Varicose veins are a pathological enlargement of the veins located on the surface, which is characterized by an increase in their diameter and length, which consequently leads to a cylindrical, serpentine, saccular and mixed type change in the vein trunks. Today, varicose veins are a widespread pathology, and women get 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 extremities 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 great vein, which is located under the skin or congenital dysfunction of the valves. The development of secondary venous pathology is affected by deep vein thrombosis or acquired valve insufficiency due to pregnancy, strenuous 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 weakened functions of the valves worsen. All this disrupts the blood circulation in the veins on the surface, and as a result of insufficient function of the veins in the periphery, blood return is formed from deep veins into saphenous veins, which are too stretched, begin to twist, forming various forms of expansion. In the future, as a result of pronounced stagnation, tissue strophism is disturbed, ulcers, eczema and dermatitis are formed.
Varicose veins in 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 length and insufficiency of valves.
Varicose veins usually occur in the lower extremities in 20% of the population. In addition, it affects both boys and girls just before puberty. However, women in adulthood are much more likely to be affected by varicose veins, unlike men. The number of patients is also increasing with increasing age. This can be explained by the restructuring of the hormonal background in the female body due to pregnancy, menstruation, which causes a weakened tone in the veins, their dilation, a certain insufficiency of the valves in the communicating and saphenous veins, opening of arteriovenous shunts and circulatory disorders inthe veins.
To date, the true cause of varicose veins development in the lower extremities is still unknown. It is believed that insufficient function 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 predispose to the beginning 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.
Risk factors involved in the formation of varicose veins in the lower extremities are: increased hydrostatic pressure in the trunks of the veins, thinning of their walls, impaired metabolic processes in smooth muscle cells, 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, elongation and twisting of veins located under the skin, i. e. superficially. The last link in the pathogenesis is represented by cellulitis, dermatitis and trophic venous ulcer in the lower leg.
The symptomatic picture of varicose veins in the lower extremities consists of complaints from patients about the existing dilated veins, which cause cosmetic discomfort, a certain degree of severity and in some cases pain in the lower extremities, cramps at night and trophic changes in the legs.
The dilation of the venous vessels can range from smaller "stars", reticular nodules to coarsely twisting trunks, as well as nodules, plexuses, which are clearly visible in the upright position of patients. Nearly 80% are lesions of the trunk and branches of the great vein on the surface, and 10% are in the small vein saphenous. 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, some degree of difficulty and distention is noted in the legs, cramps occur in the muscles of the calves, and the legs and feet become swollen and paresthesias develop. In addition, the legs usually swell in the late afternoon, but after sleep, this swelling goes away.
Quite often, varicose veins are complicated by acute thrombophlebitis in the veins on the surface with manifestations of redness, cord-like, painful compression of the vein, which is characterized by expansion as well as periflebitis. Very often varicose veins rupture due to minor injuries and this leads to bleeding. As a rule, blood from a ruptured nodule 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 in the lower extremities, as well as joining CVI on the basis of patient complaints, medical history of the disease and the results of an objective examination.
An important value in making a diagnosis is the ability to determine the condition of the veins' valves of a main and communicative nature as well as to assess the openness of deep veins.
Varicose veins causes
This pathological process is characterized by the dilation of the veins located on the surface under the skin and is associated with insufficient work of the valves in the veins and decreased blood circulation in them. Varicose veins are among the most common vascular pathologies among half of the working-age population.
There are usually several predisposing factors for the development of the disease, as well as its progression. A specific contribution of heredity to the occurrence of varicose veins has not yet been proven. The emergence of this pathological process can currently be affected 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 work process. Many people spend a significant amount of time in a standing or sitting position, depending on their work, and it has a rather poor effect on the valve apparatus in the veins of the lower extremities. In addition, work associated with hard physical work 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, adversely 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 it is not recommended to wear them all the time. This also applies to shoes with high heels in the presence of uncomfortable instep supports.
Repeated pregnancies are a documented 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 vein wall. Also diseases such as rheumatoid arthritis, osteoporosis, change in hormone 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, i. e. 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. During normal blood circulation, blood flow to the lower extremities occurs in 90% of the deep veins and 10% of the superficial ones. But for the blood to move towards the heart, and not the other way around, there are valves in the vein walls that slam together and do not allow blood to pass under the influence of gravity from top to bottom. Muscle contractions are also of great importance, contributing to normal blood flow. In addition, blood stagnation develops in an upright position, the pressure in the veins begins to increase, and this leads to their expansion. In the future, insufficient function of the valves is formed, which becomes the reason for the non-closing of the valve blades with the formation of an incorrect movement of blood from the heart.
The valves in deep veins are affected particularly quickly due to the maximum load on them. And to reduce overpressure by means of a system of perforating veins, blood flows into the veins under the skin, which are not designed for a large amount of it. All this leads to overstretching of the vein walls, and as a result, characteristic varicose nodes are formed. However, an increased volume of blood continues to flow into deep veins, thereby forming an insufficiency of the valve apparatus for perforating veins without certain obstructions to the blood flow in the horizontal position, first into deep vessels and then into superficial ones. And eventually, CVI develops with such manifestations as edema, pain, and ulcers of a trophic nature.
