Varicose veins are a pathological expansion of veins located on the surface, characterized by an increase in their diameter and length, which consequently leads to changes in the type of cylindrical, serpentine, saccular and mixed in the venous trunk. 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 the specific load on the lower limbs during pregnancy.
As a rule, varicose veins are primary and secondary. In the first variant, the disease is caused by an initial weakness of the large venous wall, localized under the skin or congenital dysfunction of the valve. The development of secondary venous pathology is influenced by deep venous thrombosis or valve insufficiency acquired as a result of pregnancy, strenuous physical exertion, prolonged standing, etc.
At the time of the increase in hydrostatic pressure in the vein, this duct expands in diameter and the impaired function of the valve becomes more severe. All this interferes with blood circulation in the veins on the surface, and as a result of insufficient venous function at the periphery, blood reflux is formed from the deep veins into the saphenous vein, which is too stretched, begins to writhe, forming various forms of expansion. In the future, as a result of obvious stagnation, tissue trophism is disturbed, ulcers, eczema and dermatitis are formed.
Varicose veins on the lower part of the leg
The disease is characterized by the formation of venous walls in the form of saccular expansion, serpentine tortuosity, increased length and valve insufficiency.
As a rule, varicose veins on the lower legs occur in 20% of the population. In addition, before puberty, it affects both men and women equally. But women in adulthood are more likely to get varicose veins, in contrast to men. Also, the number of sick people increases with increasing age. This can be explained by the restructuring of the hormonal background in the female body as a result of pregnancy, menstruation, which causes weak tone of the veins, their dilation, some lack of communicating venous and saphenous valves, opening of arteriovenous shunt and circulatory disorders in veins.
To date, the exact cause of the development of varicose veins on the lower legs is still unknown. It is assumed that inadequate valve function and increased pressure in the veins are related to the etiological cause of disease progression. Given all the factors that predispose to the onset of pathological processes in the veins of the lower extremities, there are two types of varicose veins: primary and secondary.
Primary varicose veins on the surface are characterized by the presence of normal deep veins. And in the case of secondary varicose veins, various deep vein complications, arteriovenous fistulas, congenital absence or venous valve insufficiency play an important role.
Risk factors involved in the formation of varicose veins in the lower legs are: increased hydrostatic pressure in the venous trunk, thinning of its walls, impaired metabolic processes in smooth muscle cells, movement of blood from deep veins to superficial ones. This reverse movement of blood in the form of vertical reflux and horizontal reflux causes a gradual nodular expansion, elongation and twisting of the veins located under the skin, i. e. , superficially. The last link in the pathogenesis is represented by cellulitis, dermatitis and trophic venous ulcers of the lower extremities.
The symptomatic description of varicose veins in the lower leg consists of patient complaints of pre -existing dilated veins, which cause cosmetic discomfort, of a certain severity, and in some cases pain in the lower leg, night cramps and trophic changes in the leg.
The expansion of the venous duct can vary from a small "star, " a reticular node to a roughly squirming trunk, as well as a node, the plexus, which is clearly visible in the patient’s upright position. Nearly 80% were lesions on the trunk and branches of large veins on the surface, and 10% were in small saphenous veins. In addition, in 9% of patients, there were lesions of both veins involved in the pathological process.
As a result of the progressive process, the patient begins to experience rapid fatigue, a certain severity and distension is observed in the legs, cramps appear in the calf muscles, and the legs and feet become swollen and paresthesia develops. In addition, the feet are mostly swollen in the late afternoon, but after sleep this swelling disappears.
Often, varicose veins are complicated by acute thrombophlebitis of the veins on the surface with manifestations of redness, such as cord, painful vein compaction, characterized by expansion, as well as periphlebitis. Often varicose veins rupture due to minor damage, and this leads to bleeding. As a rule, blood from a ruptured node can flow in the stream and patients sometimes lose a relatively large amount.
In addition, there were no particular difficulties in diagnosing varicose veins in the lower extremities, as well as in participating in CVI based on patient complaints, disease anamnesis and objective examination results.
An important value in making a diagnosis is the ability to determine the condition of the venous valve which is primary and communicative in nature, as well as to assess the patency of the deep vein.
Causes of varicose veins
This pathological process is characterized by the expansion of veins located on the surface under the skin and is associated with insufficient valve work in the veins and impaired blood circulation in them. Varicose veins are among the most common vascular pathologies among the working middle age.
There are, as a rule, several predisposing factors for the development of the disease, as well as its progression. The definite hereditary contribution to the appearance of varicose veins has yet to be proven. The emergence of this pathological process at this time can be influenced by the nature of diet, lifestyle and conditions caused by changes in the hormonal background.
