Varicose veins is a pathological expansion of the veins located on the surface, which is characterized by an increase in their diameter and length, which as a result leads to a change of cylindrical, serpentine, saccular and mixed type in the venous trunks. Today, varicose veins are a very widespread pathology and women get sick more often than men almost 3 times. This is mainly due to the anatomical characteristics of the body and certain loads on the lower extremities during pregnancy.
As a general rule, varicose veins are primary and secondary. In the first variant, the disease is caused by the initial weakness of the wall of the great vein, which is located under the skin or by a congenital dysfunction of the valves. The development of secondary venous pathology is influenced by deep vein thrombosis or valve insufficiency acquired due to pregnancy, intense physical effort, prolonged standing, etc.
At the time of an increase in hydrostatic pressure in the veins, these vessels expand in diameter and the damaged functions of the valves are aggravated. All this interferes with blood circulation in the veins on the surface, and as a result of insufficient functioning of the veins on the periphery, blood reflux is formed from deeply seated veins in the saphenous veins, which are too stretched, begin to twist , forming various forms of expansion. In the future, as a result of pronounced stagnation, tissue trophism is disturbed, ulcers, eczema and dermatitis are formed.
Varicose veins of the lower extremities.
This disease is characterized by the formation of venous walls in the form of saccular expansion, serpentine tortuosity, increased length and insufficiency of the valves.
As a general rule, varicose veins of the lower extremities occur in 20% of the population. Also, before puberty, it affects boys and girls equally. But women in adulthood are much more likely to be affected by varicose veins than men. Also, the number of sick people increases with age. This can be explained by the restructuring of the hormonal background in the female body as a consequence of pregnancy, menstruation, which cause a weakened tone of the veins, their dilation, some insufficiency of the valves of the communicating and saphenous veins, the opening of shunts arteriovenous and circulatory disorders in the veins.
To date, the true cause of the development of varicose veins of the lower extremities is still unknown. It is assumed that insufficient valve function and increased pressure in the veins are related to the etiological cause of the development of the disease. Taking into account all the factors that predispose to the appearance of the pathological process in the veins of the lower extremities, there are two types of varicose disease: primary and secondary.
Primary varicose veins on the surface are characterized by the presence of normal deep veins. And in the case of secondary varicose veins, various complications of deep veins, arteriovenous fistulas, congenital absence or underdevelopment of venous valves play an important role.
The risk factors involved in the formation of varicose veins of the lower extremities are: increased hydrostatic pressure in the trunks of the veins, thinning of their walls, alteration of metabolic processes in smooth muscle cells, blood movement from deep to superficial veins. This reverse movement of the blood in the form of vertical reflux and horizontal reflux causes a gradual nodular expansion, elongation and tortuosity of the veins that are located under the skin, that is, superficial. The final link in the pathogenesis is represented by cellulitis, dermatitis, and trophic venous ulcer of the lower leg.
The symptomatic picture of varicose veins of the lower extremities consists of patient complaints about the existing dilated veins, which cause cosmetic discomfort, some severity, and in some cases pain in the lower extremities, night cramps and trophic changes in the legs.
The expansion of the venous vessels can vary from minor "stars", reticular nodules to roughly twisted trunks, as well as nodules, plexuses, which are clearly visible in the upright position of patients. Almost 80% are lesions of the trunk and branches of the great vein on the surface and 10% are in the lesser saphenous vein. Furthermore, in 9% of patients there is a lesion of both veins involved in the pathological process.
As a result of a progressive process, the patient begins to experience rapid fatigue, a certain severity and distention is noted in the legs, cramps appear in the calf muscles, the legs and feet swell, and paresthesias develop. Also, the legs swell mainly in the late afternoon, but after sleeping this swelling goes away.
Most often, varicose veins are complicated by acute thrombophlebitis of the veins on the surface with manifestations of redness, painful cord-like compaction of the vein, characterized by expansion, as well as perifebitis. Very often, varicose veins rupture as a result of minor damage and this leads to bleeding. As a rule of thumb, blood from a ruptured node can flow in a gush, and the patient sometimes loses quite a large amount.
Also, there are no certain difficulties in diagnosing varicose veins of the lower extremities, as well as in joining CVI on the basis of patient complaints, anamnesis of the disease and the results of an objective examination.
