Varicose veins of the lower limbs is a chronic venous disease, which is characterized by a thinning of their walls, a continuation of the lumen and formation of aneurysm-sicut nodes. Most varicose disease affects the lower limbs; it is one of the most common pathologies – it affects approximately 40% of women and 20% men.
Causes and risk factors
Through the veins of the lower limbs blood flows upwards, that is, it has to overcome the force of gravity. This current is provided by the pressure which are located in the vicinity of the veins and tendons of the residual arterial pressure. The movement of the blood through the veins of the lower limbs and promotes a "muscle pump": when moving, the leg muscles contract and compress veins, placebat ei pulsare thus in their blood, because the reverse-current inhibit venous valves.
The weakness of the muscular layer of the venous wall and valvular incompetence be the reason that influenced the work of the "muscle pump" the blood begins to flow in the opposite direction, i.e. down. This leads to increased pressure on the walls of the blood vessels, further progression of the valve disease, enlargement of the lumen of the veins, and nodules. The muscle fibers of vein walls atrophy, disrupted neural receptors that regulate venous tone, which, in turn, further enhances the manifestations of venous insufficiency.
Risk factors for development of varicose disease of lower limbs:
- genetic predisposition;
- pregnancy;
- thickness;
- daily prolonged sitting or standing;
- activities associated with lifting heavy items;
- systematic wearing of tight clothing, corsets;
- improper diet with inadequate intake of dietary fiber and vitamins;
- violations of the hormonal status.
In the prevention of varicose veins play an important role in an active pastime: sports (swimming, Biking, fitness), dancing, Hiking, etc.
Forms of the disease
On the basis of the characteristics of clinical manifestations, there are the following forms of varicose veins of the lower limbs:
- segmental lesions intradermal and subdermal veins without reverse flow;
- segmental lesion of the veins of the lower limbs, accompanied by abnormal flow of blood;
- common in vessels with reversed flow of blood in the superficial veins;
- common vascular lesions, accompanied by abnormal discharge of blood in the deep venous system.
Stage of the disease
In 2000, the Russian phlebologists was adopted the classification of varicose veins of the lower extremities, taking into account the form of the disease, the degree of venous insufficiency, presence or absence of complications. In accordance with that, there are three stages of varicose disease of lower limbs:
- The fee phase. Patients do not show any complaints. In the course of the inspection of one or both feet are detected superficial dilated veins.
- The stage subcompensation. Patients complain of night cramps, disturbance of skin sensation (paresthesias) in the legs, bloating. In the evening is not often a swelling of the legs, ankles and feet, disappear after a night's sleep. In the course of inspection of the feet clearly visible dilated veins.
- Stage of decompensation. The above signs be accompanied by eczema and dermatitis. Skin with pigment spots, dry, shiny, closely related to the subcutaneous fat.
Symptoms
The clinical picture is varicose veins of the lower limbs is determined by the stage of the disease. So, when the compensated stage the only symptom of venous insufficiency is the appearance of leg spider veins (telangiectasias).
The transition of the disease in subcompensated stage is accompanied by pain in the legs, swelling of feet and ankles, cramps in calf muscles. After resting in a horizontal position, these symptoms stop.
The most clear clinical picture is varicose veins of the lower limbs is manifested in the decompensated stage of the disease. Foot pain to become permanent. Patients complain of itching of the skin, which intensifies in the evening and night hours. With the passage of time, there are dermatitis, eczema, difficult healing of the sores. The scenes are frequent common symptoms are: dizziness, low blood pressure. They are associated with deposition in the expanded venous network of the legs of the large amounts of blood.
Complication of varicose veins is phlebitis, thrombophlebitis, bleeding from varicose veins, ulcers, pulmonary embolism.
Diagnosis
The diagnosis of varicose veins of the lower limbs is not difficult. It is on the basis of characteristic clinical symptoms and data for the purpose of inspection.
To assess the severity of hemodynamic disorders apply the instrumental methods of diagnostics:
- Doppler ultrasound of lower limb veins;
- duplex angioscanning;
- rheovasography of the lower limb veins.
Treatment
In the treatment of varicose disease of the lower limbs according to the testimony of the following methods or their combination:
- conservative therapy;
- sclerosing therapy;
- surgery.
Conservative therapy of varicose disease of the lower extremities may be recommended in patients in the early stages of the disease, its aim – prevention of progression of chronic venous insufficiency. It is also used when subcompensated and decompensated stages of the disease during the period of preparation of the patient for surgical intervention or in cases when other methods are contraindicated. Conservative treatment of varicose veins based on the use of phlebotonics, wearing of compression hosiery. In addition, patients should regularly engage in physical therapy, to avoid prolonged static loads.
Varicose veins of the lower limbs is not complicated by significant hemodynamic disturbance, can be used for compression sclerotherapy. The method consists in the implementation in the affected vein drug, causing its spasm. After that leg wear compression stockings or bandaging, exercise the legs with an elastic bandage for the maintenance of the wall of the vein in the dormientes condition. After a few days begins the process of gluing the vein walls. The compression garment must be worn after sclerotherapy for at least six weeks, while the formation between the walls of the veins, and dense adhesions.
In the advanced stages of the varicose disease of the lower limbs is the most effective method – surgery. Techniques operating techniques are selected on the basis of the stage of the disease, its forms, characteristics of hemodynamic disorders:
- laser coagulation;
- radiofrequency coagulation;
- miniphlebectomy;
- phlebectomy.
The possible complications and consequences
Complications of varicose veins develop mainly in the stage of decompensation. They include:
- phlebitis (inflammation of the veins continues);
- thrombophlebitis (inflammation of vein with formation in the lumen of blood clots);
- bleeding from the veins;
- sores;
- pulmonary embolism (PE).
Most varicose disease affects the lower limbs; it is one of the most common pathologies – it affects approximately 40% of women and 20% men.
Forecast
The prognosis of varicose veins of the lower limbs with timely treatment favorable.
Prevention
To prevent varicose veins of the lower limbs it is necessary to avoid prolonged static loads. If the job requires a long stay in a standing position or sitting, you must make periodic breaks for small exercises or at least walking. After the working day, it is recommended to lie down, giving the legs a horizontal or elevated position.
In the prevention of varicose veins play an important role in an active pastime: sports (swimming, Biking, fitness), dancing, Hiking, etc.