Varicose veins, varicose veins, varicose veins
- uneven increase in the lumen and length of the vessels,
- formation of nodules in the regions of thinning veins due to pathological changes in the venous walls, their thinning, lengthening, decrease in tone and elasticity;
- functional failure of venous valves and impaired blood flow.
Varicose veins are a very common disease. Varicose veins and its complications are diagnosed in 25% of the population, women suffer 2-3 times more than men. In women, the first symptoms of the disease are often observed at a young age, and are most often associated with pregnancy and childbirth. In old age, the incidence of disease increases in both men and women, and the frequency of complex forms increases. At the age of 70, the disease occurs 6-10 times more often than at the age of 30. However, recently, the manifestation of varicose veins is observed in very young people, even teenagers. Therefore, identifying all possible causes of the disease and preventing venous disorders is becoming an increasingly urgent task.
How varicose veins develop and develop
To understand how varicose veins occur, let's briefly explain the physiology of the venous system of the lower extremities. Venous flow in the legs is provided by two interconnected mechanisms - central and peripheral. The central mechanism is associated with the heart, lungs, and diaphragm, and the peripheral mechanism is directly related to the functioning of the venous system of the lower extremities, which covers the veins of muscles and tissues.
The initial symptoms of varicose veins are capillary circulation disorders, swelling, a feeling of heaviness in the legs, the appearance of spider veins and spider veins. These changes can be reversed, but if timely preventive measures are not taken, the problems will increase.
As a rule, more than a year passes from the initial symptoms of varicose veins of the lower extremities to the formation of varicose nodes and the appearance of obvious signs of varicose veins. Varicose veins, which develop gradually, cause blood flow disorders and chronic venous insufficiency. Stagnation of blood in veins can cause phlebitis (inflammation of blood vessels), thrombophlebitis (inflammation of blood vessels with the formation of blood clots), phlebothrombosis (thrombosis with subsequent inflammation of blood vessels), non-healing dermatitis (inflammation of blood vessels). skin), trophic ulcers.
Types and forms of varicose veins
There are primary (real) and secondary (symptomatic) varicose veins.
Primary varicose veins is an independent disease of the venous system (varicose veins). It develops gradually over several years. Varicose enlargement of the great saphenous vein is often observed (70-85%), less often the small saphenous vein (5-12%). 50-70% of vascular damage with varicose veins is bilateral.
Secondary varicose veins are a sign and result of diseases of obstructions to the outflow of blood from the deep veins of the lower extremities (postthrombotic disease, tumors, scars, inflammatory processes, aplasia and dysplasia of deep veins, arteriovenous). fistulas, etc. ). Secondary varicose veins are extremely rare.
Varicose veins often affect the saphenous veins of the lower extremities, which are part of the varicose vein system. Branches of the small saphenous vein suffer less than varicose veins.
Classification of types of varicose veins
Until recently, doctors in our country classified varicose veins according to several types of classification. V. S. Saveliev's staged clinical classification was used, reflecting the degree of venous circulation in the limbs and the body's ability to resist and compensate for these disorders, as well as the classification of varicose veins according to the forms and complications caused by them.
But currently the main one is CEAP, an international classification based on clinical (C - clinic), etiological (E - etiology), anatomical (A - anatomy) and pathogenetic (P - pathogenesis) features of the disease.
6 clinical classes ("C") are organized from telangiectasias (TAE) to trophic ulcers in increasing severity of the disease.
The etiologic section ("E") indicates whether the process is primary or not.
The anatomical part of the classification ("A") divides the venous system of the lower extremities into 18 relatively separate segments, which allows to show the localization of the affected area of the venous system.
The pathophysiological section ("P") characterizes the presence of reflux and/or obstruction in the affected venous segment.
Symptoms of varicose veins
Symptoms of varicose veins depend on the stage of the disease, i. e. about the degree of changes in blood vessels and the violation of the venous system. Depending on the stage, a prognosis can be made for the further development of the disease.
The initial stage of varicose veins - 1st degree varicose veins
At the initial stage, when the pathology of the veins is not yet clearly expressed, there may be no visible signs of varicose veins. Patients complain of heaviness and discomfort in the legs, very quick fatigue, feeling of heat, paresthesia (numbness, burning, tingling). Symptoms worsen towards the end of the day, as well as under the influence of heat - when wearing warm shoes indoors in summer or winter. Swelling appears in the foot and ankle, which disappears after a short rest. Sometimes night cramps of the calf muscles are possible, but patients associate this with overwork.
