Varicose veins of the lower extremities is a chronic venous disease, which is characterized by the thinning of their walls, the extension of the lumen and formation of aneurysm-sicut nodes. Most often varicose disease affects the lower extremities; it is one of the most common pathologies – it affects about 40% of women and 20% men.
Causes and risk factors
Through the veins of the lower extremities blood flows upwards, that is, she has to overcome the force of gravity. This current is provided by a pressure located near the veins and tendons of the residual arterial pressure. The movement of blood through the veins of the lower limbs and promotes a "muscle pump": when moving, the leg muscles contract and compress veins, placebat ei pulsare thereby are in their blood up, since the reverse-current inhibit venous valves.
The weakness of the muscular layer of the venous wall and valvular incompetence be the reason that influenced the actions of the "muscle pump" the blood begins to flow in the opposite direction, i.e. down. This leads to increased pressure on the walls of blood vessels, further progression of the valve disease, enlargement of the lumen of veins and nodules. The muscle fibers of vein walls atrophy, disrupted nerve receptors that regulate venous tone, which in turn further enhances the manifestations of the venous insufficiency.
Risk factors for development of varicose disease of lower limbs:
- genetic predisposition;
- pregnancy;
- obesity;
- daily prolonged sitting or standing;
- activities associated with heavy lifting;
- systematic wearing of tight clothing, corsets;
- improper diet with inadequate intake of dietary fiber and vitamins;
- violations of hormonal status.
In the prevention of varicose veins plays an important role in active pastime: sports (swimming, Cycling, fitness), dancing, Hiking, etc.
Forms of the disease
Based on the characteristics of clinical manifestations, there are the following forms of varicose veins of the lower extremities:
- segmental lesions intradermal and subdermal veins without reverse flow;
- segmental lesion of the veins of the lower limbs, accompanied by abnormal blood flow;
- common in vessels with reversed flow of blood in the superficial veins;
- common vascular lesions, accompanied by abnormal discharge of blood in the deep venous system.
The stage of the disease
In 2000, the Russian phlebologists was adopted the classification of varicose veins of the lower extremities, taking into account the form of the disease, the degree of venous insufficiency, presence or absence of complications. In accordance with it, there are three stages of varicose disease of lower limbs:
- The compensation stage. Patients do not show any complaints. During the inspection on one or both legs are detected superficial dilated veins.
- The stage subcompensation. Patients complain of night cramps, disturbance of skin sensation (paresthesias) in the legs, bloating. In the evening there is often swelling of legs, ankles and feet, disappearing after a night's sleep. During the inspection of the feet clearly visible dilated varicose veins.
- Stage of decompensation. To the above signs be joined by eczema and dermatitis. Skin with pigment spots, dry, shiny, tightly connected with subcutaneous fat.
Symptoms
The clinical picture is varicose veins of the lower extremities is determined by the stage of the disease. So, when compensated stage the only symptom of venous insufficiency is the appearance on the legs spider veins (telangiectasias).
The transition of the disease in subcompensated stage is accompanied by pain in the legs, swelling of feet and ankles, cramps in calf muscles. After resting in a horizontal position, these symptoms cease.
Most clearly the clinical picture is varicose veins of the lower extremities is manifested in decompensated stage of the disease. Foot pain to become permanent. Patients complain of itching of the skin, which intensifies in the evening and night hours. Over time, there are dermatitis, eczema, hard healing sores. On the stage are frequent common symptoms: dizziness, low blood pressure. They are associated with deposition in the expanded venous network of the legs of large volumes of blood.
Complication of varicose veins is phlebitis, thrombophlebitis, bleeding from varices, ulcers, pulmonary embolism.
Diagnosis
Diagnosis of varicose veins of the lower extremities is not difficult. It is based on characteristic clinical symptoms and data of objective inspection.
To assess the severity of hemodynamic disorders apply the instrumental methods of diagnostics:
- Doppler ultrasound of lower limb veins;
- duplex angioscanning;
- rheovasography of the lower limb veins.
Treatment
In the treatment of varicose disease of the lower extremities according to the testimony of the following methods or their combination:
- conservative therapy;
- sclerosing therapy;
- surgery.
Conservative therapy of varicose disease of the lower extremities may be recommended in patients in the early stages of the disease, its aim – prevention of progression of chronic venous insufficiency. It is also used when subcompensated and decompensated stages of the disease during the period of preparation of the patient for a surgical intervention or in cases when other methods are contraindicated. Conservative treatment of varicose veins based on the use of phlebotonics, wearing compression hosiery. In addition, patients are encouraged to regularly engage in physical therapy, to avoid prolonged static loads.
Varicose veins of the lower extremities is not complicated by significant hemodynamic disturbance, can be used for compression sclerotherapy. The method consists in conducting into the affected vein drug, causing its spasm. After that leg wear compression stockings or bandaging, exercise the legs with an elastic bandage to maintain the wall of the vein in dormientes condition. After a few days begins the process of gluing the vein walls. A compression garment must be worn after sclerotherapy at least six weeks, until the formation between the walls of the veins rather dense adhesions.
In advanced stages of varicose disease of the lower extremities is the most effective method – surgery. Techniques operating techniques are selected on the basis of the stage of the disease, its forms, characteristics of hemodynamic disorders:
- laser coagulation;
- radiofrequency coagulation;
- miniphlebectomy;
- phlebectomy.
Possible complications and consequences
Complications of varicose veins develop mainly in the stage of decompensation. These include:
- phlebitis (inflammation of veins extended);
- thrombophlebitis (inflammation of a vein with formation in the lumen of blood clots);
- bleeding from varices;
- sores;
- pulmonary embolism (PE).
Most often varicose disease affects the lower extremities; it is one of the most common pathologies – it affects about 40% of women and 20% men.
Forecast
The prognosis of varicose veins of lower extremities with timely treatment favorable.
Prevention
To prevent varicose veins of lower extremities it is necessary to avoid prolonged static loads. If the job requires a long stay in a standing position or sitting, you must make periodic breaks for small exercises or at least walking. After the working day is recommended to lie down, giving the feet a horizontal or elevated position.
In the prevention of varicose veins plays an important role in active pastime: sports (swimming, Cycling, fitness), dancing, Hiking, etc.