Varicose veins, varicose veins - what is it?

The word "varicose" comes from the Latin varix, varicis - swelling. The first mention of the treatment of varicose veins is found in the ancient Greek papyri.

Varicose veins are the most common disease. Up to 40% of the adult population suffer from chronic lower extremity vein disease. Its complications in the form of dermatitis, cellulite, bleeding, thrombosis and trophic ulcers often lead to long-term disability, sometimes causing disability.

Structure and function of the venous system

How our veins work is a complex process. To understand this, you need an initial knowledge of the structure of veins. The venous wall consists of three layers. Internal - the endothelium, represented by a layer of cells in the connective tissue membrane. The middle layer is muscular. It consists mainly of smooth muscle cells arranged in a circle, which are, as it were, in a frame of collagen fibers. The superficial veins contain a thicker muscular layer than the deep veins. The outer sheath of the veins, the so-called adventitia, is a dense tissue of collagen fibers. If we compare the structure of veins and arteries, then it must be said that the ratio of the lumen of the vessel to the thickness of its wall in the veins is much greater than in the arteries. Veins have much less elastic fibers than arteries.

The main property of the veins, thus affecting the indicators of blood flow, is the great elongation of its wall. In particular, when the pressure in the vessel increases, the veins dilate and tend to take on a round shape from that of the slit. The degree to which the venous wall extends is quite temporary and depends on many other things. It is this factor that does not allow the use of rigorous mathematical formulas for calculating the movement of blood along them. The thickness of the venous wall in the vessels of the legs is much greater than, for example, in the neck.

Venous valves originate from its wall. They normally consist of two valves, which are oriented towards the heart. In the area of ​​connection of the valve to the wall, the diameter of the vein is slightly larger. Normally, when the valve caps are closed, blood from the overlapping part cannot penetrate to the basal part. When this happens, the condition is called reflux. Reflux is also debatable. It can be relative, (some call it physiological) and absolute. The main difference is in the duration of reflux during functional tests. There is also an opinion that there should be no reflux with a normal valve. The valves are unevenly distributed through the veins. There are more of them where the work of the muscle pump is more pronounced - namely in the lower part of the leg.

The main venous system of the lower extremities is represented by the following groups:

• leg veins;
• deep veins of the leg and thigh (deep vein system);
• large and small saphenous veins (superficial veins system);
• communication (perforation) of veins - provide communication between superficial and deep veins.

The deep and superficial venous systems together form a "sponge", from which, as you walk, blood rushes to the heart. The work of this system is supported by the work of a muscle pump located in the lower part of the leg, which creates permanent pressure in the veins.

These systems move the blood column up, and the valves inside the veins prevent the return flow.

Blood flow from the lower extremities through deep and superficial veins is uneven. About 85-90% of blood flows through the deep veins and only 10-15% through the subcutaneous veins. Thus, in healthy people, blood flow is carried out by the system of deep, subcutaneous and communicating veins.

Varicose veins are a serious problem

To say that varicose veins are "a disease of the twentieth or twenty-first century" is to deviate from the truth. Varicose veins bother people for a long time. Even in ancient treatises on medicine, there is a description of varicose veins, in ancient Rome people bandaged their feet with leather "bandages" to get rid of venous insufficiency.

If the legs often get tired, this may be the first sign of an initial disease of the venous system. Evening discomfort, accompanied by swelling in the foot and ankle, especially after a long standing, are clear signs of congestion in the veins. Soon, unfortunately, you discover the first varicose vein. The altered vessels form a blue-blue or red "pattern" on your legs, capillary "stars", "telangiectasias" and, finally, varicose veins and varicose veins.

Severity, burning, tingling and itching, pain and swelling, "stars", swelling of the veins in the legs - an acute signal for urgent action to save the beauty and health of your feet.

A question about the condition of your veins should be addressed immediately to a specialist - a phlebologist who studies and treats venous diseases.

Vein disease starts harmlessly, but can become a serious problem if left untreated.

Causes of varicose veins

To date, a large number of theories have been proposed to explain the causes of varicose veins. The most common are hereditary, mechanical, hormonal, etc. However, they mainly reflect the factors that contribute to the development of the disease or accelerate the onset of clinical signs of the disease.

Both lower extremities are affected more often. However, at first, varicose veins appear in one limb, and after a while - in the other. Varicose veins are more common in the right leg.

