Varicose veins are abnormal enlargements of veins located on the surface, characterized by an increase in their diameter and length, resulting in cylindrical, serpentine, cultural, and mixed changes in the venous stems. Nowadays varicose veins are a widespread pathology and women get sick almost 3 times more often than men. This is mainly due to the anatomical features of the body and a certain load on the lower extremities during pregnancy.
Typically, varicose veins are primary and secondary. In the first variant, the disease is caused by an initial weakness of the large vein wall, which is localized under the skin or by congenital dysfunction of the valves. The development of secondary venous pathology is influenced by deep vein thrombosis or valve failure acquired due to pregnancy, heavy physical exertion, prolonged standing, and so on. Sh.
As the hydrostatic pressure in the veins increases, this vessel expands in diameter and the impaired functions of the valves become more acute. All of this impedes blood flow to the superficial veins, and as a result of the insufficient functioning of the veins in the periphery, deep-seated veins produce blood reflux into the diaphragm veins, which when over-stretched begin to oscillate. Formation of various forms of expansion. In the future, as a result of pronounced stagnation, tissue trophism is violated, 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 widening of the joint, serpentine tortoiseshell, increased valve length, and insufficiency.
Typically, varicose veins of the lower extremities occur in 20% of the population. In addition, it affects both boys and girls equally before puberty. But in adulthood women suffer from varicose veins much more often than men. Also, the number of patients increases with age. This is explained by the restructuring of the hormonal background in a woman's body as a result of pregnancy, menstruation, which leads to a weakening of the tone of the veins, their expansion, a certain failure of the communication and peripheral venous valves, the opening of the veins. Arteriovenous shunt and circulatory disorders in the veins.
The true cause of the development of varicose veins in the lower extremities is still unknown. It is suggested that insufficient functioning of the valves and increased pressure in the veins are related to the etiological cause of the disease. Considering all the factors before the onset 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. 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.
Risk factors involved in the formation of varicose veins of the lower extremities are: increase in hydrostatic pressure in the veins of the veins, thinning of their walls, disruption of metabolic processes in smooth muscle cells, movement of blood from deep veins to superficial veins. This reverse movement of blood in the form of vertical reflux and horizontal reflux causes gradual nodular dilation, elongation, and rotation of the localized, i. e. superficial veins under the skin. The final link in the pathogenesis is cellulite, dermatitis, and trophic venous ulcer of the lower leg.
The symptomatic picture of varicose veins of the lower extremities includes patients complaining of enlarged veins, causing cosmetic discomfort, some severity, and in some cases pain in the lower extremities, night cramps, and trophic changes in the legs.
Venous vasodilation can range from small "stars" to reticular nodes to coarsely flexible vertebrae, as well as nodes with plexuses that are clearly visible in the patient's vertical position. , 9% of patients show damage to both veins involved in the pathological process.
As a result of the progressive process, the patient begins to experience rapid fatigue, some heaviness and tension in the legs, cramps in the calf muscles, swelling of the legs and feet, and the development of paresthesia. In addition, the legs are mostly swollen in the late afternoon, but after sleep this swelling disappears.
Often varicose veins are complicated by acute thrombophlebitis of the veins with a red, vascular-like, painful compression of the vein characterized by dilation as well as periphlebitis. Very often varicose veins experience rupture as a result of minor damage and this causes bleeding. Typically, blood can flow from a ruptured nodule, and the patient sometimes loses quite a large amount of it.
In addition, there are some difficulties in the diagnosis of varicose veins of the lower extremities, as well as on the basis of patient complaints, disease history and the results of objective examination when connecting to the CVI.
The ability to determine the condition of the valves of the main and communicative nature, as well as to assess the permeability of the deep veins is essential in making a diagnosis.
Causes varicose veins
This pathological process is characterized by enlargement of the veins on the surface under the skin and is associated with insufficient work of the valves in the veins and disruption of blood circulation in them. Varicose veins are one of the most common vascular pathologies in half of the working age population.