After prolonged physical activity, the veins swell and their network can be easily seen through the skin. They are especially noticeable on the thighs, lower legs and feet. The number of such vessels and their degree of expansion can be different. These can be single and not very noticeable formations on the lower leg, which appear more clearly in the evening or after physical activity. Spider veins are also observed at this stage of varicose veins.
If you start the simplest conservative treatment at this stage, as well as follow preventive measures, it is possible to prevent the development of the disease by eliminating almost all symptoms.
Symptoms of varicose veins of the 2nd degree, compensatory stage
At this stage of the disease, changes in large subcutaneous vessels are noticeable. Veins are deformed, swollen, blood flow is disturbed, noticeable swelling appears in the legs and ankles. Swelling in the legs increases with prolonged physical activity, but disappears after a night's rest. Calf muscle cramps are common at night. Paresthesia is observed - temporary loss of sensation in the legs, numbness of the legs, burning, "eyelid". As the disease progresses, the pain becomes worse in the evening.
This stage of subcompensation, as a rule, lasts for several years, and at this time, if treatment is started in time, the development of the disease can be stopped. Otherwise, the disease will inevitably progress to a more severe stage.
Symptoms of 3rd degree varicose veins - decompensation stage
At this stage of varicose veins, symptoms increase significantly, pains, heaviness in the legs become more intense, and peripheral blood and lymph circulation disorders (chronic venous insufficiency) are observed. Swelling does not go away even after a long rest and spreads to the bottom of the leg. Patients are bothered by itching of the skin. The skin of the feet dries up, loses its elasticity, the skin is easily damaged, loses its ability to recover quickly, and as a result, wounds take a long time to heal. Brown spots appear on the skin, mostly on the inner surface of the lower third of the leg (hyperpigmentation due to subcutaneous hemorrhages).
All these complaints are permanent. In the future, complaints such as pain in the heart area, shortness of breath, headaches, deterioration of the locomotor function of the injured limb may appear.
Although the decompensation stage is already a very important manifestation of the disease, with appropriate treatment, the patient's condition can be maintained at a satisfactory level for a long time, preserves work ability and prevents the transition to the stage of complications.
Varicose veins of the 4th degree - the stage of complications
This stage of the disease is characterized by a clear violation of the venous circulation. Swelling of the legs is almost constant, itching of the skin intensifies, trophic disorders appear in the skin of the lower legs. Advanced varicose veins are often accompanied by eczema, dermatitis and long-term damage, and since the regenerative abilities of the skin with varicose veins are significantly reduced, even a small wound can turn into a persistent trophic ulcer. Thinned skin and venous walls are easily damaged, resulting in extensive bleeding. Damaged soft tissues and open ulcers become a door for infection.
The most common complications of varicose veins:
- phlebitis - inflammation of a vein;
- thrombosis - the formation of a blood clot (thrombus) in a vein can cause blockage of a vein;
- trophic ulcers - formed where the affected vessel cannot provide sufficient blood flow from the skin, as a result of which tissue nutrition (trophism) is disturbed.
Varicose veins can be complicated by acute (sometimes purulent) thrombophlebitis.
At this stage, it is no longer possible to restore the condition of the venous system, we can only talk about preventing further complications and improving the patient's quality of life as much as possible.
Causes of varicose veins
There is no single cause of primary varicose veins of the lower extremities. The development of this disease is usually provoked by several factors. But all the painful symptoms of varicose veins are associated with structural changes in the tissue of the venous walls of blood vessels and dysfunction of the venous valves.
What causes these violations?
You can often come across the statement that one of the most important physiological reasons for the development of a disease such as varicose veins is an upright posture. Indeed, in humans, by nature, the load on the vascular system of the lower extremities is very high. Blood flowing through the veins and rising to the heart is countered by the pressure created by gravity, as well as high pressure in the abdominal cavity. However, not everyone develops varicose veins. What factors cause the development of varicose veins?
