The word "varicose veins" comes from the Latin varix, varicis - bloating. The first mention of the treatment of varicose veins is in the ancient Greek papyri.
Varicose veins are the most common disease. Up to 40% of the adult population suffers from chronic diseases of the veins of the lower extremities. Its complications in the form of dermatitis, cellulitis, hemorrhage, thrombosis and trophic ulcers often lead to long-term disability, sometimes resulting in disability.
The structure and work of the venous system
The functioning of our veins is a complicated process. To understand this, you need an initial knowledge of the structure of the veins. The venous wall consists of three layers. Internal - endothelium, represented by a layer of cells on the connective tissue membrane. The middle layer is muscular. It mainly consists of circularly located smooth muscle cells, which are, so to speak, in a framework of collagen fibers. Superficial veins contain a thicker muscle layer than deep veins. The outer venous sheath, called the adventitia, is a dense tissue of collagen fibers. If we compare the structure of veins and arteries, it should 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 influencing the indicators of blood flow, is the great extensibility of its wall. In particular, as the pressure in the vessel increases, the veins dilate and tend to acquire a round shape from a slit shape. The degree of extensibility of the venous wall is quite ephemeral and depends on many other things. It is this factor that does not allow the use of rigorous mathematical formulas to calculate the movement of blood along them. The thickness of the venous wall in the vessels of the legs is much greater than, for example, on the neck.
The venous valves come from its wall. They are normally composed of two valves, oriented towards the heart. In the area where the valve attaches to the wall, the diameter of the vein is slightly larger. Normally, when the valve leaflets close, blood from the overlying section cannot enter the underlying section. When this happens, the condition is called reflux. Reflux is also controversial. It can be relative (some call it physiological) and absolute. The main difference is 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 distributed unevenly in the veins. There are more where the work of the muscle pump is most pronounced, that is, on the leg.
The main venous system of the lower extremities is represented by the following groups:
- veins of the foot;
- deep veins of the leg and thigh (deep venous system);
- large and small saphenous veins (superficial venous system);
- communicating (perforating) veins - provide communication between the 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 leg, which creates intermittent pressure in the veins.
These systems move the blood column upwards and the valves inside the veins prevent backflow.
The outflow of blood from the lower limbs through the deep and superficial veins is uneven. About 85 to 90% of the blood circulates in the deep veins and only 10 to 15% in the subcutaneous veins. So, in healthy people, blood flow is carried out through the system of deep, subcutaneous and communicating veins.
Varicose veins are a serious problem
To say that varicose veins are "a disease of the 20th or 21st century" is to stray from the truth. Varicose veins have worried people for a long time. Even in ancient medical treatises there is a description of varicose veins, in ancient Rome people bandaged their legs with leather "bandages" to get rid of venous insufficiency.
If your legs get tired often, this may be the first sign of the onset of venous system disease. Evening discomfort, accompanied by swelling of the foot and ankle, especially after a long stay on the legs, are obvious 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", "spider webs" (telangiectasias) and, finally, dilated veins and varicose ganglia.
Severity, burning, tingling and itching, pain and swelling, "stars", swelling of the veins of the legs - a sharp signal for urgent action to save the beauty and health of your legs.
A question about the condition of your veins should be quickly asked of a specialist - a phlebologist who studies and treats venous disease.
Venous disease starts out 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 limbs are more often affected. However, at first, the expansion of the veins appears on one limb, and after some time - on the other. Varicose veins are more common on the right leg.
Varicose veins of the lower extremities only appear in men. This is due to the vertical position of the body, the influence of the hydrostatic and hydrodynamic venous pressure on the valve apparatus and on the venous wall of the limb. With weakness of the venous wall and impaired function of the valve apparatus in the main veins, which occurs with their congenital inferiority, pathological reverse 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 enlargement of the uterus and fetus puts pressure on the iliac veins and significantly impedes blood flow to the lower extremities.
- Obesity is a proven risk factor for varicose veins. This is due to the increasing load on the venous system of the lower extremities.
- Lifestyle: People with prolonged static charges (hairdressers, teachers, cooks, surgeons) suffer more often.
- Wear tight underwear that hugs the main veins at the folds of the groin. Women wearing high heels.
- Intense physical activity (carrying loads, lifting weights).
- Thermal procedures (saunas and baths), the abuse of which can also cause varicose veins.
The essence of varicose veins lies in the fact that due to the above reasons, a gradual expansion of the lumen of the saphenous and perforating veins occurs, as a result of which insufficiency of the valve apparatus is formed(non-closing of the valve leaflets). Pathological reflux (backflow) of blood occurs both from top to bottom and horizontally through the destroyed perforating veins.
Diagnosis of varicose veins
For many years, the hands were the physician's only tool for examining 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 quite a 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 science, previously unavailable diagnostic methods have appeared: Doppler ultrasound, CT angiography, plethysmography. The advent of duplex ultrasound has provided new information that has enabled us to take a fresh look at the problems of the causes of varicose vein development, and to understand the intricacies of the disease 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 know the direction and speed of blood flow in the vessels of the lower extremities. And when carrying out 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 condition for choosing a method of treatment.
Ultrasound CT angiography
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 an ultrasound machine in real time. The doctor has the opportunity to observe the shape of the vessel, the structure of the wall, and 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 expensive, so it is used only in difficult cases and during scientific research.
Plethysmography
This is a diagnostic method based on the determination of the electrical resistance of the tissues of the lower limbs. Its essence lies in the fact that the total electrical resistance of the tissues of the human body directly depends on the amount of blood entering and leaving it and changing 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 treatment of 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 exclude a direct examination of the patient by a physician, clarifying the history of the disease and identifying the complaints presented by the patient. Based on the overall picture of the disease, the doctor chooses a method of treatment.
