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 cylindrical, serpentine, saccular and mixed type of change in the venous trunks. Today, varicose veins are a widespread pathology, and women are sick more often than men almost 3 times. 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 the initial weakness of the wall of the large vein, which is localized under the skin or congenital dysfunction of the valves. The development of secondary venous pathology is influenced by deep vein thrombosis or acquired valve insufficiency due to pregnancy, heavy physical exertion, prolonged standing, etc.
At the time of an increase in the hydrostatic pressure in the veins, these vessels expand in diameter and the impaired 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 in the periphery, blood reflux is formed from deep-seated veins into the saphenous veins, which are too stretched, begin to wriggle, 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 a saccular expansion, serpentine tortuosity, an increase in the length and insufficiency of valves.
As a rule, varicose veins of the lower extremities occurs in 20% of the population. In addition, before puberty, it affects both boys and girls equally. But women in adulthood are much more likely to be affected by varicose veins, in contrast to 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 result 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 arteriovenous shunts 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 functioning of the valves and an increase in pressure in the veins are related to the etiological cause of the development of the disease. Considering all the factors that are predisposing to 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-seated 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.
Risk factors that are involved in the formation of varicose veins of the lower extremities are: increased hydrostatic pressure in the veins' trunks, thinning of their walls, impaired metabolic processes in smooth muscle cells, the movement of blood from deep veins to superficial ones. This reverse movement of blood in the form of vertical reflux and horizontal reflux causes a gradual nodular expansion, lengthening and tortuosity of veins that are localized 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 complaints of patients about the existing dilated veins, which cause cosmetic inconveniences, a certain severity, and in some cases pain in the lower extremities, cramps at night and trophic changes in the legs.
The expansion of the venous vessels can vary from minor "stars", reticular nodes to coarsely wriggling trunks, as well as nodes, 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. In addition, 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 distension is noted in the legs, cramps appear in the muscles of the calves, and the legs and feet become swollen and paresthesias develop. In addition, the legs mostly swell in the late afternoon, but after sleep this swelling goes away.
Quite often, varicose veins are complicated by acute thrombophlebitis of the veins on the surface with manifestations of redness, cord-like, painful compaction of the vein, which is characterized by expansion, as well as periphlebitis. Very often the varicose veins undergo rupture as a result of minor damage, and this leads to bleeding. As a rule, blood from a ruptured node can flow in a stream and the patient sometimes loses a fairly large amount of it.
In addition, there are no certain difficulties in diagnosing varicose veins of the lower extremities, as well as in joining CVI on the basis of patients' 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 state of the valves of the veins of the main and communicative nature, as well as to assess the patency of deep veins.
Varicose veins causes
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 pathology among the working-age half of the population.
There are, as a rule, several predisposing factors for the development of the disease, as well as its progression. A definite contribution of heredity to the appearance of varicose veins has not yet been proven. 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 occurrence of this pathological process is associated with the incorrect organization of the working process. Many people spend a significant amount of time in a standing or sitting position, depending on their work, and this has a rather bad effect on the valve apparatus of the veins of the lower extremities. In addition, work associated with hard physical labor is considered unfavorable, especially in the form of a jerk load on the legs while lifting weights.
Today, long-term travel or flights, which contribute to the occurrence of venous stasis of blood in the legs and are risk factors for the formation of venous pathologies, negatively affect the blood flow system in the veins. In addition, wearing tight underwear causes compression of the veins in the groin area, and corsets increase the pressure inside the peritoneum, so they are not recommended to be worn all the time. This also applies to shoes with high heels 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 enlarged uterus increases the pressure inside the peritoneum, and progesterone destroys the fibers of elastic and collagen origin contained in the venous wall. Also, diseases such as rheumatoid arthritis, osteoporosis, by changing the hormonal status, increase the risk of developing this pathological process.
Typical causes of varicose veins are the peculiarities of their structure on the lower extremities. There is a system of veins located on the surface, that is, saphenous veins, such as small and large, as well as a system of deep veins in the thigh and lower leg, and perforating veins connecting the two previous systems. With normal blood circulation, blood flow to the lower extremities occurs in 90% of the deep veins and 10% of the superficial. But in order for the blood to move towards the heart, and not vice versa, there are valves in the venous walls that slam shut and do not allow blood to pass under the influence of gravitational force from top to bottom. Muscle contractions are also of great importance, contributing to normal blood flow. In addition, in an upright position, blood stagnation develops, the pressure in the veins begins to increase and this leads to their expansion. In the future, insufficient functioning of the valves is formed, which becomes the reason for the non-closure of the valve leaflets with the formation of an incorrect movement of blood from the heart.
The valves of deep-seated veins are affected especially quickly as a result of the maximum load on them. And in order to reduce excess pressure with the help of a system of perforating veins, blood flows into the veins located under the skin, which are not designed for a large amount of it. All this leads to overstretching of the venous walls and, as a result, characteristic varicose nodes are formed. However, an increased volume of blood continues to flow into deep veins, thereby forming a insufficiency of the valve apparatus of perforating veins without certain obstacles to blood flow in a horizontal position, first into deep vessels, and then into superficial ones. And in the end CVI develops with such manifestations as edema, pain and ulcers of a trophic nature.