The following are the main risk factors for the development of varicose veins:
- genetic predisposition (heredity) - congenital weakness of the venous wall, violation of venous valves;
- female sex - women suffer from varicose veins 4-6 times more often than men;
- hormonal disorders;
- hormonal contraception;
- pregnancy, especially multiple pregnancy;
- heavy physical activity (heavy physical work, power sports);
- conditions and diseases that cause increased intra-abdominal pressure (chronic respiratory diseases, constipation, etc. )
- diseases that have a negative effect on blood vessels (high blood sugar, diabetes, high blood pressure, etc. );
- work characteristics - standing or sitting work, sudden temperature changes, long-term contact with high or low temperatures;
- overweight, obesity, which creates increased stress on the legs and increased pressure in the pelvic region;
- lack of vitamin C and other useful substances necessary for the vascular system;
- sedentary lifestyle, bad habits that destroy blood vessels and cause additional tension in them.
Diagnosis of varicose veins
Varicose veins are often not difficult to diagnose. Clinical examination, including physical examination (examination and palpation), examination of the patient, collection of complaints and anamnesis (information about the course of the disease, life and work characteristics, past and present diseases), is usually performed for severe varicose veins. it is possible to make a diagnosis without instrumental examination. Exceptions are situations where it may be difficult to observe varicose changes due to excessive development of subcutaneous fat tissue of the lower extremities.
Currently, duplex ultrasound scanning (USDS) has been widely used to study the veins of the lower extremities. This method allows to determine the localization of changes in the vessels and the nature of the violation of venous blood flow. However, you should know that the results of ultrasound examination are largely subjective and largely depend not only on the experience and knowledge of the researcher, but also on the tactical approaches to the treatment of venous diseases adopted in a particular medical institution. When determining treatment tactics, first of all, clinical examination data is guided.
Duplex scanning is performed when planning invasive treatment of varicose veins of the lower extremities. In addition, X-ray contrast venography, MRI venography, and CT venography may be used.
All these methods make it possible to clarify the location, nature and degree of venous lesions, to clearly see the violation of venous hemodynamics, to evaluate the effectiveness of the prescribed therapy and to predict the course of the disease.
Treatment of varicose veins - modern technique
The main tasks of the doctor in the treatment of varicose veins are:
- eliminate or reduce the severity of symptoms that cause special concern in patients - pain, swelling, cramps;
- restoration and improvement of the activity of blood vessels - from capillaries to deep veins, improving the function of valves, restoring damaged vessel walls, increasing their elasticity and strength;
- improve the rheological properties of blood, reduce its viscosity;
- improving the activity of the lymphatic system.
- prevention of further development of the disease and complications;
- improving the patient's quality of life.
Depending on the stage of the disease and the degree of vascular damage, the doctor can prescribe the most optimal treatment methods for this condition, for example:
- conservative treatment- recommendations for prevention and lifestyle changes, pharmacotherapy, compression therapy;
- non-surgical invasive procedures- sclerotherapy, exosclerotherapy, foam sclerotherapy (foam therapy), etc. ;
- surgery- phlebectomy, thermal obliteration, peeling, combined methods and operations of increasing complexity for the treatment of complications of varicose veins and trophic ulcers of the lower extremities.
These methods make it possible to improve blood circulation in the lower limbs, including microcirculation, eliminate many cosmetic defects caused by varicose veins, and relieve the patient from a significant part of the painful manifestations of the pathology.
Conservative methods of treatment of varicose veins
Modern conservative therapy for varicose veins provides a complex approach to treatment and includes several areas:
- lifestyle changes;
- pharmacological therapy;
- compression therapy.
It's no coincidence that lifestyle changes come first. If possible, it is necessary to remove the sludge, at least to reduce the impact of adverse factors.
One of them is long-term static loads while standing or sitting, which causes blood stagnation. To activate the musculo-venous pump of the lower leg, you need to regularly stretch your legs and walk more. While working, you can periodically do exercises with alternating contraction and relaxation of the muscles of the lower leg (lifting toes).
It is recommended to find time to do outdoor sports that are not associated with the risk of foot injury (athletic or Nordic walking, exercise bikes, treadmills, swimming, cycling and hiking).
If you have varicose veins, you should not overheat your legs, visit baths and saunas.