There are usually several factors contributing to the development of the disease as well as its progression. Some contribution of heredity to the appearance of varicose veins has not yet been confirmed. The emergence of this pathological process can currently be influenced by the nature of the diet, lifestyle and conditions caused by changes in the hormonal background.
Also, the emergence of this pathological process is associated with improper organization of the work process. Many people spend a lot of time standing or sitting due to their work and this has quite a bad effect on the valvular valve apparatus of the lower extremities. In addition, work related to heavy physical labor is considered unfavorable, especially in the form of a strain on the legs when lifting weights.
At present, long-term travel or flights, which contribute to the production of venous blood stasis in the legs and are risk factors for the development of venous pathologies, adversely affect the blood flow system in the veins. In addition, wearing tight underwear causes the veins in the pelvic area to contract, and corsets increase the pressure inside the peritoneum, so wearing them constantly is not recommended. This also applies to high-heeled shoes in the presence of uncomfortable soles.
Recurrent pregnancy is a proven risk factor for varicose veins. This can be explained by the fact that the increased uterine pressure increases inside the peritoneum, while progesterone destroys the fibers of elastic and collagen origin in the venous wall. Also diseases such as rheumatoid arthritis, osteoporosis, changes in hormonal status, increase the risk of developing this pathological process.
Typical causes of varicose veins are the peculiarity of their structure in the lower extremities. There is a system of veins located on the surface, i. e. the saphenous veins, such as small and large, as well as the deep vein system of the thigh and lower leg, and perforated veins, which connect the two anterior systems. In normal blood circulation, blood flow to the lower extremities occurs in 90% of the deep veins and 10% of the superficial veins. But in order for the blood to go to the heart and not vice versa, there are valves in the venous walls that close and do not allow the blood to move from top to bottom under the influence of gravitational force. It is also of great importance to contract the muscles, which promotes normal blood flow. In addition, in the vertical position blood stagnation develops, the pressure in the veins begins to increase and this causes them to expand. In the future, there will be insufficient functioning of the valves, which will lead to the closure of the valve leaflets, resulting in improper movement of blood from the heart.
Deep-set venous valves are particularly rapidly damaged by the maximum load on them. And with the help of a perforated venous system to reduce excess pressure, blood flows into veins under the skin that are not intended for its large number. All this causes the venous walls to stretch and the resulting varicose nodes to form. However, the increased volume of blood still flows into the deep veins, resulting in a failure of the perforated venous valve apparatus, without any obstruction to blood flow, in a horizontal position, first in deep vessels and then superficially. Finally CVI develops with manifestations such as edema, pain, and ulcers of a trophic nature.
Symptoms of varicose veins
Varicose veins are characterized by dilation of localized veins subcutaneously, in the form of cult or cylindrical changes. With this pathological disease, mixed veins appear on the skin surface of the feet and legs. The maximum appearance of varicose veins is formed after prolonged or heavy physical exertion. Varicose veins are quite common in young women during or after pregnancy.
The early stage of varicose veins is characterized by few and nonspecific symptoms. At this time patients quickly get tired of the constant heaviness in the legs, burning, bloating, especially after physical exertion. Also, sometimes there is transient swelling and excruciating pain along the entire length of the veins. At the same time, in the late afternoon, the ankle and back of the foot are swollen after a long static load. Some characteristics of edema are their disappearance in the morning, after a night rest. At this stage, there are usually no noticeable signs of varicose veins. However, these early stage symptoms should be a signal for the patient to consult a specialist to prevent the progression of varicose veins.
This disease is characterized by slow development, sometimes over several decades. Therefore, as a result of poor treatment, varicose veins develop CVI (chronic venous insufficiency) in its progression.
