Varicose veins

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

What it is

Varicose veins are a pathology that only people suffer from. Animals do not have this problem, which suggests that the disease is associated with upright posture. When a person stood up, most of the circulating blood began to be below the level of the heart. In this case, all the conditions are met for the blood to circulate less well 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. In addition, more and more often, similar problems are found in people at a young age. In all likelihood, one of the reasons varicose veins "get younger" is a sedentary lifestyle, which only contributes to stagnation.

Interestingly, in the age group under 20, varicose veins of the lower extremities occur with the same frequency in men and women. However, after the age of 20, women begin to predominate in the pattern of morbidity. This is due to pregnancy and childbirth, which are a serious factor in the development of venous diseases.

Features, 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 in the valve apparatus of the veins of the lower extremities.

For an unobstructed ascending blood flow in the veins, a well-coordinated work of the venous valves is necessary. These valves only open for the blood flowing upwards. However, with a valve defect, partial descending blood flow is also possible. This is how venous insufficiency develops, which is manifested by edema, cramps of the muscles of the legs and dilation of the venous vessels.

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

Since venous valves are under constant mechanical stress, inflammation develops particularly quickly in the region of the venous valve system.

Today, the vast majority of people in developed countries lead sedentary lives. But why then does not everyone have varicose veins? Consider the main risk factors that contribute to the appearance of this pathology:

• Hereditary factors. . . Despite the fact that the 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 strong counter-arguments regarding heredity in the development of varicose veins. For example, this is the prevalence of varicose veins among ethnic Africans and African immigrants who have moved to the United States. If the prevalence of varicose veins among sedentary Africans is about 0. 5%, then among emigrants 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 prevail.
• 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 the vessels, and in connection with the risk of other diseases affecting the vessels (diabetes mellitus, hypertension, and others).
• Pregnancy. . . It 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 an increase in the volume of circulating blood, as well as compression of the retroperitoneal veins by the developing fetus in the uterus. According to epidemiological studies, the second and subsequent pregnancies lead to a significant increase in the likelihood of developing varicose veins. After the first pregnancy, the likelihood 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 who take hormonal contraceptives, as well as for those who use hormone replacement therapy for the treatment of certain diseases (eg, osteoporosis) or during the premenopausal period. Female sex hormones (especially estrogen and progesterone) have been shown to reduce vascular tone and destroy collagen fibers. Thus, the wall of the veins is pathologically dilated.
• Way of life. . . A person's lifestyle has a great influence on the course of the disease. A sedentary lifestyle, as well as work associated with prolonged standing or sitting (for example, security guards, drivers, office workers, service workers and others) contribute to the development of varicose veins. You should also 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 international CEAP classification, adopted in 1994, is considered generally accepted. CEAP is an abbreviation, where each letter corresponds to the name of a classification category:

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

The course of the disease takes place in six stages:

• Floor zero. . . The earliest stage of varicose veins, which even doctors cannot reliably diagnose. At this stage, there are no outward signs of the disease. Ultrasound diagnosis does not show the presence of pathology. At the same time, a person at stage zero is worried about symptoms such as swelling, a feeling of heaviness in the legs, as well as cramps, which indicates the presence of problems with the blood vessels.
• First stage. . . Already at the first stage of the disease, spider veins are visible on the surface of the skin of the legs, the diameter of which is less than 1 millimeter. Medium-sized veins can increase in diameter up to 3 mm. At this point, doctors are not always able to make the correct diagnosis, as the presence of such asterisks does not always indicate varicose veins.
• Second step. . . At this stage, veins can appear and disappear depending on the conditions. For example, the 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.
• Third step. . . If in the previous stages of the disease the swelling of the legs appeared and disappeared, then at the third stage the edema becomes permanent. The swelling of the legs is most severe in the evening.
• Fourth step. . . At this point, significant trophic changes occur. In particular, tissue nutrition is disturbed near the affected veins. The patient develops changes on the skin such as lipodermatosclerosis (inflammation of the subcutaneous fatty tissue), eczema, as well as darkening or discoloration of the skin. For the fourth stage of the disease, pigmentary changes are characteristic. For example, the skin in the area of the affected vessels may turn brown and even black, which indicates the concentration of pigments in this area. The reverse situation is also possible when, due to a pathological process, the pigment does not penetrate the affected area, which leads to the appearance of a pale complexion. If at this stage the varicose veins are not treated, the problem will only worsen with the appearance of trophic ulcers.
• Fifth step. . . At this stage of the disease, in addition to the above symptoms, trophic ulcers also appear, which heal quickly. If you don't take any treatment action, ulcers will appear again and again.
• Sixth step. . . Non-healing trophic ulcers appear. In the affected area, the temperature rises dramatically and pus may ooze from the sores.

