Varicose veins are a pathological dilation of veins located on the surface, which is characterized by an increase in their diameter and length, which results in a cylindrical, serpentine, sacral and mixed type of change in venous trees. Today, varicose veins are a widespread pathology, and women get sick almost 3 times more often than men. This is mainly due to the anatomical characteristics 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 great vein wall, which is localized under the skin, or congenital valve dysfunction. The development of secondary venous pathology is influenced by deep venous thrombosis or acquired valve insufficiency due to pregnancy, heavy physical exertion, prolonged standing, etc.
At the time of increasing hydrostatic pressure in the veins, these vessels dilate in diameter and impaired valve function worsens. All this interferes with the blood circulation in the veins on the surface, and as a consequence of insufficient functioning of the veins on the periphery, blood reflux is created from deep sitting veins in the saphenous veins, which are too stretched, begin to twist, forming various forms of expansion. In the future, as a result of pronounced stagnation, there will be disorders of tissue trophism, ulcer formation, eczema and dermatitis.
Varicose veins of the lower extremities
This disease is characterized by the formation of venous walls in the form of sacral dilation, serpentine curvature, increased length and insufficiency of the valves.
As a rule, varicose veins of the lower extremities occur in 20% of the population. In addition, it affects both boys and girls before puberty. But women in adulthood are much more likely to get varicose veins, unlike men. Also, the number of patients 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 weakened venous tone, their expansion, a certain insufficiency of the valves of communication and saphenous veins, opening of veins. arteriovenous shunts and venous circulation disorders.
To date, the true cause of the development of varicose veins of the lower extremities is still unknown. Insufficient valve function and increased venous pressure are thought to be associated with the etiological cause of the disease. Considering all the factors that predispose to the development of the pathological process in the veins of the lower extremities, two types of varicose veins are distinguished: 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 deficiency 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 venous trees, thinning of their walls, disturbed 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 gradual nodular expansion, elongation and twisting of veins that are localized under the skin, ie superficially. The final 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 complaints of existing varicose veins, which cause aesthetic discomfort, certain strength, and in some cases pain in the lower extremities, cramps at night and trophic changes in the legs.
Dilation of venous vessels can vary from smaller "stars", reticular nodes to roughly twisting 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 great 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 the progressive process, the patient begins to feel rapid fatigue, a certain heaviness and distension in the legs is noticed, cramps in the leaf muscles appear, and the legs and feet swell and paresthesias develop. In addition, the legs usually swell in the late afternoon, but after sleeping this swelling disappears.
Very often, varicose veins are complicated by acute thrombophlebitis of the veins on the surface with manifestations of redness, ribbon, painful varicose veins, which is characterized by varicose veins, as well as periphlebitis. Very often varicose veins rupture as a result of minor damage, leading to bleeding. As a rule, blood from a ruptured node can flow in a stream and the patient sometimes loses a fairly large amount.
In addition, there are no specific difficulties in diagnosing varicose veins of the lower extremities, as well as in the inclusion in CVI based on patient complaints, medical history and the results of objective examination.
An important value in making the diagnosis is the ability to determine the condition of the veins of the main and communicative nature, as well as to assess the patency of deep veins.
Causes of varicose veins
This pathological process is characterized by dilation of veins located on the surface under the skin and is associated with insufficient valve function in the veins and impaired blood circulation in them. Varicose veins are among the most common vascular pathologies among the able-bodied half of the population.
As a rule, there are several predisposing factors for the development of the disease, as well as for its progression. The definite contribution of heredity to the appearance of varicose veins has not yet been proven. The occurrence 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 improper organization of the work process. Many people spend a significant amount of time in a standing or sitting position, depending on the job, and this has a rather bad effect on the valvular apparatus of the veins of the lower extremities. In addition, work associated with heavy physical work is considered unfavorable, especially in the form of twitching load on the legs when lifting weights.
Today, long journeys or flights, which contribute to the occurrence of venous blood stasis in the legs and represent risk factors for the development 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 constant wearing is not recommended. This also applies to shoes with high heels in the presence of uncomfortable climbing supports.
