Varicose veins are a pathological enlargement of veins located on the surface, which is characterized by an increase in their diameter and length, which as a result leads to a cylindrical, serpentine, saccular and mixed change in venous 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 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 wall of the great vein, which is localized under the skin or by congenital malfunction of the valves. The development of secondary venous pathology is affected by deep vein thrombosis or acquired valve insufficiency due to pregnancy, severe physical exertion, prolonged standing, etc.
At the time of the increase of hydrostatic pressure in the veins, these vessels expand in diameter and the damaged functions of the valves are aggravated. All this interferes with the circulation of blood in the veins on the surface, and as a result of insufficient functioning of the veins in the periphery, blood reflux is formed by veins deeply rooted in the saphenous veins, which are very stretched, begin to tremble, formed various forms of expansion. In the future, as a result of 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 venous walls in the form of a saccular enlargement, snake tortuosity, an increase in length, and insufficiency of 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 alike. But adult women are much more likely to be affected by 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 cause a weakened tone of the veins, their dilation, some insufficiency of the valves of the communication veins and saphenous, opening of arteriovenous shunts and disordersof blood circulation in the veins.
To date, the true cause of the development of varicose veins of the lower extremities is still unknown. It is assumed that insufficient valve function and increased venous pressure are related to the etiological cause of disease development. Considering all the factors that are predisposing to the onset of the pathological process in the veins of the lower extremities, two types of varicose diseases are distinguished: 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, an important role is played by various complications of deep veins, arteriovenous fistulas, congenital absence or underdevelopment of venous valves.
Risk factors involved in the formation of varicose veins of the lower extremities are: increased hydrostatic pressure in the trunk of the veins, thinning of their walls, damage to metabolic processes in smooth muscle cells, movement of blood from the deep veins to themsuperficial. This opposite movement of blood in the form of vertical and horizontal reflux causes a gradual nodular dilation, elongation and rotation of the veins localized under the skin, ie superficial. The final link in pathogenesis is represented by cellulitis, dermatitis, and trophic venous ulcers of the lower leg.
The symptomatic picture of varicose veins of the lower extremities consists of patients complaining of existing varicose veins, which cause cosmetic discomfort, a certain severity and in some cases pain in the lower extremities, nocturnal cramps and trophic changes in the legs.
Venous vessel dilation can range from small "stars", reticular nodes to thick-walled trunks, as well as nodes, plexuses, which are clearly visible in the vertical position of patients. Almost 80% are lesions of the trunk and branches of the large vein on the surface, and 10% is 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 a progressive process, the patient begins to experience rapid fatigue, a certain stiffness and distension in the legs is observed, cramps appear in the calf muscles, legs and feet swell, and paraesthesias develop. In addition, the feet swell mainly in the late afternoon, but after sleep this swelling goes away.
Very often, varicose veins are complicated by acute venous thrombophlebitis on the surface with manifestations of redness, painful compression in the cordal form of the vein, which is characterized by dilation, as well as periphlebitis. Too often varicose veins rupture as a result of a minor injury and this leads to bleeding. As a rule, blood from a broken joint can flow into a stream and the patient sometimes loses a fairly large amount of it.
In addition, there are no particular difficulties in diagnosing varicose veins of the lower extremities, as well as in joining the CVI based on patient complaints, medical history, and the results of an objective examination.
An essential value in establishing a diagnosis is the ability to determine the condition of venous valves of the main and communicative nature, as well as to assess the permeability of 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 accompanied by insufficient work of the valves in the veins and impaired blood circulation in them. Varicose veins are among the most common vascular pathologies in half of the working age population.
There are, as a rule, some predisposing factors for the development of the disease, as well as its progression. A definite contribution of heredity to the appearance of varicose veins has not yet been proven. The appearance 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 appearance of this pathological process is associated with incorrect organization of the work process. Many people spend considerable time in a standing or sitting position, depending on their job, and this has a rather bad effect on the lower extremity venous valve apparatus. Moreover, work related to heavy physical work is considered unfavorable, especially in the form of a jerky load on the legs while 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, adversely affect the venous blood flow system. 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 it all the time. This also applies to high-heeled shoes in the presence of uncomfortable footrests.