Varicose veins of the lower extremities occur only in humans. This is due to the vertical position of the body, the influence of hydrostatic and hydrodynamic venous pressure on the valve apparatus and the wall of the limb vein. With weakness of the venous wall and impaired function of the valve apparatus in the main veins, which occurs with their congenital inferiority, the opposite pathological blood flow occurs. The most common causes of varicose veins:

• Hormonal changes (pregnancy, menopause, puberty, use of hormonal contraceptives, etc. ) - affect the structure and tone of the vascular wall with its gradual weakening and destruction.
• Pregnancy is one of the main risk factors for developing varicose veins. In addition to hormonal changes, the enlarged uterus and fetus put pressure on the iliac veins and significantly impede blood flow from the lower extremities.
• Overweight is a proven risk factor for varicose veins. This is due to the increased load on the venous system of the lower extremities.
• Lifestyle: people with prolonged static load (hairdressers, teachers, cooks, surgeons) suffer more often.
• Tight inner lining that squeezes the main veins at the level of the hip folds. Women who wear high heels.
• Heavy physical activity (carrying loads, lifting weights).
• Thermal procedures (saunas and baths), the abuse of which can also provoke varicose veins.

The essence of varicose veins lies in the fact that as a result of the above reasons, there is a gradual expansion of the lumen of the saphenous and perforating veins, as a result of which an insufficiency of the valve apparatus is formed (failure to close the valve leaflets). Pathological reflux (return) of blood occurs both from top to bottom and horizontally through destroyed perforating veins.

Diagnosis of varicose veins

For many years, the hands have been the only tool of the doctor to examine a patient with varicose veins. X-rays have come to the aid of the surgeon over the past century. However, X-ray contrast examination of the veins is a rather complicated procedure, requiring large and expensive equipment, and the X-ray contrast agents themselves are by no means safe for the body. With the development of microelectronics and computer technology, previously unavailable diagnostic methods emerged: Doppler ultrasound, angioscanning ultrasound, plethysmography. The advent of duplex ultrasound scanning has provided new information that has made it possible to take a fresh look at the causes of varicose vein development and to understand the complications of the pathological process.

Doppler ultrasound

This is an ultrasound diagnostic method that allows you to determine the speed and direction of movement of particles (in this case, blood cells) in the body. Thus, the doctor is able to detect the direction and speed of blood flow in the vessels of the lower extremities. And when performing a number of physiological tests and the condition of the valve apparatus of the veins of the lower extremities. Knowledge of the structure of blood flow in the veins of the legs is the main requirement for choosing a method of treatment.

Ultrasound scan of angios

The essence of this method is that an image of the walls of blood vessels and the blood flowing through them is formed on the monitor screen of a real-time ultrasound scanner. The doctor has the opportunity to observe the shape of the vessel, the structure of the wall, the condition and direction of blood flow through this vessel. The method is very informative and much safer than X-ray examination, but it is quite costly, so it is used only in difficult cases and during scientific research.

Plethysmography

This is a diagnostic method based on determining the electrical resistance of lower extremity tissue. Its essence is that the total electrical resistance of the tissues of the human body depends directly on the amount of blood flowing in and out of them and changes over time with each heartbeat. Plethysmography is used to diagnose the general functional state of blood flow in the lower extremities, is used to monitor drug therapy for venous or arterial insufficiency, in the treatment of trophic disorders, and to assess the degree of venous insufficiency.

Of course, all of these techniques do not preclude a direct examination of the patient by a physician, clarifying the history of the disease and identifying complaints presented by the patient. Based on the general appearance of the disease, the doctor chooses a method of treatment.

Treatment of varicose veins

Over the last 50 years there has been a qualitative leap in the treatment of varicose veins, as well as in other branches of medicine. Over the past decades, various medications have been developed and continue to be improved to treat chronic venous insufficiency. The surgical technique for treating varicose veins has been significantly improved. Compression sclerotherapy technology has been developed and practically perfected.

Currently, so-called sclerosing surgery is gaining popularity all over the world. Sclero surgery is a clever combination of surgical treatment and sclerotherapy. It is well known that scleotherapy can only be used with the initial and uncomplicated forms of varicose veins. Varicose vein surgery is also not without problems, the operation to remove varicose veins is quite traumatic, requires hospitalization and a long period of rehabilitation. A reasonable combination of these two methods allows you to minimize the trauma of the treatment process and get an extremely high quality of treatment.

Medical therapy of varicose veins

Very often there are cases when a patient has virtually no varicose veins or their number is very small. However, the person suffers from heaviness in the legs, pain, swelling. All of these are signs of chronic venous insufficiency. In these cases, as well as when there are significantly varicose veins, it is necessary to take medication that improves blood circulation in the legs. Currently in the arsenal of a phlebologist there are several dozen drugs aimed at combating venous insufficiency.