You should not wait for the development of the last stages - you need to go to the doctor for the second in order to register and monitor 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 act on time.

Symptoms

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

• Pain. . . It is the first sign of the disease. Because pain is a nonspecific symptom, it is impossible to make a diagnosis on the basis of this symptom alone. With varicose veins of the lower extremities, the pain is often localized along the venous trunks.
• Feet in the legs. . . Also applies to the first symptoms, when the veins in the skin are not yet visible. Often the feeling of heat is accompanied by a throbbing pain.
• Cramps and itching in the muscles. . . Most often disturbed at night.
• Swelling in the legs. . . In the early stages of the disease, the swelling is minor 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 turns brown. In advanced stages of the disease, eczema and dermatitis appear. The terminal stages of varicose veins are characterized by the appearance of trophic ulcers. Initially, ulcers heal, but later, non-healing wounds form.
• Vascular spiders. . . In the medical literature, these asterisks are called telangiectasias. In some people, varicose veins may be limited to spider veins, without progression to larger veins.
• Twisted dilated veins. . . The most characteristic sign of varicose veins is the twisted dilated veins on the surface of the legs.

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

When to consult a doctor

You should see a doctor 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, they can be misdiagnosed initially. The patient should carefully monitor the condition of his legs and be regularly observed by a phlebologist.

Diagnostic

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

• External examination of the skin of the legs;
• Doppler ultrasound;
• Duplex venous scan;
• Phlebography.

Processing characteristics

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

• Drug therapy. . . It is the taking of drugs that improve the tone of the venous walls. In addition, the patient is prescribed drugs that reduce capillary permeability and improve blood microcirculation. If there is a risk of blood clots, anticoagulants are also prescribed.
• Compression therapy. . . It is the wearing of special compression stockings, which reduces the load on the leg. The advantage is that it is possible to evenly distribute the load, even with intense physical exertion. When using compression garments, congestion and swelling can be avoided.
• Catch-up gymnastics and lifestyle changes. . . The patient is advised to exercise to relieve tension in the legs. It is important to avoid prolonged sitting or standing. If you have to stand or sit for a long time at work, you need to take breaks more often.

If the conservative treatment of varicose veins does not bring the expected results, a decision is made about the surgery. Most often, these are minimally invasive interventions, including:

• Sclerotherapy- the introduction into the vein of substances which stick to the walls of the affected vessel. This treatment results in resorption of spider veins.
• Laser coagulation- introduction of a laser light guide into a vein and irradiation of the walls with a laser, which also leads to sticking of the walls and additional resorption of the vessel.
• Radiofrequency ablation- bonding of veins by high frequency current.
• Phlebectomy- Removal of the affected veins, in which blood circulation has deteriorated by 90%.

In some countries, you can have the operation free of charge, as part of compulsory medical insurance. But it is not a fact that all types of compulsory insurance operations are insured everywhere. In all cases, help will be provided, but it is necessary to know whether it will be a classic or laser removal.

Contraindications for people with varicose veins

• Sedentary lifestyle. . . It is important to avoid prolonged sitting or standing. Physical activity will help prevent congestion in the veins.
• Running and vigorous 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. . . We must give up junk food, even if it seems that health allows it. You should limit the consumption of sweets, semi-finished products, as well as rich meat broths and smoked meats. But eating more vegetables and fruits would be a good idea.
• Spas and showers. . . For people with vascular problems in the extremities, too hot and prolonged water procedures 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 which threatens human life.

Conclusion

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