Acute treatment
Lower extremity varicose veins
Thrombophlebitis: anticoagulant treatment is available, and antibiotics should be applied when accompanied by infection. After the inflammation subsides, surgery should be performed as soon as possible.
Ulcer formation: wet compresses on the wound, elevate the affected limb to facilitate reflux, shallow ulcers can generally heal, and surgery should be performed after the ulcers have healed. Larger or deeper ulcers, after the above treatment around the inflammation subsides, can also receive surgical treatment, such as the absence of infection, can be done at the same time to clear the skin grafting, can shorten the cycle of wound healing.
The varicose vein rupture bleeding: immediately localized pressure bandage, elevate the affected limb, generally can stop bleeding, if necessary, can be sutured to stop bleeding, and then later for surgical treatment.
Gastroesophageal varices
Rupture of the bleeding speed, bleeding, serious cases can appear shock, or even death, should be emergency medical care.
Medication
Varicose veins of the lower extremities
Patients at all stages of varicose veins need medication, which can effectively reduce the patient's symptoms, especially those with severe varicose veins, those who do not want to undergo surgical treatment for the time being, those with active ulcers, and those who combine with symptomatic deep venous insufficiency are considered to be controlled with medication.
Vein-activated drugs: can increase venous tone, reduce vascular permeability, promote lymphatic and venous return and improve muscle pump function. They are indicated for patients at any stage of the disease and may also be used in combination with sclerotherapy, surgery and/or compression therapy. Commonly used venoactive drugs include: flavonoids, hepatic saponins, and coumarins.
Other drugs: fibrinolytic drugs, prostaglandin El, hexacosanoids, non-steroidal anti-inflammatory drugs, etc.
Pedigastric-esophageal varices
Nonselective beta receptor inhibitors (e.g., propranolol, nadolol, timolol, etc.) are currently used as first-line agents in the prevention of ruptured esophageal variceal bleeding and rebleeding.
For acute bleeding, growth inhibitors, growth inhibitor analogs, and pressors can be used as first-line drugs in addition to treatments such as blood transfusions.
Varicose veins
For mild cases, lifestyle improvement can be the first step, supplemented by medication if necessary. Available drugs mainly include antioxidants (such as L-carnitine, vitamin C, coenzyme Q10, vitamin E, vitamin B9, vitamin B12, etc.), hormonal drugs (such as follicular growth hormone, clomiphene), and anti-inflammatory response drugs.
Surgical treatment
Varicose veins of the lower limbs
High saphenous vein ligation and stripping surgery: it is the most classic surgery for the treatment of varicose saphenous veins, which minimizes the chances of postoperative recurrence and provides the most thorough treatment due to the complete removal of the saphenous vein trunk. However, it is an open surgery with relatively large surgical trauma.
Subcutaneous varicose vein transillumination rotary excision (TriVex): TriVex system, after point incision of the skin, subcutaneous high-pressure injection of anesthesia swelling fluid in the range of varicose veins, using cold light source irradiation of subcutaneous varicose veins, and then introduced into the electric rotary excisional cutter, along the venous route of the suction and complete excision of varicose vein clusters. This method is especially suitable for larger varicose vein clusters, due to the greater trauma, strict control of the indications.
Gastroesophageal varices
Transendoscopic fundus-esophageal variceal ligation: with the help of gastrointestinal endoscopy, the ligature fixed at the front end of the endoscopy, the ligature on the "O" ring ligature on the varicose veins, to play a role in eliminating varicose veins, hemostasis.
Transjugular intrahepatic portosystemic shunt (TIPS): It is a transjugular puncture that creates a decompression channel between the hepatic vein and the intrahepatic portal vein branches to reduce portal hypertension and achieve the same effect as surgical shunt. This procedure is suitable for cirrhosis esophageal varices drug, endoscopic treatment is ineffective.
Varicose veins
Open high spermatic vein ligation: ligation of the internal spermatic vein above the internal ring in the inguinal area.
Laparoscopic surgery: laparoscopy is used to ligate the spermatic vein microscopically from the opening of the internal ring in the inguinal area.
Chinese medicine
Varicose veins of the lower limbs are equivalent to the Chinese medicine "tendon tumors", "pollicization" and other categories. Varicose veins of the spermatic cord is not clear in Chinese medicine, belonging to the "tendon tumor", "tendon hernia", "partial fall", "gas hernia" and so on. The category. The dialectical typing of this evidence, but also the lack of uniform standards.
There is a lack of evidence from large-scale clinical studies to support the effectiveness of most Chinese medicines, so treatment with Chinese medicine should be carried out under the guidance of a Chinese pharmacist or Chinese medicine practitioner.
Other treatments
Varicose veins of the lower limbs
Endovenous laser treatment: the principle is to use the laser energy to destroy the endothelium of the saphenous vein, and then apply pressure bandage, so that the vein is occluded by adhesion. Its advantage is that it is carried out under local anesthesia, and can go down to the ground after treatment, with little trauma, fewer complications, and satisfactory early postoperative effect.
Sclerosant injection and compression therapy: sclerotherapy is the injection of sclerosant into the varicose vein, so that aseptic inflammation, fibrous occlusion, to achieve the varicose vein atrophy of the therapeutic method, at present the main foam sclerotherapy.
Gastroesophageal varices
Endoscopic varicose vein sclerotherapy: By injecting sclerosing agent into the esophagus or fundus of the stomach, the endothelial cells of the local blood vessels are damaged, which results in aseptic inflammation and thrombosis, and thus occlusion of the varicose veins.
Endoscopic tissue glue injection: the physical and chemical properties of α-cyanoacrylate, which instantly polymerizes and solidifies in the presence of trace anions, are utilized to occlude the varicose vein and stop bleeding in time.
Endoscopic ultrasound (EUS)-guided endoscopic treatment: ultrasound-guided combined tissue glue-spring coil injection is used to treat fundic varices, in which the injected spring coil acts as a venous stent.