Varicose veins is a pathological enlargement of the veins located on the surface, characterized by an increase in their diameter and length, which leads to a cylindrical, serpentine, sacred and mixed change in the vein trunks. Today, varicose veins are a widespread pathology, and women are almost three times more likely to get the disease than men. This is mainly due to the anatomical features of the body and certain stresses on the lower limbs during pregnancy.
Varicose veins are usually primary and secondary. In the first variant, the disease is caused by an initial weakness in the wall of the large vein, which is located under the skin, or a congenital dysfunction of the valves. The development of secondary venous pathology is influenced by deep vein thrombosis or acquired valve regurgitation due to pregnancy, vigorous physical exertion, prolonged standing, etc.
When the hydrostatic pressure in the veins increases, these vessels expand in diameter and the functional limitations of the valves are increased. All of this disrupts the blood supply to the veins on the surface, and as a result of insufficient function of the veins in the periphery, blood backflow is formed from deep-set veins into the distended trunk veins, which begin to twist, forming various forms of dilatation. In the future, due to 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 vein walls in the form of a sac-shaped expansion, serpentine curvature, increase in length and insufficiency of the valves.
Varicose veins of the lower extremities typically affect 20% of the population. In addition, boys and girls are equally affected before puberty. However, women in adulthood are affected by varicose veins much more often than men. The number of sick people also 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 causes a weakened tone of the veins, their dilation, a certain insufficiency of the valves of the communication and saphenous veins, the opening of the veins, arteriovenous shunts and circulatory disordersin the veins.
To date, the real cause of the development of varicose veins of the lower extremities is still unknown. It is believed that inadequate function of the valves and an increase in pressure in the veins are related to the etiological cause of the development of the disease. Taking into account all the factors that predispose to the onset of the pathological process in the veins of the lower extremities, there are two types of varicose veins: primary and secondary.
Primary varicose veins on the surface are characterized by the presence of normal deep-seated veins. And with 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: increased hydrostatic pressure in the venous trunks, thinning of their walls, disturbed metabolic processes in smooth muscle cells, blood flow from deep veins to superficial ones. This reverse movement of blood in the form of vertical reflux and horizontal reflux causes gradual nodular expansion, elongation, and tortuosity of veins that are located under the skin, that is, superficial. The last link in the pathogenesis is cellulitis, dermatitis and trophic venous ulcer of the lower leg.
The symptomatic picture of varicose veins of the lower extremities consists of patient discomfort about the existing dilated veins causing cosmetic discomfort, some severity and in some cases lower extremity pain, nocturnal cramps and trophic changes in the legs.
The expansion of the venous vessels can vary from small "stars", reticular knots to coarsely twisting trunks, as well as knots and plexuses that are clearly visible when the patient is in an upright position. Almost 80% are lesions of the trunk and branches of the large vein on the surface, and 10% are in the minor trunk 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 get tired quickly, a certain heaviness and stretching is noted in the legs, cramps appear in the calf muscles, and the legs and feet swell, and paresthesia develops. In addition, the legs tend to swell in the late afternoon, but this swelling disappears after bed.
Very often, varicose veins are complicated by acute thrombophlebitis of the veins on the surface with manifestations of redness, cord-like, painful densification of the vein, which is characterized by expansion, as well as periphlebitis. Very often the varicose veins tear due to minor damage, which leads to bleeding. As a rule, blood can flow in a stream from a torn knot, and the patient sometimes loses a fairly large amount of it.
In addition, the diagnosis of varicose veins of the lower extremities, as well as the inclusion of a CVI based on patient complaints, medical history and the results of an objective examination, are not particularly difficult.
An essential value in making the diagnosis is the ability to determine the condition of the venous valves of the main and communication mode, as well as 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 venous valves and impaired blood flow in them. Varicose veins are one of the most common vascular diseases affecting half of the working-age population.
There are usually several predisposing factors to the development of the disease as well as its progression. A certain contribution of heredity to the occurrence of varicose veins has not yet been proven. The development of this pathological process can currently be influenced by the type of diet, lifestyle and conditions caused by changes in the hormonal background.
Also, the appearance of this pathological process is associated with the wrong organization of the working process. Many people spend a lot of time standing or sitting, depending on their activity, which tends to have a negative effect on the valve apparatus of the veins of the lower extremities. In addition, work associated with heavy physical labor is considered unfavorable, especially in the form of jerk loading on the legs when lifting weights.