An essential value in making a diagnosis is the ability to determine the status of the valves of the main and communicative veins, as well as to assess the patency of the deep veins.
Causes of varicose veins
This pathological process is characterized by the expansion of the veins located on the surface under the skin and is associated with insufficient work of the valves in the veins and impaired blood circulation in them. Varicose veins are among the most common vascular pathologies among half of the working-age population.
As a general rule, there are several predisposing factors for the development of the disease, as well as its progression. A definitive contribution of heredity to the development of varicose veins has not yet been demonstrated. The onset of this disease process may currently be influenced by the nature of diet, lifestyle, and conditions caused by changes in the hormonal background.
Also, the appearance of this pathological process is associated with the incorrect organization of the work process. Many people spend a significant amount of time in a standing or sitting position, depending on their job, and this has quite a negative effect on the valvular apparatus of the veins in the lower extremities. Also, work associated with hard physical work is considered unfavorable, especially in the form of jerking the legs when lifting weights.
Today, long-duration trips or flights, which contribute to the appearance of venous blood stasis in the legs and are risk factors for the formation of venous pathologies, negatively affect the blood flow system in the veins. Also, wearing tight underwear causes compression of the veins in the groin area and corsets increase the pressure within the peritoneum, so it is not recommended to wear them all the time. This also applies to shoes with high heels in the presence of uncomfortable supports on the instep.
Repeat pregnancies are a proven risk factor for varicose veins. This can be explained by the fact that the enlarged uterus increases the pressure within the peritoneum and the progesterone destroys the fibers of elastic origin and collagen contained in the venous wall. In addition, diseases such as rheumatoid arthritis, osteoporosis, change in hormonal status, increase the risk of developing this pathological process.
The typical causes of varicose veins are the peculiarities of their structure in the lower extremities. There is a system of veins located on the surface, that is, saphenous veins, both small and large, as well as a system of deep veins in the thigh and calf, and perforating veins that connect the two previous systems. With normal blood circulation, blood flow to the lower extremities occurs in 90% of deep veins and 10% of superficial veins. But in order for the blood to move towards the heart, and not the other way around, there are valves in the venous walls that snap shut and do not allow the blood to pass under the influence of gravitational force from top to bottom. Muscle contractions are also of great importance, as they contribute to normal blood flow. Also, in an upright position, stagnation of blood develops, the pressure in the veins begins to increase, and this leads to their expansion. In the future, insufficient valve function is formed, which becomes the reason for the non-closing of the valve leaflets with the formation of an incorrect movement of blood from the heart.
The valves of the deep veins are affected especially quickly as a result of the maximum load on them. And to reduce excess pressure with the help of a perforating vein system, blood flows into veins located under the skin, which are not designed for a large amount of it. All this leads to excessive stretching of the venous walls and, as a result, the characteristic varicose nodules are formed. However, a greater volume of blood continues to flow into the deep veins, thus forming an insufficiency of the valve apparatus of the perforating veins without certain obstacles to the blood flow in a horizontal position, first towards the deep vessels and then towards the superficial ones. And in the end, CVI develops with manifestations such as edema, pain and ulcers of a trophic nature.
Symptoms of varicose veins
Varicose veins are characterized by the expansion of the veins located under the skin, in the form of saccular or cylindrical changes. With this pathological disease, contoured veins appear on the surface of the skin of the legs and feet. The maximum appearance of varicose veins forms after prolonged or intense physical exertion. It is quite common for veins to dilate in young women during or after pregnancy.
The early stage of varicose veins is characterized by few nonspecific symptoms. At this time, patients quickly tire with constant heaviness in the legs, burning, bursting, especially after physical exertion. In addition, transient edema and painful pains sometimes appear along the entire length of the veins. At the same time, in the late afternoon, the ankle and the back of the foot swell after prolonged static loads. Some characteristic of edema is its disappearance in the morning, after a night's rest. At this stage, as a rule, there are no visible signs of varicose veins. However, these early stage symptoms should be a signal for the patient to see a specialist to prevent the progression of varicose veins.