An important symptom of the disease is also the spider veins, which are a slightly enlarged network of capillaries that are practically visible under the skin. Sometimes eliminating disorders of a non-hormonal nature, eliminating the sauna, solarium allows you to once and for all forget about a disease such as varicose veins. But mostly, these spider veins refer to the only sign of superficial veins overlapping and the formation of varicose veins. Therefore, even the appearance of such a minor sign should be a signal to consult a surgeon.
In addition, varicose veins are a cosmetic discomfort, so doctors perform surgeries to solve such problems.
Quality of varicose veins
This disease can be manifested in different degrees of severity and is characterized by different structure, depending on its clinical symptoms. There are usually several types of enlarged venous structures on the surface. The first type, the basic one, is characterized by the expansion of the main stems of the saphenous veins without joining the tributaries with them. The second type, or loose, is a network-like extension with multiple branches. This type of varicose veins is detected at the very beginning of the disease. But in the case of the mixed type, a combination of the two anterior occurs, and this third type is much more common than the others.
The symptomatology of varicose veins is directly proportional to the stage of the pathological process, which is divided into compensation, subcompensation and decompensation.
In addition, ICD for varicose veins distinguishes between pathology with ulceration, inflammation, the presence of concomitant ulcers, and inflammation of the lower extremities and varicose veins without inflammation or ulceration.
The first degree of varicose veins is characterized by moderately pronounced expansion of the veins on the surface, along the main stems or branches, without a lack of venous valves on the surface and some manifestation of communicative properties. Patients experience mild leg pain, some heaviness, fatigue on prolonged workload. The diagnostic tests performed indicate satisfactory function of the valves, while the presence of small dilation of the veins under the skin indicates poor work of drainage from the affected limb to the veins. The first degree of VL corresponds to the compensatory stage of varicose veins.
The second degree of varicose veins is characterized by superficial veins dilation with insufficiency of their valves based on functional tests. In the process of disruption of drainage into the veins develops insufficiency of the lymphatic system of the extremities, which is manifested by swelling of the ankles and feet. Characteristic swelling occurs after prolonged exercise on the lower extremities, which disappears after resting in a horizontal position. In addition, there is constant intense pain in the injured limb. The second degree of the disease is characterized by the stage of subcompensation properties.
In the third degree of varicose veins, dilation of the superficial veins and dysfunction of the deep-set venous valves, perforated and laminated, leading to persistent venous hypertension in the distal parts of the limb are noted. This is what causes microcirculation disorders and trophic ulcers. At the same time, skin pigmentation develops in the lower leg area with the initial manifestation of the induration pathological process. But the feet and legs, especially if there are trophic disorders, are characterized by persistent swelling. It is associated with impaired blood flow, organ lymphatic system damage, and secondary lymphostasis. The symptoms of grade 3 varicose veins are quite pronounced, varied and persistent.
With further progression of varicose veins, the zones of trophic ulcers expand to some extent, dermatitis and eczema appear, indicating the presence of the fourth stage of the disease. The last two degrees of severity represent the stage of decompensation of the pathological process. In this case, not only local but also general hemodynamics are violated. Ballistocardiography can detect impaired myocardial contracture, which is detected in 80% of patients with varicose vein decompensation.
An important point in choosing the appropriate treatment is to determine the quality of the varicose veins and the type of dilated superficial veins.
Treatment of varicose veins
Comprehensive treatment of varicose veins of the legs is considered a complex process that is directly proportional to the severity of the disease. Surgical and conservative treatment methods are usually used.
Varicose veins are treated without surgery and give a positive result only at the beginning of the pathological process, when the manifestations on the skin are slightly pronounced, moderately reducing the ability to work. This method of treatment, as a conservative, is also used because of the contraindications to surgical intervention. In addition, this method is definitely used to prevent recurrent condition of varicose veins in the postoperative period.
During conservative treatment, the severity of risk factors is reduced through adequate physical activity, elastic compression, medication, and physiotherapy. Only a combination of all these therapeutic measures can guarantee a positive result.
