Varicose veins are a pathological expansion of the veins located on the surface, which is characterized by an increase in their diameter and length, which, in turn, leads to a cylindrical, serpentine, saccular and mixed change in the venous trunks. Today, varicose veins are a common condition and women get sick almost 3 times more than men. This is mainly due to the anatomical features of the body and certain loads on the lower limbs during pregnancy.
As a rule, varicose veins are primary and secondary. In the first variant, the disease is caused by initial weakness of the wall of the great vein, located under the skin, or congenital dysfunction of the valves. The development of secondary venous pathology is influenced by deep venous thrombosis or acquired valve insufficiency due to pregnancy, heavy physical exertion, standing for a long time, etc.
At the time of an increase in hydrostatic pressure in the veins, these vessels expand in diameter and the impaired function of the valves is aggravated. All of this interferes with blood circulation in the veins on the surface and, as a result of the insufficient functioning of the veins in the periphery, blood reflux is formed from the deep veins to the saphenous veins, which are very stretched, begin to squirm, forming various forms of expansion. . In the future, as a result of pronounced stagnation, tissue trophism is disturbed, ulcers, eczema and dermatitis are formed.
Lower extremity varicose veins
This disease is characterized by the formation of venous walls in the form of saccular expansion, serpentine tortuosity, increased length and valve insufficiency.
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 compared to men. Furthermore, the number of sick people increases with increasing age. This can be explained by the restructuring of the hormonal background in the female body as a result of pregnancy, menstruation, which weakens the tone of the veins, their dilation, some insufficiency of the communicating and saphenous vein valves, the opening of arteriovenous shunts and circulatory disorders in the veins .
So far, the true cause of the development of varicose veins in the lower limbs is still unknown. It is assumed that the insufficient functioning of the valves and the increase in pressure in the veins are related to the etiological cause of the disease's development. Considering all the factors that predispose to the appearance of the pathological process in the veins of the lower limbs, there are two types of varicose disease: primary and secondary.
Surface primary varicose veins are characterized by the presence of normal deep veins. And in the case of secondary varicose veins, various deep vein complications, arteriovenous fistulas, congenital absence or underdevelopment of venous valves play an important role.
The risk factors involved in the formation of varicose veins in the lower limbs are: increased hydrostatic pressure in the trunks of the veins, thinning of the walls, impaired metabolic processes in smooth muscle cells, blood circulation from the deep to the superficial veins. This reverse blood movement in the form of vertical and horizontal reflux causes a gradual nodular expansion, stretching and tortuosity of the veins that are located under the skin, that is, superficial. The final link in pathogenesis is represented by cellulitis, dermatitis, and trophic venous leg ulcer.
The symptomatic picture of varicose veins in the lower limbs consists of complaints from patients about the existing dilated veins, which cause aesthetic inconveniences, a certain severity and, in some cases, pain in the lower extremities, nocturnal cramps and trophic changes in the legs.
Expansion of venous vessels can range from small "stars", reticular nodules to grossly contorted trunks, as well as nodules and plexuses, which are clearly visible in the upright position of patients. Almost 80% are lesions of the trunk and branches of the large vein on the surface, and 10% are in the small saphenous vein. Furthermore, in 9% of patients there is damage to 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 distension is noticed in the legs, cramps appear in the calf muscles, and the legs and feet become swollen and develop paresthesias. Also, the legs swell mostly in the late afternoon, but after sleeping this swelling goes away.
Varicose veins are often complicated by acute thrombophlebitis of the veins on the surface with manifestations of redness, painful cord-like compaction of the vein, which is characterized by expansion, as well as periphlebitis. Often, varicose veins rupture as a result of minor damage, and this leads to bleeding. As a rule, blood from a torn nodule can flow in one spurt and sometimes the patient loses a great deal of it.
In addition, there are no difficulties in diagnosing varicose veins in the lower limbs, as well as in entering CVI based on the patients' complaints, the history of the disease and the results of an objective examination.
An essential diagnostic value is the ability to determine the status of the valves in veins of a main and communicative nature, as well as to assess the patency of the deep veins.
Causes of varicose veins
This pathological process is characterized by expansion of the veins located on the surface under the skin and is associated with insufficient work of the valves in the veins and reduced blood circulation in the veins. Varicose veins are among the most common vascular pathologies in half of the working-age population.
There are, as a rule, several predisposing factors for the development of the disease, as well as its progression. A definitive contribution of heredity to the appearance of varicose veins has not yet been proven. The emergence of this pathological process may currently be influenced by the nature of the diet, lifestyle and conditions caused by changes in hormonal background.
Furthermore, the occurrence of this pathological process is associated with the incorrect organization of the work process. Many people spend a significant amount of time standing or sitting, depending on their job, and this has a very negative effect on the lower extremity vein valve apparatus. Furthermore, work associated with heavy physical work is considered unfavorable, especially in the form of a sudden load on the legs when lifting weights.
