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 leads to a change of the cylindrical, serpentine, saccular and mixed type of the 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 extremities during pregnancy.
Typically, varicose veins are primary and secondary. In the first variant, the disease is caused by the initial weakness of the wall of the large vein, which is localized under the skin, or by congenital dysfunction of the valves. The development of secondary venous pathology is influenced by deep vein thrombosis or acquired valve insufficiency due to pregnancy, intense physical exertion, prolonged standing, etc.
With an increase in hydrostatic pressure in the veins, these vessels increase in diameter and impaired valve functions worsen. All this interferes with the blood flow in the veins on the surface, and due to the insufficient functioning of the veins of the periphery, blood reflux is formed from the deep veins into the saphenous veins, which are too stretched, begin to wiggle. , forming 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 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. In addition, before puberty, it affects both boys and girls. But women in adulthood are much more likely to be affected by varicose veins, unlike men. In addition, the number of sick people 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 causes a weakening of the tone of the veins, their dilation, a certain insufficiency of the valves of the communicating and saphenous veins, theopening of arteriovenous shunts and circulatory disturbances in the veins.
To date, the true cause of the development of varicose veins of the lower extremities is still unknown. It is believed that insufficient function of the valves and increased pressure in the veins are related to the etiological cause of the development of the disease. Taking into account all the factors that predispose to the appearance of the pathological process in the veins of the lower extremities, there are two types of varicose disease: primary and secondary.
Primary surface varicose veins are characterized by the presence of deep normal veins. And in the case of secondary varicose veins, various complications of the deep veins, arteriovenous fistulas, congenital absence or underdevelopment of venous valves play an important role.
The 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, impaired metabolic processes in smooth muscle cells, movement of blood from the veinsdeep to the superficial veins. This reverse movement of the blood in the form of vertical reflux and horizontal reflux causes progressive nodular expansion, lengthening and tortuosity of the veins located under the skin, that is to say superficial. The last link in the pathogenesis is cellulitis, dermatitis and trophic venous ulcer of the lower leg.
The symptomatic picture of varicose veins of the lower extremities consists of complaints of patients about the existing dilated veins, which cause cosmetic inconvenience, some severity and, in some cases, pain in the lower extremities, cramps at night and trophic changesin the legs.
The expansion of the venous vessels can vary from minor "stars", reticular nodes to coarsely wiggling trunks, as well as nodes, plexuses, which are clearly visible in the upright position of patients. Almost 80% are lesions of the trunk and branches of the large surface vein, and 10% are in the small saphenous vein. In addition, in 9% of patients there is a lesion of both veins, which is involved in the pathological process.
As a result of a gradual process, the patient begins to feel rapid fatigue, some severity and distension is noted in the legs, cramps appear in the calf muscles, the legs and feet swell, and paresthesia develops. In addition, 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, painful cord-like compaction of the vein, characterized by expansion, as well as periphlebitis. Very often, varicose veins rupture as a result of minor damage, resulting in bleeding. As a rule, blood from a ruptured node can flow into a stream, and sometimes the patient loses a fairly large amount.
In addition, there are no definite difficulties in diagnosing varicose veins of the lower extremities, as well as joining the CVI on the basis of patient complaints, the history of the disease and the results of an examination. goal.
An essential value in making a diagnosis is the ability to determine the condition of the valves of the veins of a main and communicative nature, as well as to assess the patency of the deep veins.
Varicose veins cause
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. Varicose veins are among the most common vascular pathologies 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 definite 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.
In addition, the appearance of this pathological process is associated with the incorrect organization of the labor process. Many people spend a lot of time in a standing or sitting position, depending on their work, which has a rather detrimental effect on the valve apparatus of the veins of the lower extremities. In addition, the work associated with heavy physical labor is considered unfavorable, especially in the form of a jerky load on the legs when lifting weights.
Today, long trips or flights, which contribute to the appearance of venous blood stasis in the legs and are risk factors for the formation of venous pathologies, negatively affect the blood circulation system in the veins. 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 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 collagenous origin contained in the venous wall. In addition, such diseases 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 on the lower extremities. 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, andperforating veins connecting the two previous systems. With normal blood circulation, blood flow to the lower extremities occurs in 90% of deep veins and 10% of superficial veins. But in order for the blood to move to the heart, and not the other way around, there are valves in the venous walls that close and do not allow the blood to pass under the influence of gravitational force up and down. Muscle contractions are also of great importance, contributing to normal blood circulation. In addition, in an upright position, stagnation of blood 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 becomes the reason for the non-closing of the valve leaflets with the formation of incorrect movement of blood from the heart.
The valves of the deep veins are affected particularly quickly due to the maximum load they undergo. And in order to reduce the excess pressure with the help of a system of perforating veins, blood flows through the veins below the skin, which are not designed for much of it. All this leads to excessive stretching of the venous walls and, as a result, characteristic varicose knots are formed. However, an increased volume of blood continues to flow into the deep veins, thus forming an insufficiency of the valve apparatus of the perforating veins without certain obstacles to blood flow in a horizontal position, first in the deep vessels, then insuperficial vessels. And in the end, CVI develops with such manifestations as edema, pain and ulcers of a trophic nature.
