Varicose veins are a pathological expansion of the veins located on the surface, which is characterized by an increase in their diameter and length, which consequently leads to a cylindrical, serpentine, saccular and mixed type 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 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 dysfunction 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 time of an increase in hydrostatic pressure in the veins, these vessels expand in diameter and aggravate the impaired functions of the valves. All this interferes with blood circulation in the veins on the surface, and due to the insufficient functioning of the veins in the periphery, blood reflux is formed from the deep veins in the saphenous veins, which are too strained, begin to wriggle, forming various forms of expansion . In the future, due to pronounced stagnation, the trophism of tissues is disturbed, ulcers, eczema and dermatitis are formed.
Varicose veins of the lower limbs
This disease is characterized by the formation of venous walls in the form of saccular expansion, serpentine tortuosity, increased length and insufficiency of the valves.
As a rule, varicose veins of the lower extremities occur in 20% of the population. Also, before puberty, it affects both boys and girls equally. But adult women are much more likely to be affected by varicose veins, unlike men. Furthermore, the number of sufferers increases with increasing age. This can be explained by the restructuring of the hormonal background in the female body due to pregnancy, menstruation, which cause a weakening of the tone of the veins, their dilation, a certain insufficiency of the valves of the communicating and saphenous veins, the opening of arteriovenous shunts and circulatory disorders 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 functioning of the valves and an increase in pressure in the veins are related to the etiological cause of the development of the disease. Considering all the factors that predispose to the onset of the pathological process in the veins of the lower limbs, two types of varicose disease are distinguished: primary and secondary.
Primary surface varicose veins are characterized by the presence of normal deep veins. And 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.
The risk factors that are involved in the formation of varicose veins of the lower limbs are: increased hydrostatic pressure in the trunks of the veins, thinning of their walls, impaired metabolic processes in smooth muscle cells, blood circulation from deep to superficial veins. This reverse movement of the blood in the form of vertical reflux and horizontal reflux causes a gradual nodular expansion, elongation and tortuosity of the veins that are localized under the skin, i. e. superficial. The last link in the pathogenesis is represented by cellulitis, dermatitis and trophic venous ulcer of the lower leg.
The symptomatic picture of varicose veins of the lower limbs consists of patient complaints about the existing dilated veins, which cause cosmetic inconvenience, a certain severity and in some cases pain in the lower limbs, night cramps and trophic changes in the legs.
The expansion of venous vessels can vary from minor "stars", reticular nodes to coarsely wriggling trunks, as well as nodes, plexuses, which are clearly visible in the standing position of the patients. Almost 80% are lesions of the trunk and branches of the large surface vein, and 10% are in the small saphenous. 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 severity and distention in the legs is noted, cramps appear in the calf muscles, the legs and feet swell, and paresthesias develop. Also, the legs swell mostly in the late afternoon, but after sleep this swelling goes away.
Quite often, varicose veins are complicated by acute thrombophlebitis of the veins on the surface with manifestations of redness, cordon and painful compaction of the vein, which is characterized by expansion, as well as periplebitis. Very often varicose veins rupture following minor damage, and this leads to bleeding. As a rule, blood from a ruptured node can flow in one stream, and the patient sometimes loses a fairly large amount of it.
In addition, there are no certain difficulties in diagnosing varicose veins of the lower extremities, as well as in joining CVI on the basis of patient complaints, disease history and the results of a physical examination.
An essential value in making a diagnosis is the ability to determine the state of the valves 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 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 impaired blood circulation in them. Varicose veins are among the most common vascular diseases in 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. A definitive contribution of heredity to the appearance of varicose veins has not yet been proven. The emergence 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 the incorrect organization of the labor process. Many people spend a significant amount of time standing or sitting, depending on their job, and this has a rather negative effect on the valve apparatus of the lower extremity veins. In addition, work associated with hard physical work is considered unfavorable, especially in the form of a jerk load on the legs when lifting weights.
Today, long-term travel or flights, which contribute to the onset 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. Also, 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 high-heeled shoes in the presence of uncomfortable instep supports.
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 fibers of elastic and collagen origin contained in the venous wall. In addition, diseases such as rheumatoid arthritis, osteoporosis, change in hormonal status, increase the risk of developing this pathological process.
The typical causes of varicose veins are the peculiarities of their structure on the lower limbs. There is a system of veins located on the surface, i. e. saphenous veins, such as small and large, as well as a system of deep veins in the thigh and lower leg and perforating veins that connect the two previous systems. With normal blood circulation, blood flow to the lower limbs occurs 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 vice versa, there are valves in the venous walls that close strongly 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 flow. Also, in a standing position, blood stagnation 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 the non-closure of the valve flaps with the formation of incorrect movement of blood from the heart.
The valves of the deep veins are affected especially quickly due to the maximum load on them. And in order 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. All this leads to excessive stretching of the venous walls and, as a result, characteristic varicose nodes are formed. However, an increase in the volume of blood continues to flow into the deep veins, thereby forming an insufficiency of the valvular apparatus of the perforating veins without any obstacles to blood flow in a horizontal position, first in the deep vessels and then in the superficial ones. And eventually 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 located under the skin, in the form of saccular or cylindrical changes. With this pathological disease, twisted veins appear on the surface of the skin of the legs and feet. 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 initial phase of varicose veins is characterized by few and non-specific symptoms. At this time, patients quickly get tired with constant heaviness in the legs, burning, bursting, especially after physical exertion. In addition, transient edema and aching pains along the entire length of the veins sometimes appear. At the same time, in the late afternoon, the ankle and the back of the foot swell after prolonged static loads. A 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 see a specialist in order to prevent progression of varicose veins.
