Varicose veins are a pathological dilation of the veins located on the surface, which is characterized by an increase in diameter and length, which results in a cylindrical, serpentine, saccular and mixed type of change in the venous trunks. Today, varicose veins are a common pathology and women get sick almost 3 times more often than men. 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 initial weakness of the great vein wall, which is located 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 and others.
As the hydrostatic pressure in the veins increases, these vessels dilate in diameter and the dysfunction of the valves deteriorates. 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 veins in the subcutaneous veins, which are too stretched, begin to twist, forming various forms of dilation. In the future, as a result of pronounced stagnation, tissue trophism is disrupted, 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 sac, 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, before puberty, it affects both boys and girls equally. But women in adulthood are much more likely to be affected by varicose veins than 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 tone of the veins, their dilation, some insufficiency of the valves of communication and subcutaneous veins, opening of arteriovenous shunts and circulatory disorders.
To date, the true cause of varicose veins in the lower extremities is still unknown. Insufficient valve function and increased venous pressure are thought to be related to the etiological cause of the disease. Taking into account all the factors that predispose to the appearance 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 veins. And in secondary varicose veins, various complications of deep veins, arteriovenous fistulas, congenital absence or underdevelopment of the 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, impaired metabolic processes in smooth muscle cells, movement of blood from deep veins to superficial ones. This backflow of blood in the form of vertical reflux and horizontal reflux causes gradual nodular dilation, lengthening and twisting of the veins that are located under the skin, ie superficial. The final link in the pathogenesis is represented by cellulite, dermatitis and trophic venous ulcer of the lower leg.
The symptomatic picture of varicose veins of the lower extremities consists of patients complaining of existing varicose veins that cause cosmetic discomfort, some 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 minor "stars", reticular nodes to roughly curving 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 subcutaneous vein. In addition, 9% of patients have a lesion of both veins involved in the pathological process.
As a result of a progressive process, the patient begins to experience rapid fatigue, there is some heaviness and swelling in the legs, cramps appear in the muscles of the calves, legs and feet swell and paresthesias develop. In addition, the legs swell mainly in the late afternoon, but after sleep this swelling disappears.
Quite often varicose veins are complicated by acute thrombophlebitis of the veins on the surface with manifestations of redness, cordial, painful varicose veins, which is characterized by varicose veins, as well as periphlebitis. Very often varicose veins rupture as a result of minor damage and this leads to bleeding. As a rule, the blood from a torn node can flow in a stream and the patient sometimes loses a large amount of it.
In addition, there are no specific difficulties in diagnosing varicose veins of the lower extremities, as well as in joining CVI based on patient complaints, medical history and the results of objective examination.
An essential value in the diagnosis is the ability to determine the condition of the valves of the veins of basic and communicative nature, as well as to assess the patency of the deep veins.
Causes of varicose veins
This pathological process is characterized by dilation of the veins located on the surface under the skin and is associated with insufficient functioning of the valves in the veins and impaired blood circulation in them. Varicose veins are among the most common vascular pathology among half of the working age 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 onset of this pathological process at the moment may be influenced by the nature of the diet, lifestyle and conditions caused by changes in the hormonal background.
Also, the appearance of this pathological process is associated with improper organization of the work process. Many people spend a lot of time standing or sitting, depending on their work, and this has a very bad effect on the valvular apparatus of the veins of the lower extremities. In addition, work involving heavy physical labor is considered unfavorable, especially in the form of leg rhythms when lifting weights.
Today, long-term travel or flights, which contribute to the occurrence of venous blood stasis 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 it is not recommended to wear them all the time. This also applies to shoes with high heels in the presence of uncomfortable footrests.
Recurrent pregnancy is 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, changes in hormonal status, increase the risk of developing this pathological process.
Typical causes of varicose veins are the peculiarities of their structure of the lower extremities. There is a system of veins located on the surface, ie subcutaneous veins, both small and large, as well as a system of deep veins of the thigh and lower leg and perforating veins connecting the two previous systems. With normal blood circulation, blood flow to the lower extremities takes place in 90% of the deep veins and 10% of the superficial ones. But in order for the blood to move to 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 under the influence of gravitational force from top to bottom. Muscle contractions are also important, contributing to normal blood flow. In addition, in an upright position, blood stasis 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 causes the non-closing of the valve valves with the formation of improper movement of blood from the heart.
The valves of the deep veins are affected particularly quickly as a result of the maximum load on them. And 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 dilated nodes are formed. However, an increased volume of blood continues to flow in the deep veins, thus forming a failure of the perforating vein valve apparatus without certain obstacles to blood flow in a horizontal position, first in deep vessels and then in 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 varicose veins located under the skin in the form of sacral or cylindrical changes. In this pathological disease, curved veins appear on the surface of the skin of the feet and legs. The maximum appearance of varicose veins is formed after prolonged or heavy exercise. Varicose veins are quite common in young women during or after pregnancy.
The early stage of varicose veins is characterized by few and nonspecific symptoms. At this point, patients quickly get tired with constant heaviness in the legs, burning, cracking, especially after exercise. Also, transient swelling and painful 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 features of the swelling 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 at the initial stage should be a signal for the patient to consult a specialist to prevent the progression of varicose veins.