Recurrent pregnancies are 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 found in the venous wall. Also, diseases such as rheumatoid arthritis, osteoporosis, change 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, i. e. the saphenous veins, such as small and large, as well as a system of deep veins in the thigh and lower leg, and the perforating veins that connect the two previous systems. With normal blood circulation, blood flow to the lower extremities occurs in 90% of the deep veins and 10% of the superficial veins. But in order for the blood to move towards the heart and not vice versa, there are valves in the venous walls that collide and do not allow the blood to pass under the influence of gravitational force from top to bottom. Muscle contractions are also of great importance, contributing to normal blood circulation. 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 becomes the reason for not closing the valve leaflets with the formation of a wrong movement of blood from the heart.
Deep vein valves are particularly particularly affected 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 excessive stretching of the venous walls and, as a result, characteristic varicose nodes are formed. However, an increased volume of blood continues to flow into the deep veins, thus forming an insufficiency of the perforating venous valve apparatus without certain obstructions to blood flow in a horizontal position, first in the deep vessels, and moreafter in the superficial ones. And finally CVI develops with manifestations such as edema, pain and ulcers of a trophic nature.
Symptoms of varicose veins
Varicose veins are characterized by the expansion of veins localized under the skin, in the form of saccular or cylindrical changes. With this pathological disease, complicated veins appear on the surface of the skin of the feet and legs. The maximum appearance of varicose veins is created after a long or heavy physical exertion. It is quite common for veins to dilate in young women during or after pregnancy.
The early stage of varicose veins is characterized by few and non-specific symptoms. At this point, patients get tired quickly with constant aggravation in the legs, burning, cracking, especially after physical exertion. Also, transient edema and excruciating pain along the entire length of the veins sometimes occur. At the same time, in the late afternoon, the wrist and back of the foot swell after prolonged static loads. A feature of edema is their disappearance in the morning, after a night rest. At this stage, as a rule, there are no visible signs of varicose veins. However, these early stage symptoms should be a signal for the patient to visit a specialist 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 in its progression form CVI (chronic venous insufficiency).
An important symptom of the disease are also spider veins, which are a slightly enlarged network of capillaries that practically appear under the skin. Sometimes the elimination of disorders of a dishormonal nature, the exclusion of a sauna, a solarium allows you to forget once and for all about a disease such as varicose veins. But basically, these spider veins refer to the only sign of overfilling of the veins on the surface and the formation of varicose veins. Therefore, the appearance of even such an insignificant sign should serve as a signal for consultation with a surgeon.
In addition, varicose veins represent a cosmetic concern, therefore, to solve such problems, doctors perform surgical operations.
The degree of varicose veins
This disease can appear 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 enlarged vein structure on the surface. The first type, the main one, is characterized by the expansion of the main trunks of the saphenous veins without joining the branches with them. The second type, or free, is a multi-branch network-like extension. This type of varicose veins is detected early in the development of the disease. But with a mixed type, a combination of the previous two 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 are divided into compensation, undercompensation and decompensation.
In addition, varicose vein ICD distinguishes pathology with ulcer, with inflammation, with the presence of concomitant ulcers and inflammations in the lower extremities and varicose veins without inflammation or ulcer.
The first degree of varicose veins is characterized by a moderately pronounced widening of the superficial veins along the main trunks or branches without certain manifestations of superficial venous valve insufficiency and communicative properties. Patients have a mild nature of leg pain, a certain severity, fatigue on the background of prolonged strain. The diagnostic tests performed show a satisfactory function of the valves, and the presence of small enlargements of the veins under the skin indicates poor functioning of the exit to the veins from the affected limb. The first degree of VL corresponds to the compensatory phase 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 impaired venous flow, insufficiency of the lymphatic system of the extremities develops, which is manifested by edema of the legs and feet. Characteristic swelling occurs after prolonged exercises in the lower extremities, which disappear after resting in a horizontal position. In addition, there is a strong persistent pain in the affected limb. The second stage of the disease is characterized by the phase correspondence of the compensatory properties.