Patients with varicose veins should control their body weight. Body mass index is known to be more than 27 kg/m22the probability of varicose veins increases by 30%. Being overweight is often associated with increased sugar levels, which leads to problems with the healing of venous ulcers and the risk of their recurrence.
The effectiveness of compression therapy is explained by the reduction of reverse blood flow, a certain decrease in the pathological ability of dilated vessels, which leads to a decrease in swelling, improvement in capillary blood flow, and a reduction in the symptoms of varicose veins.
In addition to bandages and knitting, there is hardware compression therapy, which is especially effective for chronic venous edema and trophic ulcers.
Drug treatment can be recommended as the main type of therapy in the early stages of varicose veins, complemented by elastic compression if necessary. In order to speed up rehabilitation and prevent complications, drugs are also prescribed in preparation for surgical treatment or in the postoperative period.
The following drug groups are used in the treatment of vascular diseases:
- phlebotonics and angioprotectors;
- anticoagulants and thrombolytics;
- anti-inflammatory and pain relievers;
- vascular regenerating substances.
For the systemic treatment of varicose veins, mainly bioflavonoids, rutin derivatives, saponins, etc. based on it, venotonics and angioprotectors are used. These preparations increase the elasticity and tone of the vessels, increase the strength of the blood vessels, improve the lymph flow and reduce the lymph pressure. . Anticoagulants are prescribed if there is a risk of thrombosis. Anti-inflammatory and pain relievers are used for complications of varicose veins - inflammation of veins, severe pain, trophic lesions of veins.
In addition to systemic ones, local drugs are used - ointments and gels based on venoactive active substances, heparin, non-steroidal anti-inflammatory drugs, corticosteroid ointments.
Non-surgical invasive procedures
Vascular sclerotherapy is an outpatient medical procedure in which a special substance, a sclerosant, is injected into the capillary or problematic vein with a fine needle. Then the vessel is compressed using a latex pad or elastic bandage. The walls of the vessel "stick together", the blood flow in the vessel stops. Adhesion walls usually grow together, scar, and the scar disappears. It is used to treat varicose veins of small superficial veins. The method is effective in the early stages of the disease, only in cases where varicose veins are localized only in small vessels, and allows to eliminate cosmetic defects. A series of treatments may be required to achieve results.
It differs with a special sclerosant. As in sclerotherapy, a sclerosing substance is injected into the damaged vein in the form of a thin foam, which quickly "closes" the large affected vessels. The method does not require multiple procedures and gives a high result. It is important to know that the procedure - although rare - can have side effects - visual impairment. It is also dangerous for the sclerosant to get into the blood vessels and nerve tissue. The procedure should be performed by an experienced phlebologist.
Absolute contraindications to sclerotherapy - drug allergy, deep vein thrombosis, pregnancy, breastfeeding
Surgical treatment of varicose veins
As a rule, surgical treatment is recommended in severe, advanced cases, as well as when conservative methods fail to stop the progression of the disease.
Surgical intervention for varicose veins has the following goals
- elimination of cosmetic defects;
- reduction of subjective symptoms (pain, burning, paresthesia, feeling of heaviness in the legs, etc. );
- prevention of deterioration of saphenous veins;
- prevention of bleeding from varicose veins;
- prevention of thrombophlebitis;
- reducing and preventing the development of venous edema;
- reduction of manifestations and prevention of development of hyperpigmentation, lipodermatosclerosis;
- acceleration of healing of venous trophic ulcers and prevention of recurrence.
According to Clinical Guidelines, the goals of surgical treatment are:
- elimination of pathological vertical and / or horizontal reflux;
- removal of varicose saphenous veins.
Before any surgical operation, the risk of developing venous thromboembolic complications (VTEC) is assessed.
There are several surgical methods that can be used depending on the specific situation:
Vascular suturing is the placement of multiple stitches in a damaged vein, which prevents blood from flowing through the vein. As a result, blood clots form and the vessel gradually degenerates.
It is important to remember that surgery is not a final treatment, but a relief of symptoms. Conservative treatment is also required after surgery and lasts a lifetime, and this should be explained to patients.
Depending on the stage of varicose veins, symptoms, accompanying diseases and the general health of the patient, the doctor chooses special recommendations to achieve the maximum possible improvement as soon as possible.