This disease is characterized by slow development, sometimes for several decades. Therefore, due to poor treatment, varicose veins in its progression form CVI (chronic venous insufficiency).
An important symptom of the disease is also spider veins, which are a web of slightly dilated capillaries that are practically visible under the skin. Sometimes the elimination of ailments of a dyshormonal nature, the exclusion of a sauna, a solarium allows you to forget once and for all a disease such as varicose veins. But basically, these varicose veins refer to the only sign of overflowing 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 an aesthetic discomfort, therefore, to solve such problems, doctors perform surgical operations.
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 the dilated veins on the surface. The first type, the main one, is characterized by the expansion of the main trunks of the saphenous veins without joining them to tributaries. The second type, or loose, is a mesh extension with many branches. This type of varicose veins is detected at the very beginning of 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 others.
The symptomatology of varicose veins is directly proportional to the stage of the pathological process, which is divided into compensation, undercompensation and decompensation.
In addition, the ICD of varicose veins distinguishes pathology with an 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 certain manifestations of insufficiency of the valves of the veins on the surface and communicative properties. Patients have a slight nature of pain in the leg, some severity, fatigue against the background of prolonged exertion. The diagnostic tests carried out indicate a satisfactory function of the valves, and the presence of slight enlargements of the subcutaneous veins indicate a malfunction of the outflow in the veins 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 the expansion of superficial veins with the failure of their valves on the basis of functional tests. In the process of impaired 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 prolonged exertion on the lower limbs, which disappears 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 subcompensating property.
In the third degree of varicose veins there is dilation of the superficial veins and dysfunction of the valves of the deep, perforating and saphenous veins, and this causes persistent venous hypertension in the distal parts of the limb. This is what provokes a violation of microcirculation and the formation of trophic ulcers. At the same time, skin pigmentation develops in the area of the lower leg with the 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 blood outflow disorders and lesions of the lymphatic system of the limb of an organic nature and lymphostasis of secondary origin. Symptoms of the 3rd degree of varicose veins are quite pronounced, varied and constant.
With the further progression of varicose veins, the zones of trophic ulcers expand slightly, dermatitis and eczema appear, which indicate the presence of the fourth stage of the disease. The last two degrees of severity represent the decompensation stage of the pathological process. In this case, not only local, but also general hemodynamics are disturbed. Using ballistocardiography, it is possible to detect reduced contractility of the heart muscle, which is detected in 80% of patients with decompensation of varicose veins.
An important point in choosing the appropriate treatment is to determine the degree of varicose veins and the type of dilated superficial veins.
Treatment of varicose veins
Comprehensive treatment of varicose veins of the legs is considered a complex process, 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 to surgical intervention. Also, this method is necessarily used in the postoperative period to prevent recurring conditions of varicose veins.
During conservative treatment, the severity of risk factors is reduced 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 occurrence 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 by ultrasound examination of the veins of the lower extremities . Also, if there are no complications such as thrombophlebitis or thrombosis, regular training for the lower extremity veins is recommended. This involves walking more, wearing only comfortable shoes, swimming, cycling, and jogging. All physical activities must be performed using elastic compression. It is absolutely contraindicated to perform exercises with injuries of the lower limbs, it is also necessary to exclude alpine skiing, tennis, volleyball, basketball, football, various types of martial arts, where loads on the veins of the lower limbs also prevail as exercises associated with weight lifting significant.
At home, after 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 starting the exercise to prepare the body for certain types of exercise. The choice of rhythm and speed of exercises is selected strictly individually for each patient, taking into account his physical abilities. But the main thing in such physical education is its regularity. In addition, it is recommended to use a contrast shower daily with alternating leg massage with hot and cold water, for five minutes.
Elastic compression is a method of treating varicose veins using compression bandages or stockings. In this case, muscle compression occurs in a measured way, which improves blood flow through the venous vessels and prevents stagnation phenomena. Thanks to the artificial maintenance of the vascular tone, the veins stop expanding and thus the prevention of thrombosis formation occurs.
For the treatment of all stages of varicose veins, phlebotonic drugs are used, which gradually strengthen the venous walls. All drug therapy for varicose veins should be prescribed only by the attending physician, therefore it is not recommended to self-medicate. But local therapy in the form of ointments and gels without signs of thrombophlebitis or thrombosis is simply undesirable.
Among the 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 directly depend on the severity of the pathological process and the place of its localization.
When phlebectomy is performed, 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 old age. Phlebectomy is performed using endoscopic treatment methods, which makes this operation less safe.
During sclerosis, a sclerosing agent is injected into the dilated venous vessel, which causes the venous walls to join together and thus the blood flow through it stops. Consequently, the pathological outflow of blood stops with the simultaneous elimination of the cosmetic defect, since at this time 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, in the period following sclerosis, the patient does not need specific rehabilitation.
Coagulation with a laser 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 surgical operation is indicated only with an enlarged vein 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 occurrence 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 should also perform simple exercises in the workplace.
With existing varicose veins, you need to try to place your legs in an elevated position as often as possible. Fighting excess weight by preventing it from gaining weight. It is also very important to walk in comfortable shoes with a maximum heel height of up to five centimeters and, if necessary, to use orthopedic insoles. Also, during pregnancy, taking estrogen or oral contraceptives, it is imperative to examine the veins of the lower limbs using an ultrasound.