In the third degree of varicose veins, dilation of the superficial veins and dysfunction of the valves of the deep, perforating and saphenous veins are observed, and this causes persistent venous hypertension in the distal parts of the limb. This is what causes a violation of microcirculation and the formation of trophic ulcers. At the same time, skin pigmentation develops in the lower part of the foot with the initial manifestations of an inductive pathological process. But the feet and legs, especially if there are trophic disorders, are characterized by persistent swelling. This is associated with disorders of blood flow and lesions of the lymphatic system of the limbs of organic nature and lymphostasis of secondary origin. The symptoms of third degree varicose veins are quite pronounced, varied and constant.
With the further progression of varicose veins, the areas of trophic ulcers expand somewhat, dermatitis and eczema appear, which indicates the presence of the fourth stage of the disease. The last two degrees of severity represent the decompensation phase of the pathological process. In this case, not only local but also general hemodynamics is concerned. Using ballistocardiography, it is possible to detect impaired contractility of the heart muscle, which is detected in 80% of patients with varicose vein decompensation.
An important point in choosing the right treatment is determining the degree of varicose veins and the type of superficial 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 beginning of the pathological process, when the manifestations on the skin are less pronounced, reducing on average the ability to work. This method of treatment, as conservative, is also used because of the contraindications to surgery. In addition, this method is necessarily used in the postoperative period to prevent recurrent conditions of varicose veins.
During conservative treatment, the severity of risk factors decreases with the use of adequate physical activity, the use of elastic compression, medications, and physiotherapy. Only the combination of all these therapeutic measures can guarantee a positive result.
First of all, they identify the risk factors for the appearance 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 a hereditary predisposition, even in the absence of symptoms of varicose veins, are required to consult a phlebologist twice a year using ultrasound examination of the veinsof the lower extremities. Also, if there are no complications such as thrombophlebitis or thrombosis, regular exercise for the veins of the lower extremities is recommended. This includes more walking, wearing only comfortable shoes, swimming, cycling and jogging. All physical activity should 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 loads predominate in the veins of the lower extremities, as well asas exercises related to lifting important weights.
At home, following the recommendations of a specialist, they perform simple exercises. As a general rule, the legs should be in a raised position for a few minutes before the start of the workout to prepare the body for certain types of exercises. The choice of rhythm and speed of exercises is chosen strictly individually for each patient, taking into account his physical abilities. But the main thing in such a physical education is its regularity. In addition, it is recommended to use a contrast shower daily with alternating foot massage with warm and cold water, for five minutes.
Elastic compression is a method of treating varicose veins using bandages or compression stockings. In this case, muscle contraction occurs in a dosed manner, which improves blood circulation through the venous vessels and prevents stagnant phenomena. Thanks to the artificial preservation of vascular tone, the veins stop dilating and thus, the formation of thrombosis is prevented.
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 the physiotherapeutic methods of treatment the best effect have lasers, electrophoresis, magnetic fields and the use of diadynamic currents.
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 depend directly on the severity of the pathological process and the place of its localization.
During a phlebectomy, varicose veins are removed. The main purpose of the operation is to eliminate the pathological blood flow by removing the main trunks of the small or large superficial vein and connecting 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, a sclerosant is injected into the enlarged venous vessel, which causes the venous walls to coalesce and thus the blood flow through it stops. As a result, the pathological blood flow stops with the simultaneous elimination of the cosmetic defect, as at this 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, therefore 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 closes. This method of surgery is indicated only with a vein dilated 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. Simple measures performed regularly 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 a prolonged static load with swimming, running, walking, cycling. You also need to perform simple exercises in your workplace.
With existing varicose veins, you should try to put your feet in an elevated position as often as possible. Fight excess weight, preventing it from growing. 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, while taking estrogen or oral contraceptives, it is imperative to examine the veins of the lower extremities using an ultrasound scan.