Varicose veins symptoms
Varicose veins are characterized by dilation of veins located under the skin, in the form of secular or cylindrical changes. With this pathological disease, complicated 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 the 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 quickly become tired with constant heaviness in the legs, burning, bursting, especially after physical exertion. Also sometimes transient edema and sore pain occur along the entire length of the veins. At the same time, in the late afternoon, the ankle and the back of the foot raise after prolonged static loads. Some features of edema are their disappearance in the morning after a night's sleep. At this stage, there are usually no visible signs of varicose veins. However, these symptoms at the initial stage should be a signal to the patient to see a specialist to prevent 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 form CVI (chronic venous insufficiency).
An important symptom of the disease is also spiders, which are a cobweb of slightly dilated capillaries that are practically visible under the skin. Sometimes eliminating disorders of dyshormonal nature, excluding a sauna, a solarium allows you to forget once and for all about such a disease as varicose veins. But basically, these spiders refer to the only sign of overcrowded 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 cosmetic discomfort, therefore, doctors perform surgical operations to solve such problems.
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 most important, is characterized by the dilation of the main trunks of saphenous veins without connecting 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 beginning of the development of the disease. But with a mixed type, a combination of the two previous ones 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 is divided into compensation, subcompensation and decompensation.
In addition, ICD of varicose veins distinguishes pathology with a wound, with inflammation, with the presence of concomitant ulcers and inflammation of the lower extremities and varicose veins without inflammation or ulcers.
The first degree of varicose veins is characterized by a moderately pronounced dilation of the veins on the surface along the main stems or branches without certain manifestations of insufficiency of the venous valves on the surface and communicative properties. Patients have a mild character of pain in the leg, a certain degree of severity, fatigue due to prolonged exertion. The diagnostic tests performed indicate a satisfactory function of the valves, and the presence of minor enlargements of the veins under the skin indicates poor work with the outflow into the veins from 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 dilation of the superficial veins with failure of their valves on the basis of functional tests. In the process of decreased outflow into the veins, insufficiency of the lymphatic system of the extremities develops, which is manifested by edema in the feet and legs. The characteristic swelling occurs after prolonged exertion on the lower extremities, which disappears 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 enlargement of the superficial veins and dysfunction of the valves in 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 the microcirculation and the formation of trophic wounds. 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 flow and with lesions of the lymphatic system in the limb of organic nature and lymphostasis of secondary origin. Symptoms of 3rd degree 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, 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 disturbed. Using ballistocardiography, it is possible to detect the decreased 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
Extensive treatment of varicose veins in 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 only positive results at the beginning of the pathological process when the manifestations on the skin are easily expressed, which moderately reduces the ability to work. This method of treatment, as a conservative, is also used due to contraindications to surgery. In addition, this method is necessarily used in the postoperative period to prevent recurrent conditions of varicose veins.
In conservative treatment, the severity of risk factors is reduced by the use of adequate physical activity, the use of elastic compression, medication 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 an inherited 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 in the veins. lower extremities. Also, if there are no complications such as thrombophlebitis or thrombosis, it is recommended to perform regular exercise for the veins in the lower extremities. This involves walking more, wearing only comfortable shoes, swimming, cycling and jogging. All physical activities must 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 strains on the veins of the lower extremities are prevalent. as exercises associated with lifting significant weights.
At home, following the recommendations of a specialist, they perform simple exercises. As a general rule, your legs should be in an elevated position for a few minutes before you start exercising, to prepare your body for certain types of exercise. The choice of pace and speed of exercises is chosen strictly individually for each patient, taking into account his physical abilities. But the most important 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 hot and cold water, for five minutes.
Elastic compression is a method of treating varicose veins using bandaging or compression stockings. 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 dilating, thus preventing thrombosis.
For the treatment of all stages of varicose veins, phlebotonic drugs are used, which gradually strengthen the vein walls. All drug treatment for varicose veins should only be prescribed 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 treatment methods, laser, electrophoresis, magnetic field and the use of diadynamic currents have the best effect.
Varicose veins refer 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 site of its localization.
Performing phlebectomy removes varicose veins. 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 ligating the perforating veins. However, this operation is not performed in the presence of concomitant diseases that can only aggravate the existing condition; late stages of varicose veins; pregnancy; existing purulent processes and old age. Phlebectomy is performed using endoscopic treatment methods, making this surgery less safe.
During sclerosis, a sclerosant is injected into the dilated vein vessel, which causes the vein walls to collect and thus stops the blood flow through. As a result, the pathological outflow of blood stops with the simultaneous elimination of the cosmetic defect, as the venous vessel at this moment collapses and is practically invisible. However, the use of sclerotherapy is only effective when the small branches of the main stems are enlarged, therefore it is used to a limited extent. The advantage of this surgical procedure 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 vein 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, preventing the development of varicose veins and secondary - in the presence of a pathological process.
Currently, most people place great emphasis on preventing this disease. Regularly performed simple measures can significantly reduce the incidence 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, try to place your legs in an elevated position as often as possible. Fight excess weight and prevent it from rising. 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, by taking estrogens or oral contraceptives, it is imperative to examine the veins in the lower extremities using an ultrasound scan.