Varicose veins

Varicose veins of the lower extremities are often asymptomatic in humans. Often the only problem of this pathology is an aesthetic defect in the foot caused by protruding superficial veins. In this case, the disease may be accompanied by pain or increased sensitivity of the skin of the feet. Depending on the severity of the disease, the patient is offered non-drug, drug or surgical treatment. Read more about the first symptoms of varicose veins, the nature of its course and effective methods of treatment and prevention, read our material.

What is it

Varicose veins are a pathology from which only people suffer. Animals do not have this problem, which suggests that the disease is associated with staying upright. When a person stood up, the bulk of the circulating blood began to settle below the level of the heart. In this case all the conditions are created for the blood to circulate worse in the opposite direction, which leads to stagnation.

According to statistics, some disorders of the venous system are observed in 80% of people in developed countries. Moreover, more and more often, similar problems are found in people at a young age. In all likelihood, one of the reasons why varicose veins "regenerate" is a sedentary lifestyle, which only contributes to stagnation.

It is interesting that in the age group under 20, varicose veins of the lower extremities appear with the same frequency in both men and women. However, after the age of 20, women begin to dominate the morbidity structure. This is due to pregnancy and childbirth, which are a serious factor in the development of venous diseases.

Characteristics, causes and mechanism of development of varicose veins

The exact reasons for the development of varicose veins of the lower extremities are still unknown. Currently, the disease is believed to be caused by congenital or acquired defects of the lower extremity venous valve apparatus.

For unimpeded blood flow to the veins, well-coordinated work of the venous valves is necessary. These valves open only for the blood flowing upwards. However, with a valve defect, a partial downflow of blood is also possible. Thus venous insufficiency develops, manifested by edema, leg muscle cramps, and dilation of venous vessels.

Leukocytes may also be involved in the pathogenesis of varicose vein development. This issue is now being actively studied. It is assumed that with prolonged accumulation of leukocytes in vascular tissues (in particular, in the area of the valve apparatus), an inflammatory process develops, which spreads along the venous bed.

Since venous valves are subjected to constant mechanical stress, inflammation develops particularly rapidly in the region of the venous valve apparatus.

Now the vast majority of people in developed countries lead a sedentary lifestyle. But why then do not all have varicose veins? Consider the main risk factors that contribute to the occurrence of this pathology:

• Hereditary factors. . . Despite the fact that specific hereditary mechanisms associated with the development of varicose veins have not yet been established, most experts agree on the presence of such a factor. At the same time, there are weighty counter-arguments regarding inheritance in the development of varicose veins. For example, this is the prevalence of varicose veins in ethnic Africans and African immigrants who left to live in the United States. If the prevalence of varicose veins in sedentary Africans is about 0. 5%, then in immigrants this figure reaches 20%. These figures show that hereditary factors, at least, are not the only ones in the development of the disease and, most likely, do not predominate.
• Obesity. . . Overweight and obese people are at risk. It is important to note that obesity contributes to varicose veins both due to increased stress on blood vessels and in relation to the risk of other diseases affecting the vessels (diabetes mellitus, hypertension and others).
• pregnant. . . This is one of the most obvious factors in the development of varicose veins of the lower extremities. In this case, the main risk factors are the increase in circulating blood volume, as well as the compression of the retroperitoneal veins by the developing fetus in the uterus. According to epidemiological studies, second and subsequent pregnancies lead to a significant increase in the likelihood of developing varicose veins. After the first pregnancy, the probability of varicose veins in the legs remains low.
• Hormonal imbalance. . . Hormones are involved in the pathogenesis of most diseases. These pathologies include varicose veins. This problem is especially true for women taking hormonal contraceptives as well as using hormone replacement therapy to treat certain diseases (for example, osteoporosis) or during the premenopausal period. It has been proven that female sex hormones (in particular, estrogens and progesterone) lower vascular tone and destroy collagen fibers. Thus, the vein wall expands pathologically.
• Lifestyle. . . A person's lifestyle has a major impact on the course of the disease. A sedentary lifestyle as well as work related to prolonged or sedentary stay (for example, security guards, drivers, office workers, service workers and others) contribute to the development of varicose veins. You also need to pay attention to nutrition. Lack of a sufficient amount of vegetables and fruits in the diet worsens the condition of the walls of blood vessels.