First of all, they identify the risk factors for the appearance of varicose veins and try to influence them. In addition, a group of people with certain risk factors for this disease, as well as those with a hereditary predisposition, even in the absence of symptoms of varicose veins, should consult a phlebologist twice a year with an ultrasound examination of the veins. Lower limbs. Also, unless there are complications such as thrombophlebitis or thrombosis, regular exercise of the veins of the lower extremities is recommended. This means more walking, just wearing comfortable shoes, swimming, cycling and jogging. All physical activity should be performed using elastic compression. Absolutely contraindicated in performing exercises with lower extremity injuries, it is also necessary to exclude mountain skiing, tennis, volleyball, basketball, football, various martial arts, where the load is excessive on the veins of the lower extremities. As exercises related to significant weight gain.
At home, following the recommendations of a specialist, perform simple exercises. Usually the legs should be in an elevated position for a few minutes before starting the exercise to prepare the body for a certain type of exercise. The choice of pace and speed of exercise is selected strictly individually for each patient, taking into account his physical abilities. But the main thing in such physical education is its regularity. In addition, it is recommended to use a daily contrast shower with warm and cold water alternating feet massage for five minutes.
Elastic compression is a method of treating varicose veins with a bandage or using a compression garment. In this case, muscle contraction occurs in a dosed manner, which improves blood flow to the venous blood vessels and prevents stagnation events. Thanks to the artificial maintenance of vascular tone, the veins stop dilating and, consequently, thrombosis is prevented.
Phlebotonic drugs are used to treat all stages of varicose veins, which gradually strengthen the venous walls. All medication therapy for varicose veins should be prescribed only by the attending physician, therefore self-medication is not recommended. But topical therapy in the form of ointments and gels without signs of thrombophlebitis or thrombosis is simply undesirable.
Among the physiotherapeutic methods of treatment, the use of laser, electrophoresis, magnetic field and diadynamic currents has the best effect.
Varicose veins refer to a surgical disease that can be completely cured after surgery. There are usually several types of surgical treatment (phlebectomy, sclerotherapy and laser coagulation) that directly depend on the severity of the pathological process and its location.
During a phlebectomy, varicose veins are removed. The main goal of surgery is to eliminate abnormal blood discharge by removing the main stems of small or large superficial veins and ligating perforated veins. However, this operation is not performed in the presence of concomitant diseases, which can only worsen the existing condition; Late stages of varicose veins; Pregnancy; Existing purulent processes and aging. Phlebectomy is performed with endoscopic methods of treatment, which makes this operation less safe.
In case of sclerosis, the sclerosant is inserted into an enlarged venous vessel, which causes the venous walls to connect and thus stops the blood circulation in it. As a result, abnormal blood flow is stopped by the simultaneous elimination of the cosmetic defect, since at this moment the venous vessel collapses and is practically invisible. However, the use of sclerotherapy is effective only when the small branches of the main stems are enlarged, so it is used in limited quantities. The advantage of this surgical intervention is the absence of postoperative scars, hospitalization of patients, and in the post-sclerosis period 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 surgery is indicated only with an enlarged vein up to ten millimeters.
Prevention of varicose veins
Prevention of this disease can be primary, which prevents the development of varicose veins, and secondary - in the presence of a pathological process.
Most people today attach great importance to the prevention of this disease. Simple measures taken regularly can significantly reduce the appearance and further progression of varicose veins. In this case it is very important, first of all, more movement and also the alternation of long static load with swimming, jogging, walking, cycling. You also need to perform simple exercises in the workplace.
In the case of existing varicose veins, you should try to place the legs in an elevated position as often as possible. Fight overweight, avoid gaining weight. It is also very important to walk in comfortable shoes, with a maximum heel height of up to five centimeters and use orthopedic underwear if necessary. In addition, during pregnancy, while taking estrogens or oral contraceptives, it is necessary to examine the veins of the lower extremities using an ultrasound scan.