Unlike Doppler ultrasound of the lower limbs, this method reveals not only the basic indices of hemodynamics and structural changes in the vessel walls.
  • USDS with color mapping (triplex scanning) is a modern method using pulsed Doppler, which allows you to visually assess the flow of blood through the vessels;
  • Lebanonese is a method for dynamic diagnosis and research of venous pressure in the vessels of the legs. Is assigned a survey, and pathological disorders in varicose veins and also the lack of informative value of ultrasonic methods of diagnostics of the venous system of the patient.

Also the doctor will prescribe laboratory tests: general urine analysis and general blood analysis, blood tests for biochemistry, coagulation etc.

Please note! All research is conducted in an outpatient basis by appointment. Emergency diagnosis is carried out only in the case of acute thrombosis, which is very dangerous.

Based on the results of the diagnosis, given the nature of the clinical picture, the patient's age, the stage of the pathological process, physiological characteristics of the patient, the doctor selects the treatment regimen.

The video shows how is the consultation and ultrasound diagnosis of the surgeon-phlebologist solomahina Anton:

Methods of treatment phlebologist

For the treatment of vascular pathologies apply a conservative and operative methods of treatment. The method of treatment is chosen taking into account the degree of vascular lesions, existing complications, comorbidities.

Conservative treatment is aimed at addressing the factors that trigger the pathology, stopping the progression of the disease, strengthening the vascular walls of the veins, reducing the likelihood of complications.

Conservative vein treatment includes:

  • Drug therapy;
  • The use of compression hosiery, tight tight;
  • Balanced diet with a predominance of fresh fruits, vegetables, greens, berries, nuts, or a little fish;
  • Physiotherapy;
  • The normalization of lifestyle, without cigarettes and alcohol;
  • The complex of physical activity every day. Jogging, squats, jumping rope are shown.

Medication used local and by oral route, in special cases – parenteral way.

Parenteral administration of medicines — these are ways of introducing drugs into the body in which they pass through the gastrointestinal tract, in contrast to oral application of drugs. This is primarily injection and inhalation. There are other, more rare, parenteral modes of administration: transdermal, subarachnoid, intraosseous, intranasal, subconjunctival, however these methods of drug penetration into the body is used only in special cases.

Distinguish between injections of small volume (100 ml) and large volume, which is called infusion.

Your doctor may prescribe the following medications:

Conservative treatment of venous diseases can be attributed to the methods of maintenance therapy, because it is more focused on addressing the symptoms, but can not cope with the arisen on the background of the pathology of the complications. Therefore, if a doctor prescribed only medication, and the patient does not feel relief, it is best to consult with another specialist.

If the disease has passed a critical stage, or the use of conservative methods did not give positive results, the doctor prescribes operational activities. They can be of two types:

  • Minimally invasive treatment of veins and vessels: sclerotherapy, endovenous radiofrequency coagulation of veins, foam sclerotherapy, echo-guided sclerotherapy.
  • Surgical intervention: venektomiya, phlebectomy, endoscopic surgery, laser photocoagulation.
Лазерная коагуляция вен - малоинвазивное вмешательство, помогающее избавиться от варикоза
Laser coagulation of veins is a minimally invasive intervention that helps to get rid of varicose veins.

Operational measures allow to eliminate the damaged areas of the veins, but not affect the cause of pathology, so the patient is additionally given the recommendation to prevent progression of the disease.

Important! Phlebologists with experience often use to their patients surgical therapies. More young specialists prefer conservative treatment and minimally invasive surgical methods.

Phlebologist is a specialist narrow profile to which you want to contact in case of problems with the venous system in the pelvic area, groin and lower limbs.

Endovenous Procedures

There are three types of endovenous procedures: endovenous laser therapy, endovenous radiofrequency ablation and ultrasound sclerotherapy (sometimes called echo-guided sclerotherapy).

Endovenous Laser Treatment

Endovenous laser treatment is a minimally invasive, stationary alternative to surgical Stripping of the great saphenous vein. Instead of removing the saphenous vein it is sealed in place. The skin on the inside of the knee anesthetized and a small laser fiber is inserted through the pen needle into the damaged vein. The pulse laser beam is inside the vein, which leads to sealing the veins.