Treatment of varicose veins
A qualitative leap in the treatment of varicose veins has occurred, as well as in other branches of medicine, over the past 50 years. Over the past decades, various drugs have been developed and continue to be improved for the treatment of chronic venous insufficiency. The surgical technique for treating varicose veins has been significantly improved. The technology of compression sclerotherapy has been developed and virtually perfected.
Currently, so-called sclerosurgery is gaining popularity around the world. Sclerosurgery is a smart combination of surgical treatment and sclerotherapy. It is well known that sclerotherapy can only be used with initial and uncomplicated forms of varicose veins. Surgery for varicose veins 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 achieve exceptionally high quality of treatment.
Drug treatment of varicose veins
Quite often there are cases when a patient has practically no varicose veins, or their number is very small. However, the person suffers from heaviness in the legs, pain, swelling. These are all signs of chronic venous insufficiency. In these cases, as well as when significantly enlarged varicose veins are present, it is necessary to take drugs that improve blood circulation in the legs. Currently, in the arsenal of a phlebologist, there are several dozen drugs intended to combat venous insufficiency.
Treatment of varicose veins and chronic venous insufficiency should only be chosen by a doctor. Despite the apparent simplicity of the selection of a venotonic agent, only a doctor can determine the set of therapeutic measures and whether to use a particular drug.
Compression therapy
Compression therapy has been considered for many years as an adjunct to drug therapy or surgery. Compression treatment for varicose veins has been used since ancient times, and it was only in the last decade that elastic compression began to be seen as a separate and independent type of treatment - compression therapy. Compression therapy includes the use of medical elastic bandages of different brands and special medical compression stockings.
The global industry produces three types of elastic bandages: short, medium and high stretch. High-elongation bandages (elongation greater than 140%) are used for the prevention of thrombotic complications in the postoperative period after operations on the abdominal and pelvic organs, as well as for fixation of the joints after and for the prevention of sports injuries. Short stretch bandages (elongation less than 70%) are used to treat complicated forms of chronic venous insufficiency, deep vein thrombosis, post-thrombophlebitis syndrome and lymphatic insufficiency. Bandages of medium elasticity (70% to 140% elongation) are used in the treatment of varicose veins, chronic venous insufficiency and compression sclerotherapy.
Medical compression stockings include medical compression stockings, tights, and knee-highs. Many people are mistaken that various "varicose veins" and "support" knits of increased density are therapeutic. To begin with, it is necessary to determine that medical compression products are never marked in the DEN. DEN is a technical characteristic of a knit which is only indirectly related to the pressure created by the product.
Medical swimsuits are classified into several classes of functional compression. The class of the product is determined by the pressure that the product creates on the ankle and in the lower third of the leg. A person with varicose veins is shown to use compression class 2 knits. These pantyhose or knee socks will create a pressure of 23 to 32 mm Hg on the affected leg. Art. , That is, completely equalize the pressure in varicose veins and eliminate venous insufficiency. In addition, medical compression products create so-called distributed pressure. The pressure they create is gradually reduced as the leg moves up and down by 25-30%, which contributes to the efficient outflow of blood and lymph.
It should be noted right away that medical knitwear is never thin and transparent, creating such pressure requires a large amount of elastic fibers, and as a result the knitting is thick. It must also be said that the medical jersey is never cheap. The technology of knitting a special knitting is much more complicated; when knitting it is also necessary to model the profile of the leg to create distributed pressure.
The ideal approach in compression therapy is the constant and widespread use of elastic bandages and / or compression stockings by the patient. For example, wearing elastic bandages every day for a month almost completely matches the effectiveness of taking an effective drug every month. 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, even compared to the best drugs, and their cost is quite comparable.
Prevention of varicose veins
If you have the first signs of varicose veins, following fairly simple rules will slow down and in some cases even prevent its development. First of all, don't get carried away by hot baths, saunas, prolonged exposure to the sun. All of the above reduces venous tone, leads to stagnation of blood in the lower extremities. Don't wear tight-fitting clothes, stockings and socks with tight elastic bands, as this will compress the veins. Excess body weight and sport associated with a strong static load on the legs (tennis, weight lifting, bodybuilding) increase venous pressure. High heels (over 4cm) - our veins don't like it. Take care of the veins, do not hurt them.
If you feel heavy in your legs in the evening after a day's work, keep your legs elevated while you sleep and rest. If your work is accompanied by a long sitting at the table, or if you are standing for a long time, you need to change the position of your legs more often, get into position and rotate your feet. There are special exercises for venous diseases. After a shower or bath, rinse 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, St. John's wort, cranberry, rosehip. A herbal diet should be followed. Your doctor may also prescribe a medicine called phlebotonic to increase venous tone and improve microcirculation. Recently, the methods of preventing compression and treating varicose veins have also become quite understandable success, due to the appearance of high-quality medical products on the market.
A special word on prevention for pregnant women. Varicose veins progress during pregnancy, especially when it's not the first, and carrying a baby under 1 year old does not contribute to good vascular function. The basis of prevention is wearing special compression stockings, using phlebotonics during pregnancy and after childbirth. Do not forget to mention your veins to the gynecologist when you are prescribed a hormonal drug, because these drugs affect the functioning of the veins, reduce their tone.
Don't heal yourself. Talk to your doctor about what is best to do with your veins. This disease is treated by doctors - phlebologists.