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Madeira Medical Center


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Varicose veins are beyond an aesthetic problem.

They are expressly a health problem, chronic and almost always evolving.

Varicose veins of the lower limbs are surface veins that are injured and that have become progressively dilated, elongated, and tortuous. The dysfunction of this disease occurs at the level of the valves and walls of the veins, compromising the return of blood flow, in the ascending direction.

Its appearance has an important hereditary context, however, there are also precipitating factors. In women, pregnancy and the use of contraceptives, in the general population, prolonged standing or sitting.

People usually complain of pain in the lower limbs associated with a feeling of heaviness and fatigue, which worsen in the heat, with long periods of standing or sitting with the legs hanging. In women, these discomforts worsen in the premenstrual and gestational period. Associated with these symptoms are also frequent complaints of itching, tingling, heat, cramps, and oedema at the end of the day in the ankles and legs, which is proportional to the severity of the varicose veins.

"When there is a hereditary context, whether it is a woman or a man, prophylaxis and surveillance should be stricter, emphasizes Dr. Nivaldo Nunes. In these circumstances, it is recommended to consult a specialist in Vascular Surgery, so that a clinical evaluation can be carried out. and imaging (echodoppler) and a treatment was instituted."

The prevention of this disease is crucial for its appearance and progression:

- Remaining for many hours standing or sitting, especially cross-legged, must be fought;

 - Regular exercise promotes muscle contraction and venous return, especially gymnastics, swimming, cycling or dancing. Sports that cause sudden movements should be avoided (for example tennis or basketball), as they require pressure variations in the veins that cause their dilation and decrease in venous return;

- The frequency of hot places should also be spared as they precipitate vein dilation. Conversely, performing cold water baths provides pain relief and reduces the sensation of heavy legs;

- Constipation and excess weight increase venous blood pressure and should also be monitored;

 - Clothing that is too tight compresses the veins and hinders circulation and flat or very high shoes have the same effect, the option being 3-4 cm heels;

- It is recommended to sleep with your feet elevated (10-15 cm) and perform movements with your legs before falling asleep;

- Massaging the legs respecting the venous return (from the bottom to the top) can alleviate.

Minimally invasive surgical techniques have provided very good results, namely thermal ablation by Radiofrequency or Laser and Sclerotherapy.

The Madeira Medical Center already has Radiofrequency available for the treatment of varicose veins, consisting in the introduction of a catheter with an electrode that allows the release of radiofrequency energy in the vein wall, leading to its ablation.

For Dr. João Oliveira, the greatest advantages of Radiofrequency for patients are those inherent to the generality of less invasive techniques: more safety and efficacy. “Fewer postoperative complaints (pain, bleeding, infections), absence of skin incisions and less aggressive anaesthesia (in some cases it can even be performed with local anaesthesia), while for the surgeon it is undoubtedly the highest degree of satisfaction of the patient, making it a very rewarding technique.

“The only precautions to be taken in the immediate postoperative period are the use of elastic stockings for 2 weeks, walking on foot and the local application of ice, with no significant restrictions on daily activities”, explains Dr. Nivaldo.

As for the possibility of varicose veins reappearing after radiofrequency treatment, “according to the studies carried out, it overlaps with other techniques, including classical surgery”, explains Dr. João Oliveira.


31, July 2020