Repeated pregnancies are a proven risk factor for varicose veins. This can be explained by the fact that an enlarged uterus increases the pressure inside the peritoneum, and progesterone destroys fibers of elastic and collagen origin contained 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 peculiarities of their structure in the lower extremities. There is a system of veins located on the surface, ie the saphenous veins, such as small and large, as well as a system of deep veins on the thigh and lower leg, and perforating veins that connect the previous two systems. With normal blood circulation, blood flow to the lower extremities occurs in 90% of deep veins and 10% in superficial ones. But in order for the blood to move towards the heart, and not the other way around, there are valves in the venous walls that close and do not allow the blood to pass from top to bottom under the influence of gravitational force. Muscle contractions are also of great importance, which contribute to normal blood flow. In addition, in the upright position, blood stagnation develops, the pressure in the veins begins to increase and this leads to their spread. In the future, valve dysfunction is formed, which becomes the reason for not closing the valves with the formation of irregular blood flow from the heart.
Valves of deeply located veins are particularly quickly affected as a result of the maximum load on them. And in order to reduce the excess pressure with the help of the perforating vein system, blood flows into the veins that are under the skin, which are not intended for a large amount. All this leads to overstrain of the venous walls and as a result, characteristic varicose nodules appear. However, the increased volume of blood continues to flow into the deep veins, which creates insufficiency of the valvular apparatus of the perforating veins without certain obstacles to the flow of blood in the horizontal position, first in the deep and then in the superficial ones. Finally, CVI develops with such manifestations as edema, pain and ulcers of a trophic nature.
Symptoms of varicose veins
Varicose veins are characterized by dilation of veins localized under the skin, in the form of sacral or cylindrical changes. With this pathological disease, twisted veins appear on the skin surface of the legs and feet. The maximum appearance of varicose veins occurs after long or heavy physical exertion. It is very common for veins to dilate in young women during or after pregnancy.
The early phase of varicose veins is characterized by few and nonspecific symptoms. At this point, patients quickly become tired with constant weight in the legs, burning, shooting, especially after physical exertion. Also, transient edema and pain along the entire length of the veins sometimes occur. At the same time, in the late afternoon, the ankle and the back of the foot swell after prolonged static loads. Some characteristic 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 in the initial phase should be a signal for the patient to visit a specialist in order to prevent the progression of varicose veins.
This disease is characterized by slow development, sometimes several decades. Therefore, as a result of poor treatment, varicose veins progress to CVI (chronic venous insufficiency).
An important symptom of the disease are spider veins, which are cobwebs of slightly dilated capillaries that are practically visible under the skin. Sometimes removing disorders of a hormonal nature, turning off the sauna, solarium allows you to forget about such a disease as varicose veins once and for all. But basically, these spider veins are the only sign of veins overflowing on the surface and forming 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 are a cosmetic discomfort, so doctors perform surgical operations to solve such problems.
Degree of varicose veins
This disease can manifest in different degrees of severity and is characterized by a different structure, which is associated with its clinical symptoms. As a rule, there are several types of structure of varicose veins on the surface. The first type, the main one, is characterized by the expansion of the main trunks of the saphenous veins without connecting the tributaries to them. The second type, or loose, is a network-like extension with many branches. This type of varicose vein is detected at the very beginning of the disease. But with the mixed type, a combination of the two previous ones occurs, and this third type is found much more often than the 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, the ICD of varicose veins distinguishes pathology with ulcers, with inflammation, with the presence of concomitant ulcers and inflammation of the lower extremities and varicose veins without inflammation or ulcers.
The first stage of varicose veins is characterized by moderately pronounced varicose 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 mild nature of leg pain, a certain weight, fatigue in the background of long-term effort. Diagnostic tests indicate satisfactory valve function, and the presence of minor varicose veins under the skin indicates poor venous outflow 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 dilation of superficial veins with failure of their valves based on functional tests. In the process of disturbed 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 a long effort on the lower extremities, which disappears after resting in a horizontal position. In addition, there is persistent severe pain in the affected limb. The second stage of the disease is characterized by the correspondence of the stage of subcompensatory property.