Long-term trips or flights, which contribute to the occurrence of venous blood congestion in the legs and are risk factors for the development of venous pathologies, nowadays have a negative effect on the blood flow system in the veins. In addition, wearing tight underwear leads to compression of the veins in the groin area, and corsets increase pressure in the peritoneum, so it is not recommended to wear them all the time. This also applies to shoes with high heels and uncomfortable instep rests.
Repeated pregnancies are a proven risk factor for varicose veins. This can be explained by the fact that the enlarged uterus increases the pressure in the peritoneum, and progesterone destroys the fibers of elastic and collagenous origin contained in the vein 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 peculiarities of their structure on the lower extremities. On the surface there is a venous system, that is, trunk veins, such as small and large, as well as a system of deep veins in the thigh and lower leg and perforation veins, which connect the two previous systems. With normal blood flow, blood flow to the lower extremities occurs in 90% of the deep veins and 10% of the superficial ones. So that the blood can flow to the heart and not the other way around, there are valves in the vein walls that strike and prevent the blood from flowing from top to bottom under the influence of gravity. Muscle contractions are also of great concern and contribute 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, an insufficient function of the valves is formed, which becomes the reason for the failure of the valve leaflets to close with the formation of wrong blood movement from the heart.
The valves of deep-seated veins are particularly quickly affected by the maximum load. And in order to relieve the excess pressure with the help of a perforation vein system, blood flows into the veins located under the skin, which are not designed for a large part of it. All this leads to an overstretching of the vein walls and as a result characteristic varicose veins form. However, an increased volume of blood continues to flow into deep veins, as a result of which insufficiency of the valve apparatus of perforation veins without certain obstacles to blood flow in a horizontal position is formed first into deep vessels and then into superficial vessels. And in the end, CVI develops with such manifestations as edema, pain and ulcer of a trophic nature.
Symptoms of varicose veins
Varicose veins are characterized by the expansion of the veins localized under the skin in the form of sac-shaped or cylindrical changes. With this pathological disease, tortuous veins appear on the skin surface of the legs and feet. The maximum occurrence of varicose veins is formed after long or heavy physical exertion. It is quite common for the veins in young women to dilate during or after pregnancy.
The early stages of varicose veins are characterized by few and unspecific symptoms. At this moment, patients quickly get tired with constant heaviness in the legs, burning, bursting, especially after physical exertion. Sometimes transient edema and aching pain also occur along the entire length of the veins. At the same time, in the late afternoon after a long period of static load, the ankles and back of the foot swell. A feature of edema is its disappearance in the morning after a night's sleep. There are usually no signs of varicose veins visible at this stage. 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 form CVI (chronic venous insufficiency) in their course.
Also, an important symptom of the disease are spider veins, a spider's web of slightly dilated capillaries that are practically visible under the skin. Sometimes, getting rid of disorders of a dyshormonal nature, excluding a sauna or solarium, allows you to forget about a disease such as varicose veins once and for all. 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 the consultation of a surgeon.
In addition, varicose veins are a cosmetic discomfort. To solve such problems, doctors perform surgical procedures.
Varicose veins degree
This disease can manifest itself in different degrees of severity and be characterized by a different structure associated with its clinical symptoms. As a rule, there are several types of structure of the enlarged veins on the surface. The first type, the main type, is characterized by the expansion of the main trunks of the trunk veins without connecting tributaries to them. The second type, or loosely, is a network-like extension with many branches. These types of varicose veins are recognized very early in the development of the disease. However, 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 directly related to the stage of the pathological process, which is divided into compensation, subcompensation and decompensation.
In addition, the ICD distinguishes from varicose veins a pathology with an ulcer, with inflammation, with the simultaneous presence of 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 venous valves on the surface and communicative properties. Patients have slight pain in the leg, a certain severity, fatigue on the background of prolonged exertion. The diagnostic tests carried out indicate that the valves are functioning satisfactorily, and the presence of small enlargements of veins under the skin indicates a poor work of the drainage in 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 expansion of superficial veins with the failure of their valves due to functional tests. With a disturbed outflow in the veins, insufficiency of the lymphatic system of the extremities develops, which is expressed in 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 persistent severe pain in the affected extremity. The second degree of the disease is characterized by the coincidence of the stage of subcompensatory property.