Also, the occurrence of these pathological processes is associated with improper organization of work processes. Many people spend a lot of time in a standing or sitting position, depending on their work, and this has a relatively bad effect on the lower leg vein valve device. In addition, work associated with heavy physical labor is considered unprofitable, especially in the form of jerky loads on the legs while lifting loads.
Today, long -term travel or flight, which contributes to the occurrence of venous blood stasis in the legs and is a risk factor for the formation of venous pathology, has a negative impact on the blood flow system in the veins. In addition, wearing tight underwear causes compression of the veins in the groin area, and corsets increase the pressure in the peritoneum, so they are not recommended to be worn all the time. This also applies to shoes with high heels in the presence of uncomfortable instep support.
Repeated pregnancies are a proven risk factor for varicose veins. This can be explained by the fact that the enlarged uterus increases the pressure in the peritoneum, and progesterone destroys the original elastic fibers and collagen contained in the venous wall. Also, diseases such as rheumatoid arthritis, osteoporosis, changes in hormonal status, increase the risk of developing this pathological process.
A common cause of varicose veins is a structural abnormality in the lower part of the leg. There is a system of veins located on the surface namely the saphenous veins such as small and large, as well as the system of deep veins in the thighs and lower legs, and the perforated veins that connect the two previous systems. With normal blood circulation, blood flow to the bottom occurs in 90% of the deep veins and 10% of the superficial. But in order for the blood to move towards the heart, and not the other way around, there is a valve in the wall of the vein that closes and does not allow the blood to flow under the influence of gravity from top to bottom. Muscle contraction is 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 valve function is formed, which is the reason for not closing the leaflets of the valve with the formation of improper movement of blood from the heart.
The deep venous valves are affected particularly rapidly as a result of the maximum load on them. And to reduce excess pressure with the help of a perforated venous system, blood flows into the veins located under the skin, which are not designed for large volumes. All this leads to overstretching of the venous wall and, as a result, characteristic varicose nodes are formed. However, the increased volume of blood continues to flow into the deep veins, thus forming an insufficiency of the perforated venous valve apparatus without certain obstruction for blood flow in a horizontal position, first into the deep veins, and then into the superficial. And eventually CVI develops with manifestations such as edema, pain and ulcers that are trophic.
Symptoms of varicose veins
Varicose veins are characterized by the development of localized veins under the skin, in the form of saccular or cylindrical changes. With this pathological disease, convoluted veins appear on the skin surface of the feet and legs. The maximum appearance of varicose veins is formed after prolonged or strenuous physical exercise. It is common for veins to expand in young women during or after pregnancy.
The early stages of varicose veins are characterized by few and nonspecific symptoms. During this time, patients become quickly tired with constant heaviness in the legs, burning, breaking, especially after doing physical exercise. Also, sometimes temporary edema and aching pain along the entire vein appear. At the same time, in the late afternoon, the ankles and back of the feet swell after a prolonged static load. Some feature of edema is its disappearance in the morning, after night rest. At this stage, as a rule, no signs of varicose veins are visible. However, these early -stage symptoms should be a signal to the patient to see a specialist to prevent the development of varicose veins.
The disease is characterized by slow progression, sometimes over decades. Thus, 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 vein, which is a slightly widened capillary spider's web that can be seen under the skin. Sometimes the elimination of disorders of dishormonal nature, the exclusion of saunas, solariums allow you to forget once and for all diseases such as varicose veins. But basically, these spider veins refer to the only sign of overflowing veins on the surface and the formation of varicose veins. Therefore, the appearance of even insignificant signs should serve as a signal to consult a surgeon.
In addition, varicose veins represent a cosmetic discomfort, therefore, to solve such problems, doctors perform surgical operations.
Stages of varicose veins
The disease can manifest itself in various degrees of severity and is characterized by different structures, which are associated with its clinical symptoms. As a rule, there are several types of dilated vein structures on the surface. The first type, the main one, is characterized by the expansion of the main trunk of the saphenous veins without joining tributaries to them. The second type, or loose, is a network -like connection with many branches. This type of varicose veins is detected early in the development of the disease. But with mixed types, a combination of the previous two occurs, and this third type is found more often 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 ulcers, with inflammation, with the presence of simultaneous ulcers and inflammation of the lower extremities and varicose veins without inflammation or ulcers.
The first stage of varicose veins is characterized by moderate expansion of the veins on the surface along the trunk or main branch without specific manifestations of venous valve insufficiency on the surface and communicative properties. The patient has the nature of slight pain in the legs, a certain severity, fatigue against the background of prolonged effort. Diagnostic tests carried out showed satisfactory valve function, and the presence of small enlargement of the veins under the skin indicates poor outflow work in the veins from the affected limb. The first stage of VL corresponds to the stage of varicose vein compensation.