This disease is characterized by slow development, sometimes for several decades. Therefore, as a result of improper treatment, varicose veins progress to CVI (chronic venous insufficiency).
An important symptom of the disease are spider veins, which are a web of slightly dilated capillaries that are practically visible under the skin. Sometimes the elimination of disorders of a hormonal nature, the exclusion of sauna, solarium allows you to forget once and for all about such a disease as varicose veins. But in general, these spider veins are the only sign of surface overflow and varicose veins. Therefore, the appearance of even a minor such sign should serve as a signal to consult a surgeon.
In addition, varicose veins are a cosmetic discomfort, therefore, to solve such problems, doctors perform surgery.
Degree of varicose veins
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 varicose veins on the surface. The first type, the main one, is characterized by dilation of the main trunks of the subcutaneous veins without the addition of tributaries to them. The second type, or free, is a multi-branch network extension. This type of varicose vein is found at the very beginning of the disease. But in the mixed type a combination of the two previous ones is obtained, and this third type is much more common than the others.
The symptoms of varicose veins are directly proportional 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 ulcer, with inflammation, with the presence of simultaneous ulcers and inflammation of the lower extremities and varicose veins without inflammation or ulcers.
The first degree of varicose veins is characterized by moderate varicose veins on the surface of the main trunks or branches without certain manifestations of insufficiency of the venous valves on the surface and communicative properties. Patients have a mild nature of leg pain, a certain severity, fatigue on the background of prolonged exercise. Diagnostic tests have shown 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 insufficiency of their valves based on functional tests. In the process of impaired outflow in the veins develops insufficiency of the lymphatic system of the limbs, which is manifested by swelling of the feet and legs. The characteristic swelling occurs after prolonged loading of the lower extremities, which disappears after resting in a horizontal position. In addition, there is constant severe pain in the affected limb. The second stage of the disease is characterized by the correspondence of the stage of the subcompensatory property.
In third degree varicose veins, there is dilation of the superficial veins and dysfunction of the valves of the deep veins, perforating and subcutaneous, and this causes persistent venous hypertension in the distal parts of the limb. This causes a violation of microcirculation and the formation of trophic ulcers. At the same time, pigmentation of the skin in the area of the lower leg develops with 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 lesions of the lymphatic system of the limb of an organic nature and lymphostasis of secondary origin. The symptoms of grade 3 varicose veins are quite pronounced, varied and permanent.
With the further progression of varicose veins, the areas of trophic ulcers expand to some extent, 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. With the help of ballistocardiography it is possible to detect impaired contractility of the heart muscle, which is found in 80% of patients with varicose vein decompensation.
An important point in choosing the appropriate treatment is to determine the extent 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 that is directly proportional 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 performance. This method of treatment, as a conservative, is also used due to contraindications for surgery. In addition, this method must be used in the postoperative period to prevent recurrent varicose veins.
During conservative treatment, the severity of risk factors is reduced with 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, they identify the 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, should consult a phlebologist twice a year by ultrasound examination of the veins of the lower extremities. In addition, if there are no complications such as thrombophlebitis or thrombosis, it is recommended to regularly train the veins of the lower extremities. This includes more walking, wearing only comfortable shoes, swimming, cycling and jogging. All physical activities must be performed with the help of 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 martial arts, where the predominant loads on the veins of the lower extremities, as well as exerciseswhich are 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 a raised position for a few minutes before you start training to prepare your body for certain types of exercises. The choice of pace and speed of exercise is chosen strictly individually for each patient, taking into account his physical capabilities. But the main thing in such physical education is its regularity. In addition, a daily contrast shower with alternating foot massage with hot and cold water for five minutes is recommended.
Elastic compression is a method of treating varicose veins with a bandage or compression stockings. In this case, muscle compression is performed in doses, which improves blood flow through the venous vessels and prevents congestion. Thanks to the artificial maintenance of vascular tone, the veins stop dilating and thus prevent the formation of thrombosis.
Phlebotonic drugs are used to treat all stages of varicose veins, which gradually strengthen the venous walls. All drug therapy for varicose veins should be prescribed only by the attending physician, therefore self-medication is not recommended. But topical 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 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 location of its location.
When performing a phlebectomy, varicose veins are removed. The main goal of the operation is to eliminate the pathological bleeding 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, sclerosant is injected into the dilated venous vessel, which leads to the union of the venous walls and thus stops the flow of blood through it. As a result, the pathological bleeding stops with the simultaneous elimination of the cosmetic defect, because at that 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, so it is used to a limited extent. The advantage of this surgical intervention is the lack of postoperative scars, hospitalization of patients, and in the period after sclerosis the patient does not need specific 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 performed simple measures can significantly reduce the appearance and further progression of varicose veins. In this case, it is very important, above all, to move more, and also to alternate prolonged static load with swimming, running, walking, cycling. You also need to perform simple exercises at work.
With existing varicose veins, you should try to put your legs in an elevated position as often as possible. Fight overweight by preventing weight gain. 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 estrogen or oral contraceptives, it is imperative to examine the veins of the lower extremities using an ultrasound scan.