This procedure is performed under local anesthesia. After the procedure, the treated leg is imposed a bandage or compression hose. Patients can walk immediately after the procedure, and most people can return to work the next day.

На фото показана схема эндовенозного лазерного лечения. Изображение предоставлено Diomed, Inc.
The photo shows the scheme of endovenous laser treatment. Image courtesy of Diomed, Inc.

Endovenous Radiofrequency Ablation (procedure)

Endovenous radiofrequency ablation is a minimally invasive, but a valid alternative to surgical Stripping of the great saphenous vein. Instead of removing the saphenous vein it is sealed in place. The skin on the inner side of the knee is anesthetized with and into the damaged vein through a needle syringe into the skin of the injected radio-frequency catheter. The catheter delivers radiofrequency energy to the vein wall causing it to heat up. As Vienna warm, it collapses and seals shut.

На фото показана схема проведения процедуры Эндовенозной Радиочастотной Абляции по Closure®. 1. Вставлен катетер, 2. Вены обработаны, разогреты и разрушаются, 3. Катетер медленно выводится, закрывая Вену. Изображение предоставлено VNUS Medical Technologies, Inc.
The photo shows a scheme of the procedure Endovenous Radiofrequency Ablation for Closure®. 1. Is inserted the catheter 2. Veins processed, heated and dissolved, 3. The catheter is slowly eliminated, closing the vein. Image courtesy of VNUS Medical Technologies, Inc.

The procedure is usually performed on an outpatient basis or in the doctor's office under local anesthesia.

After the procedure, the catheter is removed and the treated leg bandage or compression stocking. Patients can walk immediately after the procedure, and most people can return to work the next day.

Ultrasonic Sclerotherapy (Echo-Guided Sclerotherapy)

Ultrasonic sclerotherapy (echo-guided sclerotherapy) is another alternative to surgical intervention. By using this technique and based on clinical judgment of the doctor, sclerotherapy is done with either a liquid or ”foamed ” sclerosant, while the doctor visually monitors the vein on an ultrasound screen. This enables treatment of veins that can't be seen because they are under the skin surface and otherwise would require surgical removal. Ultrasonic imaging is used to direct the needle into the abnormal vein and deliver medication to destroy the lining of the blood vessel and seal it. Sclerotherapy guided ultrasound is primarily used to treat large veins beneath the surface of the skin.

Ambulatory Phlebectomy

Ambulatory phlebectomy is a method of surgical removal of surface varicose veins. Ambulatory phlebectomy is usually performed in the doctor's office under local anesthesia. The area surrounding clusters of varicose veins, flooded anaesthetic liquid. The needle is then used to make a puncture next to the varicose vein and a small hook inserted into the orifice of the needle and varicose veins will be captured and extracted. The punctures typically leave nearly imperceptible scars.

After removal of the veins with a phlebectomy in the short term is worn bandage and/or compression stockings.

Ambulatory phlebectomy is often performed in conjunction with minimally invasive endovenous procedures catheterise or Stripping pin. Possible complications of ambulatory phlebectomy are allergic reaction to the local anesthetic and local numbness.

Treatment based on Light

Laser and intense pulsed light (IPL) can be used to treat small veins webs and external redness. The light beam of the laser pulses through the skin and veins-spider veins, to seal them and make them dissolve. Laser light is mainly used only to treat small veins. Treatment can be combined with sclerotherapy and usually requires several procedures.

Timely access to specialist help to avoid serious complications, fraught with disabilities and even fatalities. In addition, in the early stages of occurrence of problems with the veins, pathology can be completely cured with conservative measures, but in advanced cases, surgical intervention can not be avoided.

The following video channel “Doctor” Anton Solomakhin, head of the Centre for Innovation Phlebology, surgeon-phlebologist will tell popular scientific what diseases are treated by experts of his profession, early signs, symptoms, diagnosis and treatment of venous diseases.

12 universal exercise with varicose veins of the legs

The photo below shows a complex of 12 simple and useful exercise with varicose veins of the legs, are in a state of sitting on a chair, standing and lying on the bed:

Фото с 12-ю универсальными упражнениями при варикозе ног, которые можно выполнять в положении стоя, сидя и лёжа.
Photo with 12 universal exercise with varicose veins of the legs that can be performed in standing, sitting and lying down.
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