Varicose veins, varicose veins, varicose veins
- uneven increase in the lumen and length of the veins,
- the formation of nodes in the areas of thinned veins due to pathological changes in the venous walls, their thinning, stretching, decreased tone and elasticity;
- functional insufficiency of venous valves and impaired blood circulation.
Varicose veins are a very common disease. Varicose veins and its complications are diagnosed in 25% of the population, where women suffer 2-3 times more often than men. In women, the first signs of the disease are often observed at a young age, more often associated with pregnancy and childbirth. At older ages, an increase in incidence is observed in both men and women, and the frequency of complicated forms increases. At the age of 70, the disease occurs 6-10 times more often than at the age of 30. However, in recent times, the manifestation of varicose veins is often observed in young people, even in teenagers. Therefore, identifying all possible causes of the disease and preventing venous disorders is becoming an increasingly urgent task.
How varicose veins are born and develop
To understand how varicose veins appear, let's briefly explain the physiology of the venous system of the lower extremities. Venous outflow in the leg is provided by two interconnected mechanisms - central and peripheral. The central mechanism is related to the heart, lungs, diaphragm, and the peripheral mechanism is directly related to the functioning of the venous system of the lower extremities surrounding the vessels of muscles and tissues.
The initial signs of varicose veins are impaired capillary circulation, swelling, a feeling of heaviness in the legs, the appearance of spider veins and spider veins. These changes are reversible, but if preventive measures are not taken in time, the problems will increase.
As a rule, more than a year passes from the initial signs of varicose veins of the lower extremities to the formation of varicose nodes and the appearance of pronounced symptoms of varicose veins. Gradually developing, varicose veins lead to impaired blood flow and chronic venous insufficiency. Stagnation of blood in the veins can lead to phlebitis (inflammation of the veins), thrombophlebitis (inflammation of the veins with the formation of blood clots), phlebothrombosis (thrombosis with further inflammation of the veins), non-healing dermatitis (inflammation of the skin), ulcerstrophic.
Types and forms of varicose veins
There are primary (true) and secondary (symptomatic) varicose veins.
Primary varicose veins are an independent disease of the venous system (varicose veins). It develops gradually over several years. Varicose dilatation of the great saphenous vein is most often observed (70-85%), less often - the small saphenous vein (5-12%). With varicose veins, 50-70% of vein damage is bilateral.
Secondary varicose veins are a symptom and consequence of diseases in which there are obstacles in the outflow of blood through the deep veins of the lower extremities (postthrombotic disease, tumors, wounds, inflammatory processes, aplasia and dysplasia of deep veins, arteriovenous fistula, etc. ). Secondary varicose veins are quite rare.
Most often, varicose veins affect the saphenous veins of the lower extremities, which are part of the system of the great saphenous veins. Branches of the small saphenous vein suffer from varicose veins much less often.
Classification of types of varicose veins
Until recently, in our country, doctors classified varicose veins according to several types of classifications. The filed clinical classification of V. S. Savelyev was used, reflecting the degree of disturbance of venous circulation in the limbs and the ability of the body to resist these disturbances and compensate for them, as well as the classification according to the forms of varicose veins and complicationscaused by them.
But the main one currently is the CEAP international classification, based on the clinical (C - clinic), etiological (E - etiology), anatomical (A - anatomy) and pathogenetic (P - pathogenesis) characteristics of the disease.
6 clinical classes ("C") are arranged in increasing severity of the disease from telangiectasias (TAE) to trophic ulcers.
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 makes it possible to determine 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
The symptoms of varicose veins depend on the stage of the disease, d. m. th. on the degree of changes in the blood vessels and the breakdown of the venous system. Depending on the stage, a prognosis can be given for the further development of the disease.
The initial stage of varicose veins - varicose veins of the 1st degree
In the initial stage, when the pathology of the veins is not yet clearly expressed, visible signs of varicose veins may be absent. Patients complain of a feeling of heaviness and discomfort in the legs, very fast fatigue, a feeling of warmth, paresthesia (numbness, burning, tingling). Symptoms worsen at the end of the day, as well as under the influence of heat - in summer, or when wearing warm shoes indoors in winter. Swelling appears in the foot and ankle, which disappears after a short rest. Occasionally, calf muscle cramps at night are possible, but patients attribute it to overwork.
After prolonged physical activity, the veins swell and their network can easily be seen through the skin. They are especially visible in the thigh, leg and foot area. The number of such veins and the degree of their expansion can vary. These can be single and not very visible formations on the lower part of the leg, which appear more clearly in the evening or after physical activity. Spider veins also appear in this stage of varicose veins.
If at this stage you start the simplest conservative treatment, as well as follow preventive measures, then the development of the disease can be prevented by eliminating almost all symptoms.
Symptoms of varicose veins of the second degree, compensation phase
At this stage of the disease, changes in the large subcutaneous vessels become visible. Veins are deformed, swollen, blood flow is disrupted and visible swelling appears in the legs and joints. Swelling increases with prolonged physical activity on the legs, but goes away after a night's rest. At night, calf muscle cramps are common. Paresthesia is observed - a temporary loss of sensation in the legs, numbness of the legs, burning, "goosebumps". As the disease progresses, pains appear, which intensify in the evening.
