Varicose veins are pathological dilation of the superficial veins, which are characterized by an increase in their diameter and length, resulting in a cylindrical, zigzag, shaped change. ladder and mixture in the intravenous lines. Today, varicose veins are a common disease, almost 3 times more women 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 is caused by primary weakening of the great vein wall, localized under the skin, or congenital dysfunction of the valves. The development of secondary venous disease is influenced by DVT or acquired valvular insufficiency due to pregnancy, heavy exercise, prolonged standing, etc. v.
At the time of increased hydrostatic pressure in the veins, these vessels expand in diameter and the impaired valve function is aggravated. All of these interfere with blood circulation in the superficial veins, and because the veins in the peripherys are not functioning enough, reflux blood is formed from the veins located deep into the saphenous veins, the varicose veins. This circuit is too tight, begins to contort, forms many forms of expansion. In the future, as a result of pronounced stagnation, tissue nutrition is disturbed, ulcers, eczema and dermatitis are formed.
Varicose veins lower extremities
This disease is characterized by the formation of venous walls in the form of dilated, zigzag zigzags, increased length and absence of 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 women in adulthood are often much more susceptible to varicose veins, in contrast to men. At the same time, the number of people infected with the disease also increases with increasing age. This can be explained by the restructuring of the hormonal background in the female body due to pregnancy, menstruation, weakening of the tone of the veins, their dilation, some valves of the veins. The venous and venous catheters are weakened, opening the arterial shunts and disrupting the circulation in the veins.
To date, the actual cause of the development of varicose veins of the lower extremities is unknown. It is thought that inadequate 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 risk factors for the onset of the pathological process in the veins of the lower extremities, there are two types of varicose veins: primary and secondary.
Primary superficial 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 deficiency or underdevelopment of the venous valves play an important role.
The risk factors associated with the formation of varicose veins of the lower extremities are: increased hydrostatic pressure in the venous lumen, thinning of the walls, impaired metabolism in smooth muscle cells, movement of blood from the veins. deep veins to superficial veins. This reverse movement of blood in the form of longitudinal and transverse regurgitation causes a gradual dilation of the nodules, elongation, and formation of localized veins under the skin, i. e. at the surface. The final link in pathogenesis is manifested by cellulitis, dermatitis and trophic venous ulceration of the lower leg.
The symptomatic picture of varicose veins of the lower extremities includes patient complaints of existing varicose veins, cosmetic inconvenience, certain severity, and, in some cases, pain in the lower extremities, night cramps and nutritional changes in the legs.
The dilation of the venous vessels can vary from small "stars", reticular nodes to zigzag trunks, as well as nodes and plexuses, clearly visible in the upright position. of the patient. Nearly 80% are lesions in the trunk and branches of the superior superficial veins, and 10% are in the small hemisphere veins. In addition, in 9% of patients, there was 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 degree of severity and tension is noted in the legs, cramps appear in the muscles of the legs, feet and feetswell and develop paresthesia. In addition, the legs are mainly swollen in the late afternoon, but after sleeping this swelling will disappear.
Usually, varicose veins are a complication of acute thrombophlebitis of the superficial veins with manifestations of red, tender, painful veins characterized by dilatation, as well as inflammation around the veins. kidney. Usually, veins rupture due to minor injury, and this leads to bleeding. As a rule, blood from a ruptured node can flow in a stream, and the patient sometimes loses quite a bit of it.
In addition, there were no definite difficulties in diagnosing varicose veins of the lower extremities, as well as participating in CVI on the basis of patient complaints, medical history, and objective examination results.
An essential diagnostic value is the ability to determine the state of the valves of the major and perforating veins, as well as to assess the degree of patency of the deep veins.
Causes of varicose veins
This pathological process is characterized by dilation of the veins located on the subcutaneous surface and is associated with insufficient functioning of the valves in the veins and impaired blood circulation in them. Varicose veins are one of the most common vascular diseases in half of the working-age population.
As a rule, there are several factors that lead to the development of the disease, as well as its progression. A definite contribution of heredity to the occurrence of varicose veins has not yet been demonstrated. The occurrence of this pathological process can now be influenced by the nature of diet, lifestyle and conditions caused by changes in the hormonal background.
In addition, the occurrence of this pathological process is associated with incorrect organization of the working process. Many people spend a considerable amount of time in a standing or sitting position depending on their job, and this has a rather adverse effect on the valve apparatus of the veins of the lower extremities. In addition, work that involves heavy manual labor is considered unfavorable, especially in the form of jerking loads on the legs when lifting weights.
Today, long trips or flights, contribute to the appearance of venous blood stagnation in the legs and the risk of venous diseases, negatively affecting the circulation system. blood in the veins. In addition, wearing tight underwear compresses the veins in the groin area, bras increase pressure inside the peritoneum, so it is not recommended to wear them all the time. This also applies to shoes with high heels with uncomfortable instep support.
Having multiple pregnancies is a proven risk factor for varicose veins. This can be explained by the fact that the expanding uterus increases intraperitoneal pressure, and progesterone destroys the elastic and collagen-derived fibers contained in the venous wall. In addition, diseases such as rheumatoid arthritis, osteoporosis, changes in the hormonal status, increase the risk of developing this pathological process.
