Varicose veins are pathological dilation of superficial vessels, which is characterized by an increase in their diameter and length, resulting in cylindrical, serpentine, saccular and mixed changes 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 occurs as a result of primary weakness of the wall of a large vein localized under the skin or congenital valve dysfunction. The development of secondary venous pathology is characterized by deep vein thrombosis or pregnancy, heavy physical exertion, prolonged stagnation, etc.
As the hydrostatic pressure in the arteries increases, the diameter of these vessels expands and the impaired valve function worsens. All this impedes blood circulation in the superficial vessels, and as a result of insufficient functioning of the vessels in the periphery, blood reflux occurs from the deep veins to the over-stretched sapen veins, begins to twist, and forms various forms of dilation. In the future, as a result of open stagnation, tissue trophism is impaired, ulcers, eczema and dermatitis occur.
Varicose veins of the lower extremities
The disease is characterized by the formation of venous walls in the form of saccular dilation, serpentine bending, increased length of the valves and failure.
As a rule, varicose veins of the lower extremities occur in 20% of the population. In addition, it affects both boys and girls before puberty. However, adult women are more affected by varicose veins than men. The number of patients also increases with age. This can be explained by the reconstruction of the hormonal background in the female body as a result of pregnancy and menstruation, which leads to weakened vascular tone, their dilation, some failure of the valves of the contact and saphenous veins, the opening of blood vessels. arteriovenous shunts and circulatory disorders in the vessels.
To date, the true cause of the development of varicose veins of the lower extremities is still unknown. Inadequate valve function and increased vascular pressure are thought to be related to the etiological cause of the disease. Taking into account all the factors that predispose to the onset of the pathological process in the vessels of the lower extremities, there are two types of varicose veins: primary and secondary.
Superficial varicose veins are characterized by the presence of normally deep veins. And in the case of secondary varicose veins, various complications of deep veins, arteriovenous fistulas, congenital absence or development of venous valves play an important role.
Risk factors for the formation of varicose veins of the lower extremities are: increased hydrostatic pressure in the trunks of blood vessels, thinning of their walls, disruption of metabolic processes in smooth muscle cells, the movement of blood from deep veins to superficial veins. In the form of vertical reflux and horizontal reflux, this reverse movement of blood causes the nodules, which are localized under the skin, to gradually expand, lengthen and bend. The last 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 complaints of patients with existing varicose veins, which cause cosmetic discomfort, a certain severity, and in some cases pain in the lower extremities, night cramps and trophic changes in the legs.
The dilation of venous vessels can range from small "stars" to reticular nodes to roughly curved trunks, as well as to nodes and plexuses that are clearly visible in the patient's upright position. Almost 80% of the damage is to the trunk and branches of a large vein on the surface, and 10% to a small saphenous vein. In addition, 9% of patients have damage to both vessels involved in the pathological process.
As a result of the progressive process, the patient begins to feel rapid fatigue, there is some tension and tension in the legs, cramps in the muscles of the legs, swollen legs and feet, paresthesias. In addition, the legs are mostly swollen in the afternoon, but this swelling disappears after sleep.
Often, varicose veins are complicated by acute thrombophlebitis of the superficial veins, characterized by redness of the vessel, cord-like, painful compression, dilation, as well as periphlebitis. Very often, varicose veins rupture as a result of a small injury, which causes bleeding. As a rule, the blood of a torn node can flow in a stream, and the patient sometimes loses a large enough amount.
In addition, there are no 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 objective examination.
An important value in the diagnosis is the ability to determine the condition of the valves of the main and communicative vessels, as well as to assess the openness of the deep vessels.
Causes varicose veins
This pathological process is characterized by dilation of blood vessels located on the surface under the skin and is associated with insufficient functioning of the valves in the blood vessels and disruption of blood circulation in them. Varicose veins are one of the most common vascular pathologies among the able-bodied half of the population.
As a rule, there are several predisposing factors for the development of the disease, as well as its development. A certain hereditary contribution to the appearance of varicose veins has not yet been proven. The emergence of this pathological process can be influenced by the nature of the diet, lifestyle and conditions that are currently caused by changes in the hormonal background.
Also, the occurrence of this pathological process is due to improper organization of the work process. Many people spend a lot of time standing or sitting, depending on their work, and this has a fairly bad effect on the valve apparatus of the lower extremities. In addition, work involving heavy physical labor is considered unfavorable, especially in the form of a bounce load on the legs when lifting weights.
Today, long-distance travel or flights, which contribute to the formation of venous stasis in the legs and are risk factors for the development of venous pathologies, have a negative impact on the circulatory system in the arteries. In addition, wearing tight underwear causes constriction of the arteries in the groin area, and corsets increase the internal pressure of 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 foot supports.