Stages of varicose veins of the lower extremities

Currently, several classifications of varicose veins of the lower extremities are used. The CEAP International Classification, adopted in 1994, is generally accepted. CEAP is an abbreviation, where each letter corresponds to the name of a classification category:

• C (clinic)- clinical class of the disease (type of affected veins, presence of pigmentation, eczema, trophic ulcers).
• E (Etiological)- etiology of the disease (congenital, primary, secondary).
• A (Anatomical)- anatomical localization of the pathology (superficial or perforating veins).
• P (Pathophysiological)- type of disorder (venous reflux, obstruction or a combination of both).

The course of the disease takes place in six stages:

• Phase zero. . . The earliest stage of varicose veins, in which even doctors are not able to reliably make a diagnosis. At this stage, there are no external signs of disease. Ultrasound diagnosis does not indicate the presence of pathology. At the same time, a person in stage zero is concerned about symptoms such as swelling, feeling of heaviness in the legs, as well as cramps, which indicates the presence of problems with blood vessels.
• The first phase. . . Already in the first stage of the disease, spider veins are visible on the surface of the skin of the feet, the diameter of which is less than 1 millimeter. Medium-sized veins can grow up to 3 mm in diameter. At this stage, doctors are not always able to make an accurate diagnosis, as the presence of such stars does not always indicate varicose veins.
• Second phase. . . At this stage, the veins may appear and disappear depending on the conditions. For example, veins appear clearly after prolonged sitting, standing, or lifting heavy objects. The diameter of varicose veins at this stage is 3 mm or more. Blood clots often form in the second stage.
• The third stage. . . If in the earlier stages of the disease the swelling of the feet appeared and disappeared, then in the third stage the edema becomes permanent. Swelling of the feet is most severe in the evening.
• The fourth stage. . . At this stage, significant trophic changes occur. In particular, tissue feeding is interrupted near the affected veins. The patient develops skin changes such as lipodermatosclerosis (inflammation of the subcutaneous fatty tissue), eczema, and darkening or discoloration of the skin. Pigmentary changes are characteristic of the fourth stage of the disease. For example, the skin in the area of the affected vessels may become brown and even black, which indicates the concentration of pigments in this area. The opposite situation is also possible, when, due to a pathological process, the pigment does not enter the affected area, which leads to the appearance of a pale skin color. If varicose veins are not treated at this stage, then the problem will only get worse with the further appearance of trophic ulcers.
• The fifth stage. . . At this stage of the disease, in addition to the above symptoms, trophic ulcers also appear, which heal quickly. If you do not take any measures for treatment, then the ulcers will appear again and again.
• Phase six. . . Non-healing trophic ulcers appear. In the affected area, the temperature rises significantly and pus may leak from the wounds.

You do not have to wait for the development of the last stages - you have to go to the doctor for a second in order to register and track the dynamics of the disease. Sometimes the symptoms improve on their own, and sometimes they progress quickly. Therefore, it is important to monitor the situation in order to take timely action.

Symptoms

Consider the main symptoms of varicose veins of the lower extremities at different stages of the disease:

• Pain. . . This is the earliest sign of the disease. Since pain is a non-specific symptom, it is impossible to make a diagnosis based on this symptom alone. With varicose veins of the lower extremities, the pain is often localized along the venous trunks.
• Feet on foot. . . It also applies to early symptoms, while the veins in the skin are not yet visible. Often, the feeling of heat is accompanied by a throbbing pain.
• Muscle cramps and itching. . . Most often anxious at night.
• Swelling in the legs. . . In the early stages of the disease, the swelling is small and transient. As a rule, they appear in the evening and disappear in the morning. However, as the disease progresses, the severity increases and they become permanent.
• Skin discoloration. . . As a rule, with varicose veins, the skin of the lower extremities darkens. In the area of the affected veins, the skin becomes brown. Eczema and dermatitis appear in the advanced stages of the disease. The terminal stages of varicose veins are characterized by the appearance of trophic ulcers. Initially it is about healing ulcers, but later non-healing wounds are created.
• Vascular spiders. . . In the medical literature, such stars are called telangiectasia. In some people, varicose veins can be limited to spider veins, with no progression to larger veins.
• Varicose veins. . . The most characteristic sign of varicose veins are varicose veins twisted on the surface of the legs.