Today, long-term travel or flights, which contribute to the occurrence 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 pressure within the peritoneum, so it is not recommended that they be worn all the time. This also applies to high-heeled shoes in the presence of uncomfortable instep supports.
Repeated pregnancies are a proven risk factor for varicose veins. This can be explained by the fact that the dilated uterus increases the pressure inside the peritoneum, and progesterone destroys the elastic and collagen fibers contained in the venous wall. Furthermore, diseases such as rheumatoid arthritis, osteoporosis, altered hormonal status, increase the risk of developing this pathological process.
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, the saphenous veins, such as small and large, as well as a system of deep veins in the thigh and leg, and perforating veins connecting the two anterior systems. With normal blood circulation, blood flow to the lower extremities occurs in 90% of the deep veins and 10% of the superficial ones. But for blood to move towards the heart, and not vice versa, there are valves in the venous walls that close and do not allow blood to pass under the influence of gravitational force from above. Muscle contractions are also of great importance, contributing to normal blood flow. In addition, in an upright position, blood stagnation occurs, the pressure in the veins starts to increase and this leads to their expansion. In the future, there is an insufficient functioning of the valves, which becomes the reason for not closing the valve leaflets with the formation of an incorrect movement of blood from the heart.
The deep vein valves 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 the veins located under the skin, which are not destined for a large amount of it. All of this leads to excessive stretching of the venous walls and, as a result, characteristic varicose nodules are formed. However, an increased volume of blood continues to flow into the deep veins, thus forming an insufficiency of the valvular system of the perforating veins without certain obstacles to blood flow in the horizontal position, first in the deep and then in the superficial vessels. And in the end, CVI develops with manifestations such as edema, pain and ulcers of a trophic nature.
Varicose Symptoms
Varicose veins are characterized by the expansion of veins located under the skin, in the form of saccular or cylindrical alterations. With this pathological disease, convoluted veins appear on the skin surface of the legs and feet. The maximum appearance of varicose veins is formed after long or heavy 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 and nonspecific symptoms. At this point, the patient tires quickly with a constant heaviness in the legs, burning, bursting, especially after physical exertion. In addition, temporary swelling and painful pain along the entire length of the veins sometimes appear. At the same time, in the late afternoon, the ankle and back of the foot swell after prolonged static loads. One 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 signal the patient to see a specialist to prevent the progression of varicose veins.
This disease is characterized by a slow development, sometimes over several decades. Therefore, as a result of inadequate treatment, the varicose veins in their progression form CVI (chronic venous insufficiency).
An important symptom of the disease is also spider veins, which are a spider's web of slightly dilated capillaries that are practically visible under the skin. Sometimes, the elimination of diseases of a dysormonal nature, the exclusion of a sauna, a solarium allows you to forget once and for all diseases like varicose veins. But basically these little spider veins refer to the only sign of veins overflowing the surface and the formation of varicose veins. Therefore, the appearance of even an insignificant sign should serve as a sign for consultation with a surgeon.
In addition, varicose veins represent a cosmetic discomfort, therefore, to solve such problems, doctors perform surgical operations.
varicose veins
This disease can manifest in varying degrees of severity and be characterized by a differentiated structure, which is associated with its clinical symptoms. As a rule, there are several types of structure of the dilated veins on the surface. The first type, the main one, is characterized by expansion of the main trunks of the saphenous veins without adding tributaries to them. The second, or loose, type is an extension similar to a net 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 often than the others.
The symptoms of varicose veins are in direct proportion to the stage of the pathological process, which is subdivided into compensation, undercompensation and decompensation.
In addition, varicose vein ICD 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 surface veins along the main trunks or branches, without certain manifestations of insufficiency of the surface vein valves and communicative properties. Patients have mild leg pain, some severity, fatigue in the context of prolonged exertion. The diagnostic tests carried out indicate satisfactory functioning of the valves, and the presence of small enlargements of the veins under the skin indicate malfunctioning of the flow in the veins of the affected limb. The first degree of VL corresponds to the compensatory phase of varicose veins.
Second degree varicose veins are characterized by expansion of superficial veins with failure of their valves based on functional tests. In the process of loss of flow in the veins, insufficiency of the lymphatic system of the extremities develops, manifested by edema of the feet and legs. The characteristic edema occurs after prolonged exertion on the lower extremities, which disappears after resting in the 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 the subcompensatory property.