This disease is characterized by slow development, sometimes over several decades. Therefore, as a consequence of poor treatment, varicose veins in their progression form CVI (chronic venous insufficiency).
A major symptom of the disease is also spider veins, which are a web of slightly enlarged capillaries that are practically visible under the skin. Sometimes the elimination of disorders of a dishormonal nature, the exclusion of a sauna, a solarium allows you to forget once and for all about such a disease as varicose veins. But basically, these spider veins refer to the only sign of overflowing veins on the surface and the formation of varicose veins. Therefore, the appearance of even an insignificant sign should serve as a signal to consult with a surgeon.
Also, varicose veins represent a cosmetic discomfort, therefore, to solve such problems, doctors perform surgical operations.
Degree of varicose veins
This disease can manifest itself in varying degrees of severity and be characterized by a different structure, which is associated with its clinical symptoms. As a general rule, there are several types of structure of dilated veins on the surface. The first type, the main one, is characterized by the expansion of the main trunks of the saphenous veins without joining tributaries to them. The second type, or loose, is a network-like extension with many branches. This type of varicose vein is detected early in the development of the disease. But with a mixed type, a combination of the previous two occurs, and this third type is found much more frequently than others.
The symptoms of varicose veins are directly proportional to the stage of the pathological process, which are subdivided into compensation, subcompensation and decompensation.
In addition, the ICD of varicose veins distinguishes pathology with ulcer, with inflammation, with the presence of simultaneous ulcers and inflammation in the lower extremities and varicose veins without inflammation or ulcers.
The first degree of varicose veins is characterized by a moderately pronounced expansion of the veins on the surface along the main trunks or branches without certain manifestations of insufficiency of the vein valves on the surface and communicative properties. Patients have a mild nature of leg pain, some severity, fatigue against the background of prolonged exertion. Diagnostic tests performed indicate satisfactory valve function, and the presence of minor vein enlargement under the skin indicates a malfunction of the outflow in the veins of the affected limb. The first degree of VL corresponds to the compensatory stage of varicose veins.
The second degree of varicose veins is characterized by the expansion of the superficial veins with failure of their valves based on functional tests. In the process of disturbed outflow in the veins, insufficiency of the lymphatic system of the extremities develops, manifested by edema of the feet and legs. The characteristic swelling occurs after prolonged exertion of the lower extremities, which disappear after resting in a horizontal position. In addition, there is severe and persistent pain in the affected limb. The second degree of the disease is characterized by the correspondence of the stage of subcompensatory property.
In third degree varicose veins, there is expansion of the superficial veins and dysfunction of the valves of the deep, perforating, and saphenous veins, resulting in persistent venous hypertension in the distal parts of the limb. This is what causes a violation of microcirculation and the formation of trophic ulcers. At the same time, skin pigmentation develops in the lower leg area with the initial manifestations of an indurative pathological process. But the feet and legs, especially if there are trophic disorders, are characterized by constant swelling. This is associated with blood outflow disorders and with lesions of the lymphatic system of the limb of an organic nature and lymphostasis of secondary origin. The symptoms of the third degree of varicose veins are quite pronounced, varied and constant.
With the further progression of varicose veins, the zones of trophic ulcers expand a little, dermatitis and eczema appear, indicating the presence of the fourth stage of the disease. The last two degrees of severity represent the decompensation stage of the pathological process. In this case, not only the local hemodynamics are altered, but also the general one. Using ballistocardiography, it is possible to detect impaired contractility of the heart muscle, which is detected in 80% of patients with decompensation of varicose veins.
An important point in choosing the appropriate treatment is to determine the degree of varicose veins and the type of dilated superficial veins.
Varicose vein treatment
Comprehensive treatment of varicose veins of the legs is considered a complex process, which is directly proportional to the severity of the disease. As a rule, surgical and conservative treatment methods are used.
Varicose veins are treated without surgery and give positive results only at the beginning of the pathological process, when the manifestations on the skin are slightly expressed, moderately reducing the ability to work. This method of treatment, as a conservative, is also used due to contraindications to surgical intervention. Also, this method is necessarily used in the postoperative period to prevent recurrent varicose vein conditions.
During conservative treatment, the severity of risk factors is reduced with the use of adequate physical activity, the use of elastic compression, medications, and physical therapy. Only the combination of all these therapeutic measures can guarantee a positive result.