Symptoms of varicose veins
Varicose veins are characterized by the expansion of the veins located under the skin, in the form of saccular or cylindrical changes. With this pathological disease, convoluted veins appear on the surface of the skin of the legs and feet. The maximum appearance of varicose veins is formed after long or intense physical exertion. It is quite common for the veins to dilate in young women during or after pregnancy.
The early stage of varicose veins is characterized by few and nonspecific symptoms. At this time, patients quickly tire with constant heaviness in the legs, burns, bursts, especially after physical exertion. In addition, transient edema and aching pain along the 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 hallmark of edema is its disappearance in the morning, after a night's rest. At this point, 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 in order to prevent the progression of varicose veins.
This disease is characterized by slow development, sometimes over several decades. Therefore, as a result of improper treatment, varicose veins in its progression form CVI (chronic venous insufficiency).
An important symptom of the disease is also spider veins, which are a spider's web of slightly dilated capillaries that are practically visible under the skin. Sometimes the elimination of disorders of a dyshormonal nature, the exclusion of a sauna, solarium allows you to once and for all forget about such a disease as varicose veins. But basically, these spider veins are the only sign of overflow of the veins on the surface and the formation of varicose veins. Therefore, the appearance of such a sign, however insignificant, should serve as a signal for consultation with a surgeon.
In addition, varicose veins represent cosmetic 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 is 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 saphenous veins without joining tributaries to them. The second type, or loose, is a network type 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 the others.
The symptomatology of varicose veins is directly proportional to the stage of the pathological process, which is subdivided into compensation, under-compensation and decompensation.
In addition, the CDI of varicose veins distinguishes pathology with an ulcer, with inflammation, with the simultaneous presence of ulcers and inflammation on the lower extremities and varicose veins without inflammation and ulcer.
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 pain in the leg, some severity, fatigue against the background of prolonged exertion. The diagnostic tests carried out indicate satisfactory function of the valves, and the presence of minor enlargements of the veins under the skin indicates poor work of the flow in the veins of the affected limb. The first degree of LV corresponds to the compensatory stage of varicose veins.
The second degree of varicose veins is characterized by the expansion of the superficial veins with the failure of their valves on the basis of functional tests. During the process of impaired flow through the veins, an 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 extremities, which disappear after rest in a horizontal position. In addition, there is severe and persistent pain in the affected limb. The second degree of the disease is characterized by the correspondence of the stage of the subcompensatory property.
In the third degree of varicose veins, there is an expansion of the superficial veins and dysfunction of the valves of the deep, perforating and saphenous veins, which 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 lower leg region with the first 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 disturbances in blood flow, damage to 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 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 stage of decompensation of the pathological process. In this case, not only local hemodynamics, but also general hemodynamics are disturbed. Using ballistocardiography, it is possible to detect impaired 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 very 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 method, is also used due to contraindications to surgical intervention. In addition, this method is necessarily used in the postoperative period in order to prevent recurrent ailments of varicose veins.
With conservative treatment, the severity of risk factors is reduced through the use of adequate physical activity, the use of elastic compressions, 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 a hereditary predisposition, even in the absence of symptoms of varicose veins, are brought to consult a phlebologist twice a year using aultrasound examination of the veins of the lower limbs. In addition, if there are no complications such as thrombophlebitis or thrombosis, regular training for the veins of the lower extremities is recommended. It involves walking more, wearing only comfortable shoes, swimming, biking, and jogging. All physical activities 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 ofmartial arts, where loads on the veins of the lower limbs also prevail. like exercises associated with lifting significant weights.
At home, after the recommendations of a specialist, they perform simple exercises. As a general rule, the legs should be in an elevated position for a few minutes before starting to 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 their physical capabilities. But the main thing in such physical education is its regularity. In addition, it is recommended to use a daily contrast shower with alternating massage of the legs with warm 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 manner, which improves blood circulation in the venous vessels and prevents the phenomena of stagnation. Thanks to the artificial maintenance of vascular tone, the veins stop dilating and thus the prevention of thrombosis formation takes place.
For the treatment of all stages of varicose veins, phlebotonic drugs are used, which gradually strengthen the venous walls. Any drug treatment for varicose veins should only be prescribed 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 treatment methods, 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.
During phlebectomy, varicose veins are removed. The main objective of the operation is to eliminate the pathological flow of blood by removing the main trunks of the superficial small or large vein and ligating the perforating veins. However, this operation is not carried out 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 sclerosis is injected into the dilated venous vessel, which causes the venous walls to join together and thus stop blood flow through it. As a result, 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 only effective when the small branches of the main trunks are enlarged, so it is used to a limited extent. The advantage of this surgical intervention is the absence of postoperative scars, the hospitalization of the patients and in the period following the 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 only indicated with a vein enlarged 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 of the people attach great importance to the prevention of this disease. Simple measures carried out regularly can significantly reduce the appearance and progression of varicose veins. In this case, it is very important, first of all, to move more, but also to alternate a prolonged static charge with swimming, running, walking, cycling. You should also perform simple exercises at your workplace.
With existing varicose veins, you should try to put your legs in an elevated position as often as possible. Fight excess weight, preventing it from increasing. It is also very important to walk in comfortable shoes with a heel height of no more than 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 with the help of an ultrasound.