Varicose veins of the lower extremities are characterized by the expansion of the superficial veins of the legs, which accompanies the violation of blood flow and valve failure. As a result, the veins increase in length and diameter, acquire a serpentine, cylindrical or saccular appearance, although there is also a mixed manifestation of the listed deformities.
Features of the venous system
The emergence and development of varicose veins is directly related to the venous system of the legs, which consists of:
- saphenous veins: small and large;
- deeply localized veins (in the lower leg and thigh);
- the perforating veins, which are the link between the two previous systems.
Normally, 90% of the blood is transported to the lower extremities through the deep veins and the remaining 10% through the superficial veins. When it returns to the side of the heart, this mechanism is supported by valves located in the walls of the veins. When the next portion of blood arrives, they snap to prevent its up and down movement under the influence of gravitational force. Muscle contractions push blood further towards the heart, allowing normal blood flow.
With a long stay of a person in an upright position, stagnation of blood can develop, which increases pressure in the veins and causes an increase in their diameter. This process causes incomplete closure of the leaflets of the valve, which disrupts the blood flow with its reverse flow from the heart - reflux.
The valves of the deep veins are most likely to be affected, as they carry the greatest amount of blood and therefore undergo the maximum load. To lower the high pressure in them, part of the blood is transported through perforated veins to the superficial veins, 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, the blood enters the deep veins without stopping, but due to the violation of their functions and the normal activity of the valve leaflets of the perforated veins, the blood is redistributed to the superficial vessels. As a result, chronic varicose veins develop, which over time are accompanied by painful sensations, edema and trophic ulcers.
Causes of the disease
Previously, one of the main 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 that are transmitted in the family: food culture, passive rest, sedentary work, etc.
The development of varicose veins is based on the presence of reflux in the venous system, when blood flows through the veins in the opposite direction. Further transport of blood from deep veins to superficial veins is possible due to congenital or acquired degenerative pathology of the valve apparatus. This causes the superficial vessels to be overfilled with blood and their distension during the formation of venous nodes.
One of the basic reasons for the development of varicose veins is considered to be poor diet, which in some cases leads to obesity. These people move little, eat mainly highly processed foods, and the proportion of plant fibers in the diet is minimized. After all, it is they who take part in strengthening the walls of veins and blood vessels and prevent prolonged chronic constipation, which significantly increases intra-abdominal pressure and thus causes varicose veins. It is worth noting that an increase in body weight of more than 20% increases the risk of disease fivefold.
The main provoking factor in women is carrying a child, while the risk of varicose veins increases with each subsequent pregnancy. Heavy weight gain and an enlarged uterus put a lot of stress on the legs, which stagnate. This situation is aggravated by the constantly 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 cause varicose veins of the lower extremities include:
- a sedentary lifestyle, standing during the day (eg hairdressers), long flights or long journeys. 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 in women, wearing uncomfortable and 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;
- arterial hypertension;
- smoking, which indirectly leads to thinning of the walls of the blood vessels.
Classification of the disease
Varicose veins of the lower extremities are classified according to the prevalence of venous lesions, their localization, as well as the presence of pathological reflux, characterized by impaired blood flow. There are 4 forms of varicose veins:
- intracutaneous and subcutaneous (segmental) varicose veins, in which there is no pathological outflow of venous blood;
- segmental varicose veins, when reflux occurs through perforating or superficial veins;
- a common form of varicose veins, in which reflux occurs both through the perforating and superficial veins;
- Varicose veins are characterized by reflux in the deep veins.
After varicose veins of the lower extremities become chronic, phlebology considers its three degrees:
- transient edema, periodically occurring against the background of "heavy legs" syndrome.
- Persistent and persistent edema. Hyperpigmentation and eczema may appear.
- Venous ulcer of a trophic nature.
This last degree is the most difficult to treat, since it requires the preliminary elimination of the inflammation and the scarring of the skin tissue.
Stages and symptoms
<1_img_centerxx>The disease progresses very slowly, sometimes more than ten years pass, until the symptoms which 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. In order to properly take into account the symptoms of the disease, its manifestations are classified according to the stages of varicose veins:
- The first stage begins to manifest itself more often at a young age - after 20 years, when there is a feeling of heaviness in the legs, edema may appear, which completely disappears overnight. Inside the lower leg, you can see an enlarged vein, which manifests as a lumpy protrusion of the skin. At this point, many people notice small spider veins. In general, the symptomatology is subtle and rarely receives the attention it deserves.
- The second stage is characterized by an increase in the external manifestation of the dilated vein. The disease is already developing against the background of the pathological work of venous valves. Therefore, the size of the saphenous veins increases noticeably and their elongation can also be noted. Most often there are heaviness and burning in the legs, they quickly get tired with long walks.
- The disease already becomes chronic due to the constant imbalance in the outflow of venous blood. In the evening, patients suffer from edema near the ankle, which can be very intense. The legs are heavy and cramps can occur at night.
