Varicose veins of the lower extremities are characterized by dilation of the superficial veins of the legs, which accompanies the violation of blood flow in them and the failure of the valves. As a result, the veins increase in length and diameter, gaining a serpentine, cylindrical or saccular appearance, although there is also a mixed manifestation of the listed deformities.
Characteristics of the venous system
The appearance and development of varicose veins is directly related to the venous system of the legs, which consists of:
- saphenous veins: small and large;
- veins located deep (in the lower part of the leg and thigh);
- perforating veins, which are the connecting link of the two previous systems.
Normally, 90% of blood is transported to the lower extremities through deep veins, and the remaining 10% through superficial ones. When turned to the side of the heart, this mechanism is supported by valves in the walls of the veins. When the rest of the blood reaches, they collide to prevent its movement from top to bottom under the influence of gravitational force. Muscle contractions push blood further to the heart, allowing normal blood flow.
With a long stay of a person in an upright position, blood stasis can develop, which increases the pressure in the veins and causes an increase in their diameter. This process provokes incomplete closure of the valve leaflets, as a result of which the blood circulation is disrupted with its opposite flow from the heart - reflux.
Deep vein valves are most likely to be affected, as they transport the largest amount of blood and therefore experience the maximum load. To reduce the high pressure in them, a portion of the blood is transported from the perforated veins to the superficial ones, which were not originally intended for a large volume. Such a load on the walls of the veins leads to their expansion and the formation of varicose veins.
At the same time, blood enters the deep veins without stopping, but due to the violation of their functions and the normal activity of the leaflets of the perforated venous valves, the blood is redistributed to the superficial vessels. As a result, veins with chronic varicose veins develop, which over time are accompanied by painful sensations, edema and trophic ulcers.
Causes of the disease
Previously, one of the leading causes of varicose veins was called hereditary factor, but today this theory has been refuted. Of course, it is possible to trace the frequent manifestations of the disease in some families, but this is more likely due to the peculiarities of life given in the family: food culture, passive rest, sedentary work and the like.
The development of varicose veins is based on the presence of reflux into the venous system, when blood circulates through the veins in the opposite direction. Additional transport of blood from veins located deep into superficial veins is possible due to congenital or acquired degenerative pathology of the valve apparatus. This causes superficial vessels to become congested and distended when venous nodules form.
One of the basic reasons for the development of varicose veins is considered to be unhealthy diet, which in some cases leads to overweight. Such people move little, mostly eat highly processed foods and the percentage of plant fiber in the diet is minimized. Above all, there are those who are involved in strengthening the walls of veins and blood vessels and prevent prolonged chronic constipation, which greatly increases intra-abdominal pressure and thus provokes varicose veins. It is noted that an increase in body weight of more than 20% increases the risk of disease fivefold.
The main provocative factor for women is carrying a child, as the risks of varicose veins increase with each subsequent pregnancy. Heavy weight gain and an enlarged uterus put a lot of stress on the legs, which are stagnant. This situation is exacerbated by the ever-increasing intra-abdominal pressure and the action of the hormone progesterone, which affects the condition of the elastic fibers in the walls of blood vessels.
Other factors that provoke varicose veins of the lower extremities include:
- a sedentary lifestyle, standing during the day (for example, hairdressing), long flights or long trips. All this leads to stagnant processes in the lower extremities, when blood accumulates in the superficial veins and is poorly transported to the heart;
- sometimes increases the risk of developing varicose veins for women, wearing uncomfortable, tight shoes, especially models with high heels;
- corsets and tight underwear tighten the inguinal veins and increase intra-abdominal pressure, which is a direct prerequisite for varicose veins;
- high blood pressure;
- smoking, which indirectly leads to thinning of the walls of blood vessels.
Classification of the disease
Varicose veins of the lower extremities are classified depending on the prevalence of venous lesions, their localization, as well as the presence of pathological refluxes, which are characterized by impaired blood flow. There are 4 forms of varicose veins:
- veins with intracutaneous and subcutaneous (segmental) varicose veins, in which there is no pathological venous blood flow;
- veins with segmental varicose veins, when reflux occurs through perforating or superficial veins;
- a common form of varicose veins, in which reflux occurs through the perforating and superficial veins at the same time;
- varicose veins are characterized by reflux into the deep veins.
As varicose veins of the lower extremities become chronic, phlebology considers its three stages:
- Transient edema, occurring periodically against the background of "heavy foot" syndrome.
- Persistent, persistent edema. Hyperpigmentation and eczema may occur.
- Venous ulcers of a trophic nature.
The latter stage is the most difficult to treat, as it requires the preliminary removal of inflammation and the healing of skin tissues.
Stages and symptoms
The disease develops very slowly, sometimes more than a dozen years pass, until the symptoms that appear will force the patient to seek advice from a phlebologist. In the initial stages of varicose veins, its manifestations are often attributed to fatigue, age or other reasons. To fully examine the symptoms of the disease, its manifestations are classified according to the stages of varicose veins:
- The first stage begins to appear more often at a young age - after 20 years, when there is a severe feeling in the legs, edema may appear, which disappears completely overnight. On the inside of the lower leg, you can see an enlarged vein, which is manifested by an elongation of the skin bumps. At this stage, many people notice the small spider veins. In general, the symptomatology is subtle and rarely gets the attention it deserves.
- The second stage is characterized by an increase in the external manifestation of the varicose vein. The disease is already developing against the background of pathological work of venous valves, therefore, safene veins significantly increase in size, and their elongation can also be observed. Most often there is weight and burning in the legs, they quickly get tired of long walks.