Typical causes of varicose veins are the peculiarities of their structure in the lower extremities. There is a system of superficial veins, that is, the hemispheric veins, such as the small and large, as well as the deep vein system of the thigh and lower leg, and the perforated veins that connect the two systems. before. With normal circulation, blood flow to the lower extremities occurs in 90% of the deep veins and 10% of the superficial. But in order for blood to move back to the heart, not vice versa, there are valves in the vein walls that close and prevent blood from passing through under the influence of gravity from top to bottom. Muscle contractions are also important, contributing to normal blood circulation. In addition, in an upright position, blood stagnation develops, the pressure in the veins begins to increase, and this leads to their dilation. In the future, inadequately functioning valves are formed, which will become the reason for the failure of the leaflets to close with the formation of incorrect movement of blood from the heart.
The valves of the deep veins are affected especially rapidly due to the maximum load on them. And to relieve excess pressure with the help of a system of perforated veins, blood flows into the veins located under the skin, which are not designed for large volumes. All this leads to excessive dilation of the vein walls and as a result the characteristic varicose veins are formed. However, the increased blood volume continues to flow into the deep veins, thereby forming impaired valve function of the perforated veins without definite impediments to the position of blood flow. transverse, first into the deep vessels, then into the shallow vessels. And finally CVI develops with manifestations such as edema, pain and ulceration of a nutritional nature.
Varicose veins symptoms
Varicose veins are characterized by dilation of the veins localized under the skin, in the form of cylindrical or cylindrical changes. With this pathology, convulsive veins appear on the skin surface of the legs and feet. The maximum occurrence of varicose veins is formed after a long time or with heavy physical exertion. Varicose veins in young women during or after pregnancy are quite common.
The early stages of varicose veins are characterized by few and no specific symptoms. At this time, the patient is quickly tired, his legs are heavy continuously, hot, and wet, especially after exertion. In addition, transient edema and tenderness sometimes occur along the entire length of the vein. At the same time, in the late afternoon, the ankles and insteps swell after being subjected to prolonged static loads. 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 obvious signs of varicose veins. However, these early symptoms should be a signal to see a specialist to prevent the progression of varicose veins.
This disease is characterized by slow development, sometimes lasting 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 spider web of slightly dilated capillaries that are visible under the skin. Sometimes the elimination of disorders of a dysthermic nature, the elimination of the sauna, the solarium allows you to forget once and for all about such a disease as varicose veins. But essentially, these spider veins are the only sign of superficial veins and the formation of varicose veins. Therefore, the appearance of even such an insignificant sign is a signal to consult a surgeon.
In addition, varicose veins are a cosmetically unpleasant manifestation, therefore, to solve that problem, doctors perform surgical operations.
Varicose veins
This disease can manifest itself in varying degrees of severity and is characterized by a different structure, which is accompanied by its clinical symptoms. As a rule, there are several types of structures of superficial varicose veins. The first type, the main type, is characterized by the enlargement of the main trunks of the hemispherical veins without connecting the branches to them. The latter, or loosely, is a network-like extension with many branches. This type of varicose veins is detected early in the disease's development. But with the mixed type, a combination of the former two types occurs, and this third type is found much more often than the others.
The symptoms of varicose veins are proportional to the stage of the pathological process, which is divided into compensatory, compensatory and decompensated.
In addition, the ICD of varicose veins distinguishes pathology with ulceration, with inflammation, from the presence of ulceration and concomitant inflammation in the lower extremities, and varicose veins without inflammation or ulceration.
The first degree of varicose veins is characterized by moderate dilation of the superficial veins along the main trunk or branches without definite manifestations of valve insufficiency of the superficial veins. face and nature of communication. The patient has mild leg pain of a certain severity, fatigue against the background of prolonged exertion. Diagnostic tests performed showed satisfactory valve function and the presence of enlarged subcutaneous veins indicated poor venous outflow from the affected limb. The first degree of VL corresponds to the compensatory phase of venous insufficiency.
The second degree of varicose veins is characterized by dilatation of superficial veins with their valve failure on the basis of functional tests. In the process of impaired venous outflow, deterioration of the lymphatic system of the extremities develops, which is manifested by edema of the feet and legs. The characteristic swelling that occurs after prolonged exertion in the lower extremities, disappears after rest in a horizontal position. In addition, there is a persistent severe pain in the affected limb. The second degree of the disease is characterized by the correspondence of the stages of secondary properties.
In the third degree of varicose veins, there is dilation of the superficial veins and dysfunction of the valves of the deep veins, perforation and saphenous, and this causes persistent venous hypertension indistal parts of the limb. This is the cause of a violation of the circulatory range and the formation of trophic ulcers. At the same time, skin pigmentation develops in the lower leg region with the initial manifestations of an incurable pathological process. But the feet and legs, especially if there is a nutritional disorder, are characterized by constant swelling. This is associated with disturbances in the flow of blood, and with lesions of the lymphatic system of the extremities of an organic nature, and with lymphadenopathy of secondary origin. The symptoms of grade 3 varicose veins are quite pronounced, varied and constant.