At the third degree of varicose veins, there is an expansion of the superficial veins and dysfunction of the valves of the deep veins, perforate and saphena, which leads to persistent venous hypertension in the distal parts of the extremity. This 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 first manifestations of an indurative pathological process. But the feet and legs, especially with trophic disorders, are characterized by constant swelling. This is associated with disorders of blood flow and with lesions of the lymphatic system of the extremity of an organic nature and lymphostasis of secondary origin. The 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 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 stage of decompensation of the pathological process. In this case, not only local, but also general hemodynamics are disturbed. Ballistocardiography makes it possible to identify the impaired contractility of the heart muscle, which is found in 80% of patients with decompensation of varicose veins.
An important point in choosing the appropriate treatment is determining the degree of 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 related 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 beginning of the pathological process, when the manifestations on the skin are slightly pronounced and the ability to work is moderately reduced. This method of treatment is used as a conservative method of treatment also due to contraindications to surgical intervention. In addition, this method is necessarily used in the postoperative period to prevent recurring conditions of varicose veins.
During conservative treatment, the severity of risk factors is reduced through appropriate 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 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 and with a hereditary predisposition, even without symptoms of varicose veins, are obliged to have a phlebologist twice a year with ultrasound examination of the veins of the lower extremities. Even if there are no complications such as thrombophlebitis or thrombosis, regular training of the veins of the lower extremities is recommended. This includes more running, just wearing comfortable shoes, swimming, cycling, and jogging. All physical activity should be performed with elastic compression. It is absolutely contraindicated to do exercises with lesions of the lower extremities, it is also necessary to exclude mountain skiing, tennis, volleyball, basketball, soccer, various martial arts, which also strain the veins of the lower extremities, than exercises that involve liftingconsiderable weights are connected.
At home, they perform simple exercises according to the recommendations of a specialist. As a general rule, the legs should be in an elevated position for a few minutes before starting any exercise in order to prepare the body for certain types of exercise. The choice of the pace and speed of the exercises is selected strictly individually for each patient, taking into account his or her physical abilities. But the main thing in such physical education is its regularity. In addition, it is recommended to use an alternating shower with alternating massage of the legs with warm and cold water for five minutes a day.
Elastic compression is a method of treating varicose veins using bandages or compression stockings. Muscle compression takes place in a dosed manner, which improves the blood flow to the venous vessels and prevents symptoms of stagnation. By artificially maintaining the vascular tone, the veins stop expanding and thus thrombosis formation is prevented.
To treat all stages of varicose veins, phlebotonic drugs are used, which gradually strengthen the vein walls. All drug therapies for varicose veins should be prescribed only by the attending physician, so self-medication is not recommended. However, local therapy in the form of ointments and gels with no signs of thrombophlebitis or thrombosis is simply undesirable.
Among the physiotherapy treatment methods, laser, electrophoresis, magnetic field, and the use of diadynamic currents have the best effects.
Varicose veins is a surgical condition that can be completely cured after surgery. As a rule, there are several types of surgical treatment (phlebectomy, sclerotherapy and laser coagulation), which directly depend on the severity of the pathological process and the location of its localization.
During a phlebectomy, varicose veins are removed. The main goal of the operation is to eliminate the pathological blood flow by removing the main trunks of the small or large superficial vein and tying off the perforation veins. However, this operation is not performed if there are comorbidities that can only aggravate the existing condition; late stages of varicose veins; Pregnancy; existing purulent processes and age. Phlebectomy is performed using endoscopic treatment methods, which makes this surgery less safe.
In sclerosis, a sclerosant is injected into the dilated venous vessel, which connects the walls of the veins and stops blood flow. As a result, the pathological blood flow stops while at the same time eliminating the cosmetic defect, since the venous vessel collapses at this moment and is practically invisible. However, the use of sclerotherapy is effective only when the small branches of the main trunks are enlarged, and therefore its use is limited. The advantage of this surgical intervention is the absence of post-operative scars, the patient's hospitalization and in the post-sclerosis period 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. This process closes the venous lumen. This surgical method is only indicated for a vein enlarged by 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.
At present, most of the people pay great attention to the prevention of this disease. Regularly carried out simple measures can significantly reduce the occurrence and further progression of varicose veins. In this case it is very important to move more and alternate a longer static load with swimming, running, walking and cycling. You should also do simple exercises in your workplace.
With the varicose veins present, you need to try to get your legs in an elevated position as often as possible. Fight obesity and prevent it from gaining weight. It is also very important to walk in comfortable shoes with a maximum heel height of up to five centimeters and, if necessary, to use orthopedic insoles. In addition, during pregnancy, when taking estrogens or oral contraceptives, it is imperative to examine the veins of the lower extremities using ultrasound.