- The disease is already becoming chronic due to the constant imbalance in venous blood flow. In the evening, patients suffer from edema near the ankle, which can be very intense. There is aggravation in the legs, and cramps can occur at night.
- In the absence of treatment in the previous stages, chronic insufficiency of the functioning of the venous system adversely affects the metabolic processes in the skin, especially the affected areas in the lower part of the foot. Darkening of the skin is noticeable near the ankle - hyperpigmentation, it thickens and becomes inflamed over time. The condition described is called lipodermatosclerosis. If at this time you do not start therapy in connection with the venous system, then trophic ulcers will soon begin to form.
- The fifth stage is associated with numerous trophic ulcers, some of which heal periodically with the formation of scars.
- Extensive ulcers open in the area of long-standing trophic disorders. This condition requires urgent active therapy, which aims to treat both varicose veins and skin ulcers.
Diagnosing
An external examination of the lower extremities is performed in the vertical and horizontal positions of the body, palpation of the veins and a preliminary assessment of the stage of the disease. The patient is referred for a general blood test, which allows you to study the appearance of the disease in more detail:
- at the platelet level, a predisposition to thrombosis will be reflected;
- the level of hemoglobin, as well as the number of red blood cells, indicate the degree of blood clotting;
- from increased leukocyte levels, can be judged on inflammation, which helps to diagnose thrombophlebitis more quickly.
Be sure to examine the venous system of the legs, for which there are many methods:
- dopplerography with ultrasound - USDG;
- phlebography;
- Phlebography and CT;
- duplex angioscanning - USAS;
- phleboscintigraphy;
- photography;
- phlebomanometry and the like.
In practice, patients are most often prescribed USAS and USG, as they help to thoroughly study the venous system of the legs and identify degenerative areas. The rest of the methods can be additionally described if the ultrasound examination has not given a complete vision of the appearance of the disease. Some of these methods can have complications such as venous thrombosis, catheter vessel perforation, and allergy to allergy to the contrast agent. Consider the most common techniques practiced in phlebology:
- USAS allows the assessment of anatomical, hemodynamic and functional pathologies of the venous bed. The received data is subjected to computer processing, after which the model of the venous system can be seen on video or printed on paper.
- Doppler ultrasonography with high accuracy determines the opening of superficial and deeply located veins, the speed of blood flow. Doppler ultrasonography makes it possible to assess the functioning of the valve apparatus.
After extensive diagnosis, the doctor designs a patient’s phlebocardium, which allows you to determine the damaged segments of the venous system, their extent and length. After that, an appropriate treatment is selected.
treatment
It is performed in a comprehensive manner and is determined based on the symptoms, the degree of disease development and the results of the study. In the initial stages, conservative therapy is prescribed, which consists of:
- Medication treatment when prescribing a group of medicines:
- antioprotectants and phlebotonics;
- anticoagulants;
- disrespectful
- local preparations (ointment, gel);
- anti-inflammatory drugs.
- Elastic compression, for which socks or compression bandage are used (rarely). It allows you to dose muscle contraction, prevents stagnant processes, improves blood flow through the vessels. When you wear such underwear, it has an effect of artificially preserving vascular tone.
- Physiotherapeutic methods, among which the best treatment results were shown by electrophoresis, diadynamic currents, laser radiation and a magnetic field.
- Possible physical activity, which should be performed only in compression underwear (except swimming). Cycling, swimming, jogging are recommended. The phlebologist selects an individual set of exercises for the lower limbs, which will train the leg vessels every day.
Furthermore, patients are advised to perform five-minute contrast procedures in the shower each evening, switching from warm to cold water. Such manipulations improve blood flow and tonify blood vessels.
Importers it is important at the beginning of treatment to identify the factor that provokes the disease in order to affect it effectively. And patients who are at risk should visit a phlebologist every 2 years for a preventive examination and do an ultrasound examination of the veins in the leg.
When conservative treatment does not give results or varicose veins are noticed at an advanced stage, then surgical intervention is used. Today varicose veins can be completely cured thanks to the following methods:
- Phlebectomy. The essence of the operation is the removal of the main trunks of the superficial vein to eliminate the pathological discharge of blood. Perforating veins are often ligated for the same purpose.
- Scleotherapy. It consists of inserting a sclerosant into the affected area of the vein, which leads to the attachment of its walls. Recently, they began to actively use foam sclerosant for the same purposes according to technology -. The flow of blood through the damaged area is stopped and the cosmetic defect in the form of protruding nodes is eliminated. After such an intervention, no signs remain, all manipulations are performed on an outpatient basis without a subsequent hospital stay. But sclerotherapy is used only for the fusion of small branches of venous trunks.
- Laser coagulation. With the help of a laser beam, the marked section of the vein is heated, the walls of which stick together and the blood flow stops through it. But this technique is indicated only for veins with an expansion diameter of less than one centimeter.
prevention
Preventive measures may be primary, aimed at preventing the development of varicose veins and secondary veins, when required to reduce the risk of recurrence after surgery or to prevent worsening of the course of the disease. Useful suggestions:
- lead an active lifestyle without heavy walking load: swimming, walking, cycling;
- look at your weight;
- keep both legs raised more often;
- do not wear tight underwear and heels over 4 inches;
- use orthopedic insoles;
- take a contrast bath;
- do five minutes of preventive leg exercises every day;
- wear compression stockings for long walks.
If you notice the slightest suspicion of varicose veins - prominent joints in the legs, swelling, weight, then do not postpone a visit to the phlebologist. Indeed, over time, this insidious disease can provoke many complications, including thrombophlebitis and thrombosis.