This phase of undercompensation, as a rule, lasts several years, and at this time the development of the disease can also be stopped if treatment is started at the right time. Otherwise, the disease will inevitably progress to a more severe stage.
Symptoms of varicose veins of the 3rd degree - the stage of decompensation
At this stage of varicose veins, a significant increase in symptoms is observed, pains, heaviness in the legs are more intense and there is a disturbance in the peripheral blood and lymphatic circulation (chronic venous insufficiency). The swelling does not disappear even after a long rest and spreads to the lower part of the leg. Patients are bothered by itching of the skin. The skin on the feet becomes dry, loses elasticity, the skin is easily injured, loses the ability to regenerate quickly, as a result of which wounds take a long time to heal. Brown spots appear on the skin, most often on the inner surface of the lower third of the leg (hyperpigmentation due to subcutaneous hemorrhages).
All these complaints are ongoing. In the future, complaints of pain in the heart area, shortness of breath, headache and deterioration of the musculoskeletal function of the affected limb may appear.
Although the decompensation phase is already a very significant manifestation of the disease, with proper treatment the patient's condition can be maintained at satisfactory levels for a long time, maintaining the ability to work and preventing the transition to the complication phase.
Varicose veins of the 4th degree - the stage of complications
This stage of the disease is characterized by pronounced disorders of venous circulation. Swelling of the legs becomes almost constant, itching of the skin intensifies, and trophic disorders appear in the skin of the lower part of the leg. Advanced varicose veins are often accompanied by eczema, dermatitis and long-term injuries, and since the regenerative abilities of varicose skin are significantly reduced, even a small wound can develop into a persistent trophic ulcer. The thin skin and vein walls are easily injured, resulting in extensive bleeding. Damaged soft tissues and open ulcers become gateways 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, which can lead to blockage of the vessel;
- trophic ulcers - are formed in the place where the affected vein cannot provide sufficient blood flow from the skin, as a result of which the nutrition (trophism) of the tissues is destroyed.
Varicose veins can be complicated by acute thrombophlebitis (sometimes purulent).
It is no longer possible to restore the state of the venous system at this stage; we can only talk about preventing further complications and, as far as possible, improving the patient's quality of life.
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 tissues of the venous walls of blood vessels and disruption of the functioning 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 the right posture. Indeed, in humans, by their nature, the load on the vascular system of the lower extremities is very high. The flow of blood from the veins and its rise to the heart is prevented by the pressure caused by gravity, as well as the high pressure in the abdominal cavity. However, not everyone develops varicose veins. What factors provoke the development of varicose veins?
It has been proven that the main risk factors for the development of varicose veins are:
- genetic predisposition (inheritance) - congenital weakness of the venous wall, breakdown of venous valves;
- female gender - women suffer from varicose veins 4-6 times more often than men;
- hormonal disorders;
- hormonal contraception;
- pregnancy, especially multiple pregnancies;
- heavy physical activity (heavy physical work, strength sports);
- conditions and diseases that lead to increased intra-abdominal pressure (chronic respiratory disease, constipation, etc. )
- diseases that negatively affect blood vessels (high blood sugar, diabetes, increased pressure, etc. );
- work characteristics - standing or sitting work, sudden temperature changes, prolonged contact with high or low temperatures;
- overweight, obesity, which creates increased stress on the legs and increased pressure in the pelvic area;
- lack of vitamin C and other useful substances necessary for the vascular system;
- a sedentary lifestyle, bad habits that destroy blood vessels and provoke additional tension in them.
Diagnosis of varicose veins
Most often, diagnosing varicose veins is often not difficult. A clinical examination, including a physical examination (examination and palpation), a study of the patient, collection of complaints and anamnesis (information about the course of the disease, characteristics of life and work, past and current diseases) for severe varicose veinsit is usually possible to make a diagnosis without instrumental examination. Exceptions are situations when, with the excessive development of the subcutaneous fatty tissue of the lower extremities, varicose changes may be difficult to notice.
Currently, duplex ultrasound scanning (USDS) is widely used to study the veins of the lower extremities. This method allows you to determine the localization of changes in the veins and the nature of the disturbance in the venous blood flow. However, you should know that the results of ultrasound scanning are largely subjective and depend mainly 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 certain medical institution. When determining treatment tactics, they are primarily guided by clinical examination data.
Duplex scanning is performed when invasive treatment of varicose veins of the lower extremities is planned. 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 extent of venous lesions, to clearly see disorders in venous hemodynamics, to evaluate the effectiveness of the prescribed therapy and to predict the course of the disease.
Treatment of varicose veins - modern techniques
The main tasks of the doctor in the treatment of varicose veins are:
- eliminating or reducing the severity of symptoms that cause special concern to patients - pain, swelling, cramps;
- restoring and improving the functioning of blood vessels - from capillaries to deep veins, improving the functioning of valves, restoring damaged vascular walls, increasing their elasticity and strength;
- improving the rheological properties of blood, reducing its viscosity;
- improving the functioning 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 the given situation, such assh.