With further progression of varicose veins, areas of trophic ulcers somewhat expand, dermatitis and eczema appear, which indicates the presence of a fourth stage of the disease. The last two degrees of severity represent the decompensated phase of the pathological process. In this case, not only local, but also general hemodynamic disturbances. Using myocardial angiography, it is possible to detect a decrease in myocardial contractility, which is detected in 80% of patients with decompensated venous insufficiency.
An important point in choosing the appropriate treatment is to determine the extent of the varicose veins and the type of superficial varicose veins.
Varicose veins treatment
Comprehensive treatment of varicose veins of the legs is considered a complex process, 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 early stages of the pathological process, when the skin manifestations are mild, with a moderate decrease in working capacity. This method of treatment, as a conservative one, is also used due to contraindications to surgical intervention. In addition, this method must necessarily be used in the postoperative period to prevent recurrent varicose veins.
During conservative treatment, the severity of risk factors is reduced with the use of adequate physical activity, the use of elastic compresses, drugs, and physical therapy. Only a combination of all these treatments can guarantee a positive outcome.
First, they identify the risk factors that lead to 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 genetic predisposition, even in the absence of symptoms of varicose veins, are asked to consult a phlebologist. twice a year by ultrasound examination of the veins of the lower extremities. In addition, if there are no complications such as thrombophlebitis or thrombophlebitis, regular exercise of the veins of the lower extremities should be performed. This involves more walking, wearing only comfortable shoes, swimming, cycling and jogging. All physical activity should be performed using elastic compression. Absolutely contraindicated to perform exercises with lesions in the lower extremities, it is also necessary to exclude skiing, mountaineering, tennis, volleyball, basketball, football, various types of martial arts, where the load on theVeins of the lower extremities also predominate. as exercises that involve lifting substantial weights.
At home, after being recommended by a therapist, they perform simple exercises. As a general rule, the legs should be in an elevated position for a few minutes before starting exercise to prepare the body for certain types of exercise. The choice of pace and pace of exercises is strictly selected for each patient, taking into account their physical capabilities. But the main thing in that physical education is its regularity. Alternatively, you should use a daily contrast shower with alternating foot massages with warm and cold water, for five minutes.
Elastic compression is a method of treating varicose veins using compression bandages or knitted compression. In this case, the muscle compression is dosed, which improves blood flow through the venous vessels and prevents stagnation. Thanks to the artificial maintenance of vascular tone, the veins stop widening and, as a result, prevent thrombus formation from taking place.
To treat all stages of varicose veins, drugs that dilate the veins are used, which gradually strengthen the walls of the veins. All medications for varicose veins should be prescribed only by the attending physician, and therefore should not be self-medicated. But local treatment in the form of ointments and gels without signs of thrombophlebitis or thrombophlebitis is simply undesirable.
Among the physiotherapeutic treatments, laser, electrophoresis, magnetic field and the use of diadynamic current are the most effective.
Varicose veins are a surgical disease that can be completely cured after surgery. As a rule, there are several types of surgical treatment (venous ablation, sclerotherapy and laser coagulation), which directly depend on the severity of the pathological process and its location.
During varicose vein surgery, varicose veins are removed. The primary goal of surgery is to eliminate pathological bleeding by resection of the major trunks of small or large superficial veins and ligation of the perforated veins. However, this operation is not performed in the presence of comorbidities that can only aggravate the existing condition; late stage of venous insufficiency; pregnancy; existing pyogenic processes and old age. Glandectomy is performed laparoscopically, which makes this surgery less safe.
During sclerotherapy, a sclerosing agent is injected into the dilated vein, causing the vein walls to join together and so the blood flow through it stops. As a result, the pathological outflow will stop with the simultaneous removal of the cosmetic defect, since at this point the vein collapses and is practically invisible. However, the use of sclerotherapy is only effective when the small branches of the main trunk are enlarged, so it is used to a limited extent. The advantage of this surgical intervention method is that it leaves no scars after surgery, the patient has to stay in the hospital, the post-sclerotic stage, the patient does not need specific rehabilitation.
Laser coagulation is based on the destruction of the vein wall by its thermal effect. As a result of this process, the lumen of the vein is sealed. This surgical method is only indicated for varicose veins up to 10 mm wide.
Prevention of varicose veins
Prevention of this disease can be primary, preventing the development of varicose veins, and secondary - when there is a pathological process.
Nowadays, most people attach great importance to the prevention of this disease. Simple measures taken 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, while alternating a prolonged static load with swimming, running, walking, cycling. You should also do simple exercises in your workplace.
With existing varicose veins, you should try to keep your feet elevated as often as possible. Fight excess weight, prevent it from increasing. It is very important to wear comfortable shoes with a maximum heel height of up to 5 cm, and if necessary, use orthopedic insoles. In addition, during pregnancy, taking estrogen or taking oral contraceptives, an ultrasound of the lower extremities is a must.