First, they identify risk factors for varicose veins and try to influence them. In addition, a group of people with certain risk factors for this disease, as well as a hereditary predisposition, even in the absence of symptoms of varicose veins, should consult a phlebologist twice a year by ultrasound examination of the veins of the lower extremities. . Also, if there are no complications such as thrombophlebitis or thrombosis, regular training for the veins of the lower extremities is recommended. This involves walking more, wearing only comfortable shoes, swimming, biking, and jogging. All physical activities must be done using elastic compression. It is absolutely contraindicated to perform exercises with injuries of the lower extremities, it is also necessary to exclude ski mountaineering, tennis, volleyball, basketball, football, various types of martial arts, where loads on the veins of the lower extremities prevail as well. as exercises that are associated with lifting significant weights.
At home, following the recommendations of a specialist, they perform simple exercises. As a general rule of thumb, the legs should be in an elevated position for a few minutes before beginning to exercise to prepare the body for certain types of exercise. The choice of rhythm and speed of exercises is selected strictly individually for each patient, taking into account her physical capabilities. But the main thing in such physical education is its regularity. In addition, it is recommended to use a daily contrast shower with alternate leg massage with warm and cold water for five minutes.
Elastic compression is a method of treating varicose veins using compression bandages or stockings. In this case, muscle compression occurs in a dosed manner, which improves blood flow through the venous vessels and prevents stagnation phenomena. Thanks to the artificial maintenance of vascular tone, the veins stop expanding and thus prevent the formation of thrombosis.
For the treatment of all stages of varicose veins, phlebotonic drugs are used, which gradually strengthen the venous walls. All drug therapy for varicose veins should be prescribed only by the attending physician, therefore self-medication is not recommended. But local therapy in the form of ointments and gels without signs of thrombophlebitis or thrombosis is simply undesirable.
Among the physiotherapeutic methods of treatment, laser, electrophoresis, magnetic field and the use of diadynamic currents have the best effect.
Varicose veins refer to a surgical condition that can be completely cured after surgery. As a general rule, there are several types of surgical treatment (phlebectomy, sclerotherapy and laser coagulation), which directly depend on the severity of the pathological process and the place of its localization.
By performing a phlebectomy, the varicose veins are removed. The main objective of the operation is to eliminate the pathological discharge of blood by removing the main trunks of the small or large superficial vein and ligation of the perforating veins. However, this operation is not performed in the presence of concomitant diseases that can only worsen the existing condition; late stages of varicose veins; the pregnancy; Existing purulent processes and old age. Phlebectomy is performed by endoscopic methods of treatment, which makes this operation less safe.
During sclerosis, a sclerosant is injected into the dilated venous vessel, causing the venous walls to stick together and thus stopping blood flow through it. As a result, the pathological outflow of blood stops with the simultaneous removal of the cosmetic defect, since at this time the venous vessel collapses and is practically invisible. However, the use of sclerotherapy is effective only when the small branches of the main trunks are enlarged, so it is used in a limited way. The advantage of this surgical intervention is the absence of postoperative scars, the hospitalization of the patients and in the period after sclerosis the patient does not need specific rehabilitation.
Laser coagulation is based on the destruction of the venous wall due to its thermal effect. As a result of this process, the venous lumen is sealed. This method of surgical operation is indicated only with an enlarged vein up to ten millimeters.
Varicose vein prevention
Prevention of this disease can be primary, preventing the development of varicose veins, and secondary, in the presence of a pathological process.
Currently, most of the people attach great importance to the prevention of this disease. Simple measures taken regularly can significantly reduce the appearance and progression of varicose veins. In this case, it is very important, first of all, to move more, and also to alternate a prolonged static load with swimming, running, walking, cycling. You should also do simple exercises at your workplace.
With existing varicose veins, you should try to get your legs in an elevated position as often as possible. Fight against excess weight, preventing it from gaining. It is also very important to walk in comfortable shoes with a maximum heel height of up to five centimeters and, if necessary, use orthopedic insoles. Also, during pregnancy, when taking estrogens or oral contraceptives, it is imperative to examine the veins of the lower extremities by ultrasound.