- conservative treatment– recommendations for prevention and lifestyle change, pharmacotherapy, compression therapy;
- non-surgical invasive procedures- sclerotherapy, ecosclerotherapy, foam sclerotherapy (foam therapy), etc. ;
- surgery- phlebectomy, thermal wiping, stripping, combined methods and operations with increased complexity for complications of varicose veins and treatment of trophic ulcers of the lower extremities.
These methods make it possible to improve blood circulation in the lower extremities, including microcirculation, eliminate many cosmetic defects caused by varicose veins and free the patient from a significant part of the painful manifestations of the pathology.
Conservative methods of treating varicose veins
Modern conservative therapy for varicose veins offers an integrated approach to treatment and includes several areas:
- lifestyle changes;
- pharmacological therapy;
- compression therapy.
It is no coincidence that lifestyle changes come first. It is necessary, if possible, to eliminate the sludge at least to reduce the impact of adverse factors.
One of them is long-term static loads in the standing or sitting position, which lead to blood stagnation. To activate the muscular-venous pump of the lower leg, you should regularly stretch your legs and walk more. During work, you can periodically perform exercises with alternate contraction and relaxation of the muscles of the lower leg (raising on the toes).
It is recommended to find time to engage in outdoor sports that are not associated with the risk of foot injury (athletic or Nordic walking, exercise bikes, treadmills, swimming, cycling and walking).
If you have varicose veins, you should not heat your legs, you will have to avoid visits to baths and saunas.
Patients with varicose veins should monitor their body weight. It is known that with a body mass index of more than 27 kg/m2the likelihood of varicose veins increases by 30%. Excess weight is often associated with high 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 possibility of reducing reverse blood flow, a certain reduction of the pathological capacity of dilated veins, which leads to a decrease in swelling, improvement of capillary blood circulation and reduction of symptoms of varicose veins.
In addition to bandages and knitwear, there is hardware compression therapy, which is particularly effective for chronic venous edema and trophic ulcers.
Drug treatment can be recommended in the early stages of varicose veins as the main type of therapy, supplemented, if necessary, with elastic compression. Pharmaceutical drugs are also prescribed to prepare for surgical treatment or in the post-operative period to speed up rehabilitation and prevent complications.
The following groups of drugs are used to treat vein diseases:
- phlebotonics and angioprotectors;
- anticoagulants and thrombolytics;
- anti-inflammatory and sedative;
- vascular regenerating agents.
For the systemic treatment of varicose veins, venotonics and angioprotectors based on bioflavonoids, rutin derivatives, saponins, etc. are mainly used. . These drugs increase the elasticity and tone of the veins, increase the strength of the blood vessels, improve the outflow of lymph and lower the lymphatic pressure. . If there is a threat of thrombosis, anticoagulants are prescribed. Anti-inflammatories and sedatives are used for complications of varicose veins - inflammation of the veins, severe pain, trophic lesions of the veins.
In addition to systemic ones, local drugs are used - ointments and gels based on venoactive substances, heparin, non-steroidal anti-inflammatory drugs, corticosteroid ointments.
Invasive non-surgical procedures
Vein sclerotherapy is an outpatient medical procedure in which a special substance, a sclerosant, is injected into a capillary or problematic vein using a fine needle. The vessel is then compressed using a latex pad or elastic bandage. The walls of the vessel "stick together", the blood flow in the vessel stops. The attached walls usually grow together, the scar, and the scar resolves. 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 veins and allows the elimination of cosmetic defects. A number of treatments may be required to achieve results.
It is distinguished by a special sclerosant. As with sclerotherapy, a sclerosing substance is injected into the damaged vein in the form of fine foam, which quickly "closes" the affected large veins. The method does not require multiple procedures and gives high results. 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 arteries 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 if conservative methods fail to stop the development of the disease.
Surgical intervention for varicose veins has these goals
- elimination of cosmetic defects;
- reduction of subjective symptoms (pain, burning, paresthesia, feeling of heaviness in the legs, etc. );
- prevention of deterioration of the saphenous veins;
- prevention of bleeding from varicose veins;
- prevention of thrombophlebitis;
- reducing and preventing the development of venous edema;
- reducing the manifestations and preventing the development of hyperpigmentation, lipodermatosclerosis;
- acceleration of healing and prevention of recurrence of venous trophic ulcers.
According to Clinical Guidelines, the objectives of surgical treatment are:
- elimination of pathological vertical and/or horizontal reflux;
- elimination of saphenous veins with varicose veins.
Before performing surgical operations of any kind, the risk of developing venous thromboembolic complications (VTEC) is assessed.
There are several surgical methods that can be used depending on the specific situation:
Venous suturing is the placement of multiple stitches in a damaged vein, which prevent blood flow through the vessel. As a result, blood clots form and the vein gradually degenerates.
It is important to remember that surgery is not a definitive cure, it is the elimination of symptoms. Conservative and life-long treatment is also required after surgery and this should be explained to patients.
Depending on the stage of varicose veins, symptoms, accompanying diseases and general health of the patient, the doctor selects specific recommendations to achieve the maximum possible improvements as soon as possible.