- In the absence of treatment in the previous stages, the chronic insufficiency of the functioning of the venous system negatively affects the metabolic processes of the skin, the areas of the lower leg are particularly affected. Darkening of the skin is visible near the ankle - hyperpigmentation, it thickens and becomes inflamed over time. The condition described is called lipodermatosclerosis. If at this point you do not start treatment with respect to the venous system, trophic ulcers will soon begin to form.
- The fifth stage is accompanied by numerous trophic ulcers, some of which periodically heal with the formation of scars.
- In the area of long-standing trophic disorders, extensive ulcers open. This condition requires urgent active therapy, aimed at both the treatment of varicose veins and the healing of skin ulcers.
Diagnostic
An external examination of the lower extremities in the vertical and horizontal positions of the body, palpation of the veins and a preliminary assessment of the stage of the disease is carried out. The patient is sent for a general blood test, which allows you to study the picture of the disease with greater thoroughness:
- at the platelet level, a predisposition to thrombosis will be reflected;
- hemoglobin level, as well as the number of red blood cells, indicates the degree of blood clotting;
- By the increased level of leukocytes, inflammation can be judged, which helps to diagnose thrombophlebitis more quickly.
Be sure to examine the venous system of the legs, for which there are many methods:
- ultrasound dopplerography - USDG;
- venography;
- CT venography;
- duplex CT angiography - USAS;
- phleboscintiography;
- photoplesmography;
- phlebomanometry and others.
In practice, patients are more often prescribed USAS and USG, as they help to fully study the venous system of the legs and identify degenerative areas. The rest of the methods can be prescribed in addition if the ultrasound examination did not give a complete view of the picture of the disease. Some of these methods can lead to complications such as venous thrombosis, perforation of the vessel wall with a catheter, and allergy to contrast agents. Consider the techniques most commonly practiced in phlebology:
- The USAS makes it possible to assess the anatomical, hemodynamic and functional pathologies of the venous bed. The data obtained is subject to computer processing, after which the model of the venous system can be viewed on video or printed on paper.
- Doppler ultrasound with high accuracy determines the permeability of superficial and deeply localized veins, the speed of blood flow. Doppler ultrasound is used to assess the function of the valve system.
After a thorough diagnosis, the doctor draws up a patient collection card, which allows you to determine the damaged segments of the venous system, their degree and length. After that, a suitable treatment is selected.
Treatment
It is carried out comprehensively and is determined depending on the symptoms, the degree of development of the disease and the results of the study. In the early stages, conservative treatment is prescribed, which consists of:
- Drug therapy when a group of drugs is prescribed:
- antioprotectors and phlebotonics;
- anti coagulants;
- disaggregating
- topical preparations (ointments, gels);
- anti-inflammatory drugs.
- Elastic compression, for which compression stockings or bandages are used (rarely). It allows you to dose the compression of the muscles, prevents stagnant processes, improves blood circulation in the vessels. Wearing such underwear has the effect of artificially maintaining vascular tone.
- Physiotherapeutic methods, among which the best results of treatment were shown by electrophoresis, diadynamic currents, laser radiation and magnetic field.
- Achievable physical activity, which should be performed only in compression underwear (except for swimming). Cycling, swimming, jogging are recommended. The phlebologist selects a series of individual exercises for the lower extremities, which will train the vessels of the legs every day.
In addition, patients are advised to perform five-minute contrasting procedures in the shower every evening, alternately switching from hot to cold water. Such manipulations improve blood circulation and tone blood vessels.
It is important at the start of treatment to identify the factor causing the disease in order to influence it effectively. And patients at risk should see a phlebologist every 2 years for a preventive check-up and an ultrasound of the veins in the legs.
When conservative treatment does not give results or varicose veins are observed at an advanced stage, then surgical intervention is used. Today, varicose veins can be completely cured by the following methods:
- Phlebectomy. The essence of the operation is to remove the main trunks of the superficial vein to eliminate the pathological flow of blood. Perforator veins are often ligated for the same purpose.
- Sclerotherapy. It consists of the introduction of a sclerosant into the affected area of the vein, which leads to the connection of its walls. Recently, they began to actively use the foam sclerosant for the same purposes according to the technology -. Blood flow through the defective area stops, and the cosmetic defect in the form of protruding nodules is removed. After such an intervention, no scar remains, all manipulations are carried out on an outpatient basis without subsequent hospitalization. But sclerotherapy is used only for the fusion of small branches of the 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 stops. But this technique is only indicated for veins with an expansion diameter of less than one centimeter.
Prevention
Preventive measures can be both primary, aimed at preventing the development of varicose veins, and secondary, when necessary to reduce the risk of relapse after surgery or to prevent the progression of the disease from worsening. Useful tips:
- lead an active lifestyle without a heavy load on your legs: swimming, walking, cycling;
- watch your weight;
- keep both legs raised more often;
- do not wear tight underwear and heels higher than 4 centimeters;
- use orthopedic insoles;
- take a contrasting shower;
- do preventative five-minute leg exercises daily;
- wear compression stockings for long walks.
If you notice the slightest hint of varicose veins - prominent nodules on the legs, swelling, heaviness, do not delay the visit to the phlebologist. Indeed, over time, this insidious disease can cause many complications, including thrombophlebitis and thrombosis.