Varicose veins most frequently affect the venous system of the legs. External manifestations (protruding nodular blue veins, swelling) are not just a cosmetic problem, but signs of a serious disease that worsens over time.
What are varicose veins: definition of the disease?
The word "varicose veins" comes from the Latin varix - "swelling. "The name fully reflects the pathological process: the walls of the veins become thinner and in some areas expansions (sac-shaped swellings), nodes are formed.
The first case of varicose veins was recorded in a document from the year 86 BC. BC: Roman general Gaius Marius complained of pain in his legs due to "swollen blue veins. "
The main cause of the development of varicose veins (varicose veins, varicose veins) is an increase in pressure in the system of superficial vessels. This is facilitated by certain diseases, hormonal changes and a sedentary lifestyle.
At first, even under the influence of these factors, the vessels function normally, but gradually they deform, change their structure and can no longer fully transport blood.
Varicose veins can develop almost anywhere in the body, but they appear most frequently in the lower extremities. Therefore, when it comes to varicose veins, by default they refer to the problem of the legs.
Code for varicose veins in ICD-10
The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) includes several types of varicose veins.
I83 - varicose veins of the lower extremities:
- I83. 0 - varicose veins of the lower extremities with ulcers;
- I83. 1 - varicose veins of the lower extremities with inflammation;
- I83. 2 - varicose veins of the lower extremities with ulcers and inflammation.
85 - varicose veins of the esophagus:
- I85. 0 - varicose veins of the esophagus with bleeding;
- I85. 9 - varicose veins of the esophagus without bleeding.
I86 - varicose veins from other locations:
- I86. 0 - varicose veins of the sublingual veins;
- I86. 1 - varicose veins of the scrotum (anatomical formation in men: a receptacle for the testicles and their appendages);
- I86. 2 - varicose veins of the pelvis;
- I86. 3 - varicose veins of the vulva (the external genitals of a woman);
- I86. 4 - varicose veins of the stomach.
O22. 0: varicose veins of the lower extremities during pregnancy.
In our country, 30 million people suffer from various forms of varicose veins. A third of them have complications: trophic ulcers. An open defect in the skin or mucous membranes that occurs due to impaired blood circulation and tissue innervation.
The mechanism of development of varicose veins.
The pathological reactions of the body are the same for all types of varicose veins, regardless of the cause of the problem. Understanding the anatomical features of blood vessels will help understand how and why the disease develops.
How blood moves through the body
There are two types of vessels in the human body: veins and arteries. Blood flows through arteries from the heart to all organs and tissues. This occurs under high pressure (70 to 120 mm Hg) and at high speed.
Blood flows through veins from organs and tissues and is directed to the heart at low pressure (0 to 20 mm Hg).
The walls of veins are less thick and elastic than the walls of arteries and, unlike arteries, do not contain such a developed muscular layer. Therefore, varicose veins are only possible in veins, but not in arteries.
Human arterial and venous circulatory system. Veins are indicated in blue and arteries in red.
Low pressure in the veins is necessary to transport blood from the periphery to the center. But at the same time, on the way to the heart, blood flow encounters an obstacle: the force of gravity. This force forces the blood to return through the veins.
You can often hear that varicose veins are humanity's punishment for walking upright. After all, the longest distance blood must travel in the body, overcoming gravity, is the path from the feet to the heart. The movement of blood through the veins is ensured by heart contractions, muscular pumping of the surrounding muscles and negative pressure in the chest during inhalation.
In healthy vessels, the reverse flow of blood is prevented by valves on the inner walls of the veins. The valves act like one-way swinging doors: they open and allow blood to flow toward the heart and close immediately if gravity tries to force the blood out.
It is not only the valves that help the veins carry blood to the heart, but also the muscles that surround the vessels. By contracting and relaxing, muscles help move blood through the veins. This mechanism only works when a person moves. When standing or sitting for a long time, the muscle pump is practically inactive.
The cusps of the venous valves always face the direction of blood flow: towards the heart.
How failure and illness occur
An increase in pressure in the venous system disrupts the functioning of its valvular apparatus and causes a reverse flow of blood through the vessels. Due to this, as well as stagnation of excess blood, weakness of the valve apparatus (for example, in diseases of the connective tissue), the lumen of the veins expands, the walls are deformed, become thinner and have the shape of a local bag. Bumps (nodes) are formed.
The process is similar to blowing up a balloon: if you don't let the air escape, the balloon inflates more and more.