In the third degree of varicose veins, there is dilation of superficial veins and dysfunction of the valves of deep veins, perforating and saphenous, which causes persistent venous hypertension in the distal parts of the extremities. This is what causes the 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 the indurative pathological process. But 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 of the extremities of an organic nature and lymphostasis of secondary origin. The symptoms of grade 3 varicose veins are quite pronounced, varied and constant.
With further progression of varicose veins, the zones of trophic ulcers are somewhat wider, dermatitis and eczema appear, which indicates the presence of the fourth phase of the disease. The last two degrees of severity represent the phase of decompensation of the pathological process. In this case, not only local but also general hemodynamics are disturbed. Ballistocardiography can detect impaired contractility of the heart muscle, which is detected in 80% of patients with decompensated varicose veins.
An important point in choosing the appropriate treatment is to determine the degree of varicose veins and the type of varicose veins.
Treatment of varicose veins
Comprehensive 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 mild, moderately reducing the ability to work. This method of treatment, as a conservative, is also used due to contraindications for surgery. In addition, this method is necessarily used in the postoperative period in order to prevent recurrent varicose veins.
During 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 a combination of all these therapeutic measures can guarantee a positive result.
First of all, they identify risk factors for 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, is obliged to consult a phlebologist with ultrasound examination of veins twice a year. lower extremities. Also, if there are no complications such as thrombophlebitis or thrombosis, regular training for the veins of the lower extremities is recommended. This includes more walking, wearing only comfortable shoes, swimming, cycling and running. All physical activities should be performed with the help of elastic compression. It is absolutely contraindicated to perform exercises with lower extremity lesions, 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 predominate, as well as exercises related to lifting significant weights.
At home, following the recommendations of experts, they perform simple exercises. As a general rule, the legs should be in an elevated position a few minutes before the start of the exercise in order to prepare the body for certain types of exercises. The choice of 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 contrast shower daily with alternating foot massage with hot and cold water, for five minutes.
Elastic compression is a method of treating varicose veins using bandages or compression stockings. In this case, the compression of the muscles occurs in doses, which improves the flow of blood through the venous vessels and prevents stagnation. Thanks to the artificial maintenance of vascular tone, the veins stop dilating and thus the prevention of thrombosis is prevented.
Phlebotonic drugs that gradually strengthen the venous walls are used to treat all stages of varicose veins. All medications for varicose veins should only be prescribed by a doctor, so self-medication is not recommended. But local therapy in the form of ointments and gels without signs of thrombophlebitis or thrombosis is simply undesirable.
Of the physiotherapeutic treatment methods, laser, electrophoresis, magnetic field and the application 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 directly depend on the severity of the pathological process and the place of its localization.
When performing a 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 ligating 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 age. Phlebectomy is performed with endoscopic methods of treatment, which makes this operation less safe.
During sclerosis, sclerosant is injected into the dilated venous vessel, which leads to the junction of the venous walls and thus stops the flow of blood through it. As a result, the pathological outflow of blood stops with the simultaneous removal of the cosmetic defect, because at this point the venous vessel collapses and is practically invisible. However, the application of sclerotherapy is effective only when small branches of the main trunks are enlarged, so it is used to a limited extent. The advantage of this surgical intervention is the absence of postoperative scars, hospitalization of the patient, and in the period after sclerosis, the patient does not need special 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 for varicose veins 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 taken simple measures can significantly reduce the appearance and further progression of varicose veins. In this case, it is very important, first of all, to move more, and also to alternate prolonged static load with swimming, running, walking, cycling. You should also perform simple exercises at your workplace.
With existing varicose veins, you should try to put your legs in an elevated position as often as possible. Fight against excess weight, preventing its increase. It is also very important to walk in comfortable shoes with a maximum heel height of up to five inches, and to use orthopedic insoles if necessary. In addition, it is necessary to ultrasound the veins of the lower extremities during pregnancy, taking estrogen or oral contraceptives.