Treatment of varicose veins and chronic venous insufficiency should only be chosen by a physician. Despite the apparent simplicity of choosing a venotonic agent, only a physician can determine the full range of therapeutic measures and the appropriateness of using a particular drug.

Compression therapy

Compression therapy has been considered for many years as an adjunct to medication therapy or surgery. Compression treatment of varicose veins has been used since ancient times, and only in the last decade, elastic compression began to be considered as a separate and independent type of treatment - compression therapy. Compression therapy involves the use of elastic medical bandages of various brands and special medical compression stockings.

The global industry produces three types of elastic bandages: short, medium and high. High extension bandages (extension more than 140%) are used to prevent thrombotic complications in the postoperative period after operations on the abdominal and pelvic organs, as well as to fix joints after and to prevent sports injuries. Short-stretch bandages (less than 70% elongation) are used to treat complicated forms of chronic venous insufficiency, deep vein thrombosis, post-thrombophlebitic syndrome, and lymphatic insufficiency. Medium-length bandages (extension from 70% to 140%) are used in the treatment of varicose veins, chronic venous insufficiency, and compression sclerotherapy.

Medical compression stockings include compression medical stockings, sweater, knee lift. Many people err, considering various knitted garments "anti-varicose" and "supportive" with increased density as therapeutic. To begin with, it is necessary to determine that medical compression products are never listed on the DEN. DEN is a technical characteristic of a knitted fabric that relates only indirectly to the pressure created by the product.

Medical knitwear is classified into several classes of functional compression. The product class is determined by the pressure that the product creates on the ankle and on the lower third of the lower leg. A person with varicose veins is told to use compression class knitwear 2. These tights or knee lifts will create a pressure of 23-32 mm Hg on the injured leg. Art. That is, completely equalize the pressure in the varicose veins and eliminate venous insufficiency. Moreover, medical compression products create a so-called dispersed pressure. The pressure they create is gradually reduced when the foot moves from the bottom up by 25-30%, which contributes to the effective flow of blood and lymph.

It should be immediately noted that medical vest is never thin and transparent, creating such a high pressure requires a large number of elastic fibers, and accordingly the knitted fabric is thick. It should also be said that medical jersey is never cheap. The technology of knitting a particular knitted fabric is much more complicated; when knitting, it is also necessary to model the foot profile to create a distributed pressure.

The ideal approach to compression therapy is the continued and widespread use of elastic bandages and / or compression stockings by the patient. For example, wearing elastic bandages daily for a month almost completely corresponds to the effectiveness of taking an effective medicine monthly. The use of compression stockings is particularly effective in preventing the development and recurrence of varicose veins. The main advantage of using compression products is their absolute safety for health, compared to even the best medicines, and in terms of cost they are quite comparable.

Prevention of varicose veins

If you have the initial signs of varicose veins, then following fairly simple rules will slow down, and in some cases even avoid further development. First of all, do not get carried away by hot baths, saunas, prolonged sun exposure. All of the above reduces venous tone, leads to blood stagnation in the lower extremities. Do not wear tight clothing, socks and stockings with tight elastic bands, as this will compress the veins. Excess body weight and sports associated with a large static load on the legs (tennis, weight lifting, body building) increase venous pressure. High heels (over 4 cm) - our veins do not like it. Take care of the veins, do not hurt them.

If you feel heavy on your feet in the evening after a day at work, keep your feet up during sleep and rest. If your work is accompanied by a long sitting at the desk or you are standing for a long time, then you need to change the position of your legs more often, go in place and rotate your legs. There are special exercises for venous diseases. After showering or bathing wash your feet with cold water. There are sports that are useful - first of all, swimming, but also walking, cycling, skiing. Do not neglect folk remedies for prevention. Useful infusions of lingonberry leaves, Wort St. John's, cranberry, hips rose. A plant-based diet should be followed. Your doctor may also prescribe a medicine called phlebotonic to increase venous tone and improve microcirculation. Recently, methods of preventing compression and treating varicose veins have also become quite understandable success, due to the appearance on the market of high quality medicinal products.

A special word about prevention for pregnant women. Varicose veins progress during pregnancy, especially when it is not the first and keeping a child under 1 year old does not contribute to good vascular function. The basis for prevention is the wearing of special compression stockings, the use of phlebotonics both during pregnancy and after childbirth. Do not forget to mention your veins to the gynecologist when you are prescribed a hormonal medicine, as these drugs affect the functioning of the veins, lower their tone.

Do not treat yourself. Talk to your doctor about what is best to do with your veins. This disease is treated by doctors - phlebologists.