Varicose veins symptoms
Varicose veins are characterized by the expansion of veins localized under the skin, in the form of saccular or cylindrical changes. With this pathological disease, convoluted veins appear on the surface of the skin 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 moment, patients become quickly tired with constant heaviness in the legs, burning, bursting, especially after physical exertion. Also, sometimes transient edema and aching pains along the entire length of the veins appear. At the same time, in the late afternoon, the ankle and rear of the foot swell after prolonged static loads. Some feature of edema is their 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 symptoms of the initial stage should be a signal for the patient to see a specialist in order 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 in its progression forms CVI (chronic venous insufficiency).
An important symptom of the disease is also spider veins, which are a cobweb of slightly dilated capillaries that are practically visible under the skin. Sometimes the elimination of disorders of a dyshormonal 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 such sign should serve as a signal for consultation with a surgeon.
In addition, varicose veins represent a discomfort from the cosmetic side of the issue, therefore, to solve such problems, doctors perform surgical operations.
Varicose veins degree
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 rule, there are several types of structure of the 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 veins is detected at the very beginning of 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 others.
The symptomatology of varicose veins is in direct proportion 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 an ulcer, with inflammation, with the presence of simultaneous ulcers and inflammation on 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 valves of the veins on the surface and communicative properties. Patients have a slight nature of pain in the leg, a certain severity, fatigue against the background of prolonged exertion. The diagnostic tests carried out indicate satisfactory function of the valves, and the presence of slight dilatations of the veins under the skin indicate poor work of the outflow in the veins from the limb that is affected. 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 the failure of their valves on the basis of functional tests. In the process of impaired outflow in the veins, insufficiency of the lymphatic system of the extremities develops, which is manifested by edema of the feet and legs. The characteristic swelling occurs after prolonged exertion on the lower extremities, which disappear after resting in a horizontal position. In addition, there is a persistent severe 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, there is an expansion of the superficial veins and dysfunction of the valves of the deep-seated veins, perforating and saphenous, and this causes 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 disorders of blood outflow, and with lesions of the lymphatic system of the limb of an organic nature, and lymphostasis of secondary origin. Symptoms of the 3rd degree of varicose veins are quite pronounced, varied and constant.
With the further progression of varicose veins, the zones of trophic ulcers expand somewhat, dermatitis and eczema appear, which indicates 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 disturbed. Using ballistocardiography, it is possible to detect the 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 veins treatment
Complex treatment of varicose veins of 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 give positive results only at the very 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 one, is also used due to contraindications for surgical intervention. In addition, this method is necessarily used in the postoperative period in order to prevent recurrent conditions 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, medications and physiotherapy. Only the combination of all these therapeutic measures can guarantee a positive result.
First of all, they identify 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 symptoms of varicose veins, are required to consult a phlebologist twice a year using ultrasound examination of the veins of the lower extremities. Also, if there are no complications such as thrombophlebitis or thrombosis, it is recommended to perform regular training for the veins of the lower extremities. This involves walking more, wearing only comfortable shoes, swimming, cycling and jogging. All physical activities should be performed using elastic compression. It is absolutely contraindicated to perform exercises with lesions of the lower extremities, it is also necessary to exclude mountain skiing, 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 the lifting of significant weights.
At home, after the recommendations of a specialist, they perform simple exercises. As a general rule, the legs should be in an elevated position for a few minutes before starting to exercise to prepare the body for certain types of exercise. The choice of the pace and speed of exercises is selected strictly individually for each patient, taking into account his 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 alternating massage of the legs with warm and cold water, for five minutes.
Elastic compression is a method of treating varicose veins using bandaging or compression hosiery. In this case, muscle compression occurs in a dosed manner, which improves blood flow through the venous vessels and prevents stagnant phenomena. Thanks to the artificial maintenance of vascular tone, the veins stop expanding and thus, the prevention of thrombosis formation takes place.
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, it is not recommended to self-medicate. But local therapy in the form of ointments and gels without signs of thrombophlebitis or thrombosis is simply undesirable.
Among physiotherapeutic methods of treatment, laser, electrophoresis, magnetic field and the use of diadynamic currents have the best effect.
Varicose veins refers to a surgical disease that can be completely cured after surgery. As a rule, there are several types of surgical treatment (phlebectomy, sclerotherapy and laser coagulation), which are directly dependent on the severity of the pathological process and the place of its localization.
When performing phlebectomy, varicose veins are removed. The main goal 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; pregnancy; existing purulent processes and old age. Phlebectomy is performed using endoscopic methods of treatment, which makes this operation less safe.
During sclerosis, a sclerosant is injected into the dilated venous vessel, which causes the venous walls to join and thus the blood flow through it stops. As a result, the pathological outflow of blood stops with 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 trunks are enlarged, therefore it is used to a limited extent. 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.
Coagulation with a laser 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.
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.
Currently, most people attach great importance to the prevention of this disease. Regularly performed simple measures can significantly reduce the occurrence and further 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 in your workplace.
With the existing varicose veins, you must try to place your legs in an elevated position as often as possible. Fight excess weight, preventing it from increasing. 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. In addition, during pregnancy, taking estrogens or oral contraceptives, it is imperative to examine the veins of the lower extremities using an ultrasound scan.