The second stage of varicose veins is characterized by the expansion of superficial veins with failure of their valves based on functional testing. In the process of impaired outflow in the veins, insufficiency of the lymphatic system in the legs develops, which is indicated by edema of the legs and feet. The characteristic swelling occurs after prolonged exercise on the lower part of the leg, which disappears after resting in a horizontal position. In addition, there is persistent severe pain in the affected limb. The second stage of the disease is characterized by correspondence of subcompensated property levels.
In the third stage of varicose veins, there is superficial venous expansion and dysfunction of the deep, perforated and saphenous venous valves, and this results in persistent venous hypertension in the distal part of the limb. This is what causes a violation of microcirculation and the formation of trophic ulcers. At the same time, skin pigmentation develops in the lower limb area with early manifestations of indurative pathological processes. But the feet and legs, especially if there is a trophic disorder, are characterized by persistent swelling. This is associated with disruption of blood outflow, and with lesions of the lymphatic system on the limbs of an organic nature, and lymphostasis of secondary origin. The symptoms of stage 3 varicose veins are quite pronounced, varied and persistent.
With the further development of varicose veins, the trophic ulcer zone develops somewhat, dermatitis and eczema appear, indicating 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 impaired contractility of the heart muscle, which is detected in 80% of patients with varicose vein decompensation.
The important thing in choosing the appropriate treatment is to determine the degree of varicose veins and the type of superficial veins that are dilated.
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 treatment methods 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, reducing the ability to work moderately. This method of treatment, as a conservative method, is also used because of contraindications to surgical intervention. In addition, this method must be used in the postoperative period to avoid recurrent 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 compressions, medications and physiotherapy. Only a combination of all these therapeutic measures can guarantee a positive result.
First of all, they identify risk factors for the occurrence of varicose veins and try to influence them. In addition, a group of people with certain risk factors for the disease, as well as with a hereditary predisposition, even without symptoms of varicose veins, are required to consult a phlebologist twice a year using ultrasound examination of the veins. lower body. Also, if there are no complications such as thrombophlebitis or thrombosis, it is recommended to do regular exercises for the lower leg veins. This involves more walking, just wearing comfortable shoes, swimming, cycling and jogging. All physical activities should be performed using elastic compression. It is absolutely contraindicated to do exercises with wounds on the lower legs, it is also necessary to exclude mountain skiing, tennis, volleyball, basketball, football, various types of martial arts, where the load on the lower leg veins occurs, tooas an exercise associated with significant weight lifting.
At home, after expert recommendations, they do 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 a particular type of exercise. The choice of rhythm and speed of training is chosen individually for each patient, taking into account his or her 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 foot massage with warm and cold water, for five minutes.
Elastic compression is a method of treating varicose veins using a bandage or compression sock. In this case, muscle compression occurs in a dosing manner, which increases blood flow through the venous channels and prevents the phenomenon of stagnation. Thanks to the artificial maintenance of vascular tone, the veins stop growing 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 walls of the veins. 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 methods of physiotherapeutic 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 its place of localization.
When performing a phlebectomy, the varicose veins are removed. The main goal of surgery is to eliminate the pathological discharge of blood by removing the main trunk of a small or large superficial vein and the ligation of the perforated vein. However, this operation is not performed in the presence of a concomitant disease that can only exacerbate the pre -existing condition; final stage of varicose veins; pregnancy; pre -existing purulent processes and old age. Phlebectomy is performed using endoscopic treatment methods, which makes this operation less safe.
During sclerosis, sclerosant is injected into an dilated venous canal, which causes the venous wall to constrict and thus the blood flow through it stops. As a result, the pathological outflow of blood stops with the simultaneous removal of cosmetic defects, because at this time the venous ducts collapse and are almost invisible. However, the use of sclerotherapy is only effective when the small branches of the main stem are enlarged, therefore it is used to a limited extent. The advantages of this surgical intervention are the absence of postoperative scarring, hospitalization of the patient, and in the post -sclerosis period, the patient does not require specialized rehabilitation.
Coagulation with a laser is based on the destruction of the venous wall due to its thermal effects. As a result of this process, the venous lumen is sealed. This method of surgical operation is indicated only with veins 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 pathological processes.
Nowadays, most people are very concerned about the prevention of this disease. Simple steps performed regularly can reduce the incidence and further development of varicose veins. In this case, it is very important, first of all, to move more, and also to replace the prolonged static load with swimming, running, walking, cycling. You should also do simple exercises at your workplace.
With pre -existing varicose veins, you must try to place your feet in an elevated position as often as possible. Fights excess weight, preventing it from increasing. 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 important to examine the lower leg veins using an ultrasound scan.