Varicose veins are a pathological extension of the veins located on the surface, characterized by an increase in their diameter and length, which in turn leads to a cylindrical, serpentine, sac-like and mixed change in the venous trunks. 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 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 by a congenital malfunction of the valves. The development of secondary venous pathology is affected by deep vein thrombosis or acquired valvular insufficiency due to pregnancy, intense physical exertion, prolonged standing, etc.
At the moment of increasing the hydrostatic pressure in the veins, these vessels dilate in diameter and the weakened functions of the valves deteriorate. All this impedes the circulation of blood in the veins on the surface, and as a result of insufficient function of the veins in the periphery, blood regresses from the deep veins to the clear veins, which are very stretched, begin to rotate, forming various forms of expansion. In the future, as a result of intense stagnation, tissue nutrition 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 of expansion, serpentine torsion, 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 adolescence, it affects both boys and girls. But women in adulthood are much more likely to get 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 cause impaired tone of the veins, their dilation, some insufficiency of the valves of the communicating and clear veins, the opening of arterial and venous arteriesveins.
To date, the true cause of lower extremity varicose veins is still unknown. Insufficient valve function and increased venous pressure are thought to be related to the underlying cause 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: the primary and the secondary.
Primary varicose veins on the surface are characterized by the presence of normal deep veins. 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 of the lower extremities are: increased hydrostatic pressure in the trunks of the veins, thinning of their walls, disturbances of metabolic processes in smooth muscle cells, movement of blood from the deep veins to the superficial. This reverse movement of blood in the form of vertical regression and horizontal regression causes gradual nodular dilation, elongation and edema of the veins located under the skin, ie superficial. The final link in the pathogenesis is represented by cellulite, dermatitis and trophic venous ulcer of the tibia.
The symptomatic picture of varicose veins of the lower extremities consists of patients complaining of existing dilated veins, which cause aesthetic 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 vary from secondary "stars", reticulated nodes to coarse trunks, as well as nodes, grids, which are clearly visible in the upright position of the patients. Almost 80% are lesions of the trunk and branches of the great vein on the surface and 10% are in the small clear vein. In addition, in 9% of patients, there is damage to both veins involved in the pathological process.
As a result of a progressive procedure, the patient begins to feel rapid fatigue, there is some severity and distension in the legs, cramps appear in the calf muscles and the legs and feet swell and paraesthesia develops. In addition, the feet swell mainly in the late afternoon, but after sleep this swelling subsides.
Quite often, varicose veins are complicated by acute venous thrombophlebitis on the surface with manifestations of redness, like a cord, painful compression of the vein, which is characterized by expansion, as well as periphlebitis. Very often the varicose veins rupture as a result of minor damage and this leads to bleeding. As a rule, blood from a broken node can flow in a stream and the patient sometimes loses a fairly large amount of it.
In addition, there are some difficulties in diagnosing varicose veins of the lower extremities, as well as in linking CVI based on patient complaints, disease recall, and the results of an objective examination.
An essential value for the diagnosis is the ability to determine the condition of the venous valves of the main and communicative nature, as well as to assess the patency of the deep veins.
Causes of varicose veins
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 valves in the veins and disturbed blood circulation in them. Varicose veins are one of the most common vascular pathologies among half of the working age population.
There are, as a rule, several predisposing factors for the development of the disease, as well as its progression. The clear 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 the incorrect organization of the work process. Many people spend a lot of time standing or sitting, depending on their work, and this has a rather bad effect on the valvular apparatus of the veins of the lower extremities. In addition, work related to hard physical work is considered unfavorable, especially in the form of spasmodic load on the legs when lifting weights.
Today, long trips or flights, which contribute to the occurrence of venous hemorrhage in the legs and are risk factors for venous pathology, adversely affect the blood flow system in the veins. In addition, the use of tight underwear causes compression of the veins in the groin and corsets increase the pressure inside the peritoneum, so it is not recommended to wear them constantly. This also applies to shoes with high heels in the presence of uncomfortable footrests.
Repeated 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 elastic and collagen-derived fibers contained 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 superficial vein system, that is, clear veins, both small and large, as well as a deep vein system in the thigh and lower leg, and 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 ones. But to move the blood to the heart and not the other way around, there are valves in the venous walls that close and do not allow blood to pass under the influence of gravity from top to bottom. Muscle contractions are also very 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 function of the valves is formed, which is the reason for not closing the leaflets of the valve with the formation of incorrect blood movement from the heart.
Deep vein valves are affected particularly rapidly as a result of the maximum load on them. And to reduce excessive pressure with the help of a system of perforated veins, blood flows to the veins under the skin, which are not designed for a large amount. All this leads to excessive dilation 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 a perforation of the perforated venous valve device without some obstruction to blood flow in a horizontal position, first in deep vessels and then in superficial ones. And in the end CVI develops with manifestations such as swelling, pain and ulcers of a food nature.
Symptoms of varicose veins
Varicose veins are characterized by the expansion of the veins located under the skin, in the form of sacral or cylindrical changes. With this pathological disease, convex veins appear on the surface of the skin of the feet and legs. The maximum appearance of varicose veins is formed after 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 no specific symptoms. At the moment, patients get tired quickly with constant heaviness in the legs, burning, cracking, especially after physical exertion. Also, transient swelling and pain along the entire length of the veins sometimes occur. At the same time, late in the afternoon, the ankle and the back of the foot swell after prolonged static loads. A characteristic feature 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 early stage symptoms should be a signal for the patient to visit a specialist to prevent the development of varicose veins.