Recurrent pregnancies are a proven risk factor for varicose veins. This can be explained by the fact that an enlarged uterus increases the pressure inside the peritoneum and progesterone destroys the elastic and collagenous fibers 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 features of their structure in the lower extremities. There are superficial vascular systems, such as small and large saphenous veins, as well as perforated vessels that connect the deep vascular system of the thigh and lower leg and the previous two systems. With normal blood circulation, blood flow to the lower extremities occurs in 90% of deep veins and 10% of superficial veins. However, in order for the blood to move to the heart, and not vice versa, there are valves in the venous walls that close by multiplying and prevent the blood from flowing from top to bottom under the influence of gravity. The contraction of the muscles that contribute to normal blood flow is also important. In addition, in the upright position, blood stasis develops, the pressure in the arteries begins to increase, which leads to their dilation. In the future, the valves will not work properly, which will prevent the valve leaflets from closing due to the wrong movement of blood from the heart.
Valves of deep-seated vessels are particularly sensitive to maximum load. And with the help of the perforated vascular system, blood flows to the arteries under the skin to reduce excess pressure, which is not intended for large volumes. All this leads to excessive elongation of the venous walls, resulting in the formation of characteristic varicose veins. However, the increased volume of blood continues to flow into the deep veins, thereby creating a deficiency of the valve apparatus of the vessels that perforated without certain barriers to blood flow in the horizontal position, first to the deep veins and then to the superficial veins. And in the end, CVI develops with manifestations such as edema, pain and trophic ulcers.
Symptoms of varicose veins
Varicose veins are characterized by dilation of localized vessels under the skin, cystic or cylindrical changes. With this pathological disease, wrinkled 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 physical exertion. Dilation of blood vessels during or after pregnancy is very common in young women.
The early stage of varicose veins is characterized by few and nonspecific symptoms. At this time, patients get tired quickly, especially after physical exertion, with constant heaviness in the legs, burning, bursting. Also, sometimes transient edema and excruciating pain appear along the entire length of the veins. At the same time, in the afternoon, after long static loads, the ankle and the back of the foot swell. Some features of edema are that they disappear 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 of the initial stage should be a signal for the patient to consult a specialist to prevent the development of varicose veins.
The disease is sometimes characterized by slow development over several decades. Therefore, as a result of poor treatment, CVI (chronic venous insufficiency) develops in varicose veins.
Another important symptom of the disease is spider veins, which are spider webs of slightly dilated capillaries that are practically visible under the skin. Sometimes the elimination of dyshormonal disorders, the removal of the sauna, solarium, allows you to forget about a disease such as varicose veins. However, in general, these spider veins are the only sign of the formation of superficial veins and varicose veins. Therefore, even the appearance of such an insignificant symptom should serve as a signal to consult a surgeon.
In addition, varicose veins represent a cosmetic concern, so doctors perform surgeries to address such problems.
Degree of varicose veins
The disease can manifest itself in different degrees of severity and can be characterized by a different structure associated with clinical symptoms. As a rule, there are several types of dilated vessels on the surface. The first type is characterized by dilation of the main trunk of the saphenous veins without joining the main arms. The second type, or loose, is a network-like extension with many branches. This type of varicose veins is found at the very beginning of the disease. However, with a mixed species, a combination of the previous two occurs, and this third species is more common than the others.
The symptomatology of varicose veins is 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 ulceration, inflammation, simultaneous inflammation of the ulcers and lower extremities, and the presence of varicose veins with or without ulcers.
The first degree of varicose veins is characterized by moderately open expansion at the surface along the main trunks or branches, without certain manifestations and communicative features of superficial vascular valve insufficiency. Patients have a mild nature of leg pain, a certain intensity, fatigue against the background of prolonged tension. Diagnostic tests show satisfactory valve function and the presence of a small dilation of the blood vessels under the skin indicates poor drainage from the affected extremity. The first degree of VL corresponds to the stage of compensation of varicose veins.
The second degree of varicose veins is characterized by dilatation of the superficial vessels with valve insufficiency based on functional tests. In the process of disruption of vascular flow develops a deficiency of the lymphatic system of the extremities, which is manifested by edema of the legs and feet. Characteristic swelling occurs after prolonged tension in the lower extremities, 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 appropriateness of the stage of subcompensatory property.