On the left is normal blood flow; on the right: multidirectional blood flow due to poor functioning of venous valves, vascular deformation
There are superficial and deep veins in the legs. 85-90% of the total blood volume passes through the deep ones, only 10-15% through the superficial ones. The walls of the deep veins are denser and better adapted to the increase in blood volume. And the superficial veins in the legs are thinner and more susceptible to varicose veins.
In the pelvis and lower parts of the esophagus there are large venous plexuses, which can also undergo varicose transformation. In the veins of the small pelvis, the mechanism of development of the disease is the same as in the lower extremities. But varicose veins of the esophagus arise for another reason: due to portal hypertension - increased pressure in the portal vein system, which develops with cirrhosis of the liver, hepatitis, parasitic liver lesions, fatty hepatosis, etc.
Causes of varicose veins
Several factors contribute to the development of varicose veins in the legs. The main ones arevalve insufficiencyANDinheritance. It is known that a quarter of the patients had close relatives who suffered from some form of varicose veins.
Overweight. The more extra kilos a person has, the greater the load on the venous system. Over time, the veins stop supporting that pressure: the lumen of the vessels increases and the valves in their walls stop closing completely. As a result, blood stagnation occurs and varicose veins develop.
Pregnancy. Hormonal changes occur in a woman's body, body weight, intra-abdominal pressure and circulating blood volume increase; This causes an interruption of outflow, causes stretching of the walls of the veins and changes in the functioning of the valvular apparatus.
After childbirth, the diameter of the dilated veins decreases, but does not always return to its original value. With subsequent pregnancies, the risk of developing varicose veins increases.
Age. Varicose veins usually affect people over 50 years of age. The older a person is, the more the venous valves wear out, while the recovery processes slow down and the mechanism of pathological expansion of the veins is activated - the development of varicose veins.
venous refluxVenous reflux Return of blood through the veins due to resistance to blood flow, lat. reflux - "to flow backwards. "It is found between 10% and 15% of schoolchildren aged 12 to 13. The disease "rejuvenates" due to a sedentary lifestyle and excess weight.
Varicose veins of the lower extremities develop more quickly if additional risk factors exist.
Risk factors that contribute to the development of varicose veins in the legs:
- lack of physical activity: when moving, muscles stimulate blood flow through the veins, and without movement, blood circulation in the veins can be difficult;
- smoking - chemicals contained in tobacco smoke damage the walls of blood vessels, as a result their lumen narrows, blood flow becomes difficult and stagnation occurs, which leads to the appearance of varicose veins;
- professions that involve standing or sitting for long periods of time (hairdressers, surgeons, cooks, waiters, drivers and office workers) are at risk;
- menopause - in women 40-50 years old, the production of sex hormones (estrogen and progesterone) decreases and, at the same time, the tone of the venous wall decreases. This increases the chance of having varicose veins.
Women suffer from varicose veins 3 to 4 times more than men. This occurs due to hormonal variability (menstrual cycle, pregnancy, menopause).
During pregnancy, varicose veins can affect different parts of the body: legs, thighs, vulva.
Varicose veins can appear not only in the lower extremities, but also in other parts of the body.
The main causes of varicose veins in various locations.
Varicose veins of the esophagus.
Changes in the veins of the esophagus with an uneven increase in their lumen, protrusion of the wall and the development of nodular tortuosity of the vessels. It often leads to a life-threatening complication: bleeding.
Reasons:
- cirrhosis
- liver cancer
- other diseases that cause increased pressure in the portal vein system - collects blood from the abdominal organs
Varicose veins of the scrotum (varicocele)Pathological dilation of the veins of the pampiniform plexus of the testicle. It is manifested by varicose veins in the scrotum and impaired blood flow.
Reasons:
- Congenital incompetence of the valves of the testicular veins (usually the left one).
- mechanical compression of the testicular vein (inguinal hernia)
Varicose veins of the pelvis.
It is characterized by dilation of the ovarian veins and intrapelvic venous plexuses of various diameters. The condition is also known as pelvic congestion syndrome.
Reasons:
- polycystic ovary syndrome
- two or more pregnancies
- hormonal dysfunction
Varicose veins of the vulva.
Varicose veins of the pelvis, affecting the vessels of the lips and perineum.
Reasons:
- compression of the retroperitoneal vessels by the uterus during pregnancy
- significant physical activity
- tumors of the uterus and ovaries
Varicose veins of the sublingual veins (sublingual varicose veins)
Asymptomatic damage to the veins located under the tongue. It manifests itself as a slight bulging of blood vessels and a color change from deep blue to violet.
Reasons:
- hypertension
- smoking
- old age
Varicose veins of the stomach.
Isolated change in the veins of the stomach or combined with varicose veins of the esophagus.
Reasons:
- cirrhosis