This disease is characterized by slow growth, sometimes for several decades. Therefore, as a result of poor treatment, varicose veins in their development form CVI (chronic venous insufficiency).
An important symptom of the disease is also the spider veins, which are a spider web of slightly dilated capillaries that are practically visible under the skin. Sometimes the elimination of disorders of a non-hormonal nature, the exclusion of a sauna, a solarium allows you to forget once and for all such a disease as varicose veins. But basically, these spider veins refer to the only sign of superficial veins overflowing and varicose veins forming. Therefore, the appearance of even such an insignificant point should serve as a signal for consultation with a surgeon.
In addition, varicose veins represent an aesthetic nuisance, so to solve such problems, doctors perform surgeries.
Degree of varicose veins
This disease can manifest in varying degrees of severity and is characterized by a different structure, which is associated with its clinical symptoms. As a rule, there are different types of structure of the dilated veins on the surface. The first type, the main one, is characterized by the expansion of the main trunks of the clear veins without joining tributaries with them. The second type, or loose, is a network-like extension with multiple branches. This type of varicose veins is detected at the beginning of the development of the disease. But with a mixed formula, a combination of the previous two occurs, and this third formula is much more common than others.
The symptoms of varicose veins are directly proportional to the stage of the pathological process, which are divided into compensation, undercompensation and compensation.
In addition, the ICD of varicose veins distinguishes the pathology with ulcer, with inflammation, with the presence of simultaneous ulcers and inflammation in 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 some manifestations of venous valve insufficiency on the surface and communication properties. Patients have a mild nature of leg pain, a certain severity, fatigue in the context of prolonged effort. The diagnostic tests performed indicate satisfactory function of the valves and the presence of small dilations of the veins under the skin indicates poor drainage function in the veins from the affected limb. The first degree VL corresponds to the compensatory stage of varicose veins.
The second degree of varicose veins is characterized by the expansion of the superficial veins with failure of their valves based on functional examinations. In the process of attenuated outflow into the veins, insufficiency of the lymphatic system of the limbs develops, which is manifested by swelling of the legs and feet. The characteristic swelling occurs after prolonged exercise in the lower extremities, which disappear after resting in a horizontal position. In addition, there is persistent severe pain in the affected limb. The second degree of the disease is characterized by the correspondence of the stage of the compensatory property.
In the third degree of varicose veins there is expansion of the superficial veins and dysfunction of the valves of the deep veins, perforated and clear and this causes persistent venous hypertension in the distal parts of the extremity. This is what causes the microcirculation to break down and the formation of food ulcers. At the same time, pigmentation of the skin in the tibia area develops with the initial manifestations of a severe pathological process. But the feet and legs, especially if there are eating 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 a lymph node of secondary origin. The symptoms of grade 3 varicose veins are quite intense, varied and stable.
With the further development of varicose veins, the zones of food 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 stage of compensation of the pathological process. In this case, not only the local but also the general hemodynamics is disturbed. Using ballistic cardiography, it is possible to detect reduced contractility of the heart muscle, which is detected in 80% of patients with varicose vein reversal.
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
Complete treatment of varicose veins is considered a complex procedure, which 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 beginning of the pathological process, when the manifestations on the skin are slightly expressed, 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 avoid recurrent varicose veins.
During conservative treatment, the severity of the risk factors is reduced by 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.
They first 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 varicose symptoms, are required to consult a venologist twice a year using ultrasound examination of the veins of the 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 jogging. All physical activity should be performed with elastic compression. It is absolutely contraindicated to perform exercises with injuries of the lower extremities, it is also necessary to exclude mountaineering skiing, tennis, volleyball, basketball, football, various kinds of martial arts, where there are loads on the veins of the lower extremities, as well as exercisesassociated with lifting significant 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 you start exercising to prepare your body for certain types of exercise. 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 daily contrast shower with alternating foot massage with hot and cold water, for five minutes.
Elastic compression is a method of treating varicose veins using a bandage or sock compression. In this case, the muscle compression occurs in a dosing manner, which improves blood flow through the venous vessels and prevents stagnation. 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 that gradually strengthen the venous walls. All medication for varicose veins should only be prescribed by the treating physician, therefore, self-medication is not recommended. But topical treatment in the form of ointments and gels without signs of thrombophlebitis or thrombosis is simply undesirable.
Of the physiotherapy methods, laser, electrophoresis, magnetic field and the use of dynamical currents have the best results.
Varicose veins refer to a surgical disease that can be completely cured after surgery. As a rule, there are different types of surgical treatment (phlebectomy, sclerotherapy and laser coagulation), which depend directly on the severity of the pathological procedure and its location.
During a phlebectomy, the 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 ligation of the perforated 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 aging. Phlebectomy is performed using endoscopic methods of treatment, which makes this operation less safe.
During sclerosis, a sclerosant is injected into the dilated venous vessel, which causes the venous walls to coalesce, thus stopping the flow of blood through it. As a result, the abnormal blood flow stops with the simultaneous elimination of the cosmetic defect, since 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, so it is used to a limited extent. The advantage of this surgery is the absence of postoperative scars, the hospitalization of patients and 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 with an enlarged vein up to ten millimeters.
Prevention of varicose veins
The 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 people attach great importance to the prevention of this disease. Simple measures taken regularly can significantly reduce the appearance and further development of varicose veins. In this case, it is very important, first of all, to move more, but also to alternate a prolonged static load with swimming, running, walking, cycling. You should also do simple exercises in your workplace.
With existing varicose veins, you should try to place your feet in an elevated position as often as possible. Fight excess weight by 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, taking estrogen or oral contraceptives, it is imperative to examine the veins of the lower extremities using ultrasound.