In summer the symptoms of varicose veins become more pronounced. This is due to the high ambient temperature, which already contributes to the dilation of the veins. Therefore, during the hottest hours, from 10 a. m. to 4 p. m. , it is best to be in a well-ventilated area.

When you see a doctor

You should consult a doctor already at the first symptoms of the disease - pain, swelling or the appearance of spider veins. Since the early stages of varicose veins are difficult to diagnose, it can initially be misdiagnosed. The patient should carefully monitor the condition of the feet and be monitored regularly by a phlebologist.

Diagnosing

Diagnosis of varicose veins of the lower extremities is reduced to the following activities:

• External examination of the skin of the feet;
• Doppler ultrasound;
• Duplex scanning of veins;
• Phlebography.

Characteristics of treatment

Varicose veins of the lower extremities are treated with conservative and surgical methods. Conservative treatment is reduced to the following activities:

• Drug therapy. . . This is taking medications that improve the tone of the venous walls. The patient is also prescribed drugs that reduce capillary permeability and improve blood microcirculation. If there is a risk of blood clots, then anticoagulants are also prescribed.
• Compression therapy. . . This is the wearing of special compression socks, which reduces the load on the foot. The benefit is that it is possible to distribute the load evenly, even with heavy physical exertion. When using compression garments, overload and swelling can be avoided.
• Corrective gymnastics and lifestyle changes. . . The patient is advised to do exercises to relieve tension in the legs. It is important to avoid sitting or standing for long periods of time. If you have to stand or sit for a long time at work, then you need to take breaks more often.

If conservative therapy of varicose veins does not bring the expected results, then a decision is made for surgical intervention. Most often these are minimally invasive interventions, including:

• Sclerotherapy- intravenous injection of substances that adhere to the walls of the affected vessel. This treatment leads to resorption of spider veins.
• Laser coagulation- insertion of a laser light guide into the vein and irradiation of the walls with laser, which also leads to adhesion of the walls and further resorption of the vessel.
• Radiofrequency ablation- adhesion of veins using high frequency current.
• Phlebectomy- Removal of affected veins, in which blood circulation is deteriorated by 90%.

In some countries, you can have the operation for free, under compulsory medical insurance. But it is not a fact that all types of compulsory insurance operations are offered everywhere. In any case, help will be provided, but it is necessary to find out if it will be a conventional removal or laser.

Contraindications for people with varicose veins

• Sedentary lifestyle. . . It is important to avoid sitting or standing for long periods of time. Physical activity will help avoid venous congestion.
• Jogging and strenuous exercise. . . With physical activity, it is important not to overdo it. If you have varicose veins, walking is definitely better than running.
• Unbalanced and unhealthy diet. . . You need to give up unwanted food, even if your health seems to allow it. You should limit your intake of sweets, semi-finished products, as well as rich meats and smoked meats. But eating more vegetables and fruits would be a good idea.
• Hot tub and showers. . . For people with vascular problems in the limbs, procedures with excessively hot and prolonged water are contraindicated.

Complications of varicose veins

Varicose veins can be complicated by trophic ulcers, phlebitis (inflammation of the veins) and deep vein thrombosis. The latter is the formation of blood clots in the deep veins that threaten human life.

Conclusion

Symptoms of varicose veins of the lower extremities, as a rule, do not appear immediately. Different people have a different set of manifestations. For example, sometimes with this pathology there is no edema or no local increase in temperature or pain. This does not mean that there is no disease. A timely visit to the doctor will significantly slow down the progression of the disease or even stop it, preventing the development of trophic changes.