In the third degree of varicose veins, dilatation of the superficial veins and dysfunction of the valves of the deep, perforated and saphenous veins are observed, which leads to persistent venous hypertension in the distal parts of the periphery. This leads to disruption of microcirculation and the formation of trophic ulcers. At the same time, with the initial manifestations of the indurative pathological process, skin pigmentation develops in the lower part of the legs. However, the legs and feet are characterized by permanent swelling, especially if there are trophic disorders. It is associated with impaired blood flow and damage to the lymphatic system of organic organs and secondary lymphostasis. The symptoms of grade 3 varicose veins are very clear, varied and stable.
With further progression of varicose veins, the zones of trophic ulcers expand slightly, 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. Using balistocardiography, it is possible to detect a violation of the contractility of the heart muscle, which is found 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
Complex treatment of varicose veins of the legs is a complex process that is directly proportional to the severity of the disease. As a rule, surgical and conservative treatment methods are used.
Varicose veins are treated without surgery, and only at the very beginning of the pathological process, when the manifestations on the skin are slightly expressed, give a positive result if the ability to work is moderately reduced. This method of treatment is also used conservatively for contraindications to surgery. In addition, this method is definitely used in the postoperative period to prevent recurrent conditions of varicose veins.
The severity of risk factors is reduced with the use of adequate physical activity, elastic compression, medication and physiotherapy during conservative treatment. Only a combination of all these therapeutic measures can guarantee a positive result.
First of all, they identify the risk factors for the formation of varicose veins and try to influence them. In addition, a group of people with certain risk factors for the disease, as well as hereditary predisposition, even if there are no symptoms of varicose veins, are required to consult a phlebologist twice a year using vascular ultrasound. lower extremities. Also, if there are no complications such as thrombophlebitis or thrombosis, regular exercise for the vessels of the lower extremities is recommended. It includes more walking, just wearing comfortable shoes, swimming, cycling and running. All physical activities should be performed with elastic compression. Exercises with lower extremity injuries are completely contraindicated, as well as skiing, tennis, volleyball, basketball, football, various types of combat, in which the load is predominant in the veins of the lower extremities. such as exercises related to lifting significant weights.
They do simple exercises at home after the advice of an expert. As a rule, the legs should be in a high position for a few minutes before training to prepare the body for certain types of exercises. The choice of exercise speed and pace is strictly individualized for each patient, taking into account the physical capabilities. But the main thing in such physical training is its regularity. In addition, it is recommended to use a daily contrast shower with an alternate foot massage with hot and cold water for five minutes.
Elastic compression is a method of treating varicose veins using a bandage or compression stockings. In this case, muscle contraction occurs in a dose that improves blood flow through the venous vessels and prevents stagnation. Thanks to the artificial maintenance of vascular tone, blood vessels stop dilating and thus prevent thrombosis.
For the treatment of all stages of varicose veins are used phlebotonic drugs that gradually strengthen the venous walls. All drug treatment for varicose veins should be prescribed only by the attending physician, so self-medication is not recommended. However, topical therapy in the form of ointments and gels without signs of thrombophlebitis or thrombosis is simply undesirable.
Among physiotherapeutic treatments, the use of lasers, electrophoresis, magnetic fields and diadynamic currents have the best effect.
Varicose veins are 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 location.
Varicose veins are removed during phlebectomy. The main purpose of the operation is to remove the pathological flow of blood by removing the main bodies of small or large superficial veins and closing the perforating veins. However, this operation is not performed only in the presence of concomitant diseases that may worsen the current situation; late stages of varicose veins; pregnancy; existing purulent processes and aging. Phlebectomy is performed using endoscopic treatments, which makes the operation less safe.
In sclerosis, a sclerosant is injected into an enlarged venous vessel, which causes the venous walls to coalesce, thereby stopping blood flow. As a result, the pathological flow of blood is stopped by the simultaneous removal of the cosmetic defect, because 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 trunk grow, so it is used to a limited extent. The advantages of this surgery are the absence of postoperative scars, hospitalization of patients and the fact that the patient does not need special rehabilitation in the postoperative period.
Laser coagulation is based on the destruction of the venous wall due to the 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
Prevention of this disease can be primary, which prevents the development of varicose veins, and secondary - in the presence of a pathological process.
Today, most people attach great importance to the prevention of this disease. Simple measures taken on a regular basis can significantly reduce the formation and further development of varicose veins. In this situation, first of all, it is very important to move more, as well as to replace the long-term static load with swimming, running, walking, cycling. You also need to do simple exercises at work.
With existing varicose veins, you should try to keep your legs in an elevated position as often as possible. Fight excess weight, prevent it from gaining weight. It is also important to walk in comfortable shoes with a maximum heel height of five centimeters and, if necessary, use orthopedic insoles. In addition, when taking estrogens or oral contraceptives during pregnancy, it is important to check the vessels of the lower extremities using ultrasound.