In the third degree of varicose veins, expansion of the superficial veins and dysfunction of the valves of the deep, perforating and saphenous veins occur, causing persistent venous hypertension in the distal parts of the limb. This is what causes the violation of microcirculation and the formation of trophic ulcers. At the same time, skin pigmentation develops in the leg region 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. It is associated with disorders of blood flow and lesions of the limb lymphatic system of an organic nature and lymphostasis of secondary origin. The symptoms of the 3rd degree of varicose veins are quite pronounced, varied and constant.
With the progression of varicose veins, the areas of trophic ulcers expand a little, dermatitis and eczema appear, which indicates 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 dynamics but also the general hemodynamics are disturbed. Through ballistocardiography, it is possible to detect impairment of cardiac muscle contractility, which is detected in 80% of patients with decompensated 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 treatment
Comprehensive treatment of varicose veins in the legs is considered a complex process, which is in direct proportion to the severity of the disease. As a rule, surgical and conservative methods of treatment are used.
Varicose veins are treated without surgery and present positive results only at the beginning of the pathological process, when skin manifestations are slightly expressed, moderately reducing work capacity. This method of treatment, being conservative, is also used due to contraindications to surgical intervention. Furthermore, this method is necessarily used postoperatively to prevent the recurrence of varicose veins.
During conservative treatment, the severity of risk factors is reduced with the use of adequate physical activity, the use of elastic compression, medication, and physical therapy. Only the combination of all these therapeutic measures can guarantee a positive result.
First, they identify the risk factors for the occurrence of varicose veins and try to influence them. In addition, a group of people with certain risk factors for this disease, as well as with a hereditary predisposition, even in the absence of varicose vein symptoms, are required to see a phlebologist twice a year through ultrasound examination of the veins of the patient. lower extremities. In addition, if there are no complications such as thrombophlebitis or thrombosis, it is recommended to carry out regular training for the veins of the lower limbs. This involves walking more, wearing only comfortable shoes, swimming, cycling and jogging. All physical activities must be performed with elastic compression. It is absolutely contraindicated to perform exercises with injuries to the lower limbs, and it is also necessary to exclude mountain skiing, tennis, volleyball, basketball, football, various types of martial arts, where loads in the veins of the lower limbs also prevail. as exercises that are associated with lifting significant weights.
At home, after recommendations from an expert, they perform simple exercises. As a general rule of thumb, your legs should be in an elevated position for a few minutes before starting to exercise to prepare your body for certain types of exercise. The choice of the pace and speed of the exercises is made strictly individually for each patient, taking into account their physical capacities. But the main thing about this physical education is its regularity. In addition, the daily use of a contrast bath with alternating massage of the legs with warm and cold water for five minutes is recommended.
Elastic compression is a method of treating varicose veins using a bandage or compression stockings. In this case, muscle compression occurs in a measured way, 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, the formation of thrombosis is prevented.
For the treatment of all phases of varicose veins, phlebotonic drugs are used, which gradually strengthen the venous walls. All drug therapy for varicose veins should only be prescribed by the treating 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 treatment methods, laser, electrophoresis, magnetic field and the use of diadynamic currents present the best results.
Varicose veins refer to a surgical disease that can be completely cured after surgery. As a general rule, there are several types of surgical treatment (phlebectomy, sclerotherapy and laser coagulation), which depend directly on the severity of the pathological process and the location of its location.
When performing phlebectomy, the varicose veins are removed. The main objective of the operation is to eliminate pathological blood secretion by removing the main trunks of the small or large superficial vein and connecting the perforating veins. However, this operation is not performed in the presence of concomitant illnesses that can only worsen the existing condition; late stages of varicose veins; pregnancy; existing purulent processes and old age. Phlebectomy is performed by endoscopic treatment methods, which makes the operation less safe.
During sclerosis, a sclerosant is injected into the dilated venous vessel, which causes the venous walls to stick together and thus the blood flow to stop. With this, the pathological blood flow ceases with the simultaneous elimination of the cosmetic defect, since at this moment the venous vessel collapses and becomes practically invisible. However, the use of sclerotherapy is only effective when the small branches of the main trunks are enlarged, so its use is limited. The advantage of this surgical intervention is the absence of postoperative scars, hospitalization of patients and, in the period after sclerosis, the patient does not need specific rehabilitation.
Laser coagulation is 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 of up to ten millimeters.
Prevention of varicose veins
The prevention of this disease can be primary, which prevents the development of varicose veins, and secondary - in the presence of a pathological process.
Currently, most people attach great importance to preventing this disease. Simple measurements performed regularly can significantly reduce the occurrence 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 perform simple exercises at your workplace.
With existing varicose veins, you should try to get your legs into an elevated position as soon as possible. Fight excess weight, preventing it from increasing. It is also very important to wear comfortable shoes, with a heel of up to two centimeters and, if necessary, use orthopedic insoles. Also, during pregnancy, when taking estrogens or oral contraceptives, it is imperative to examine the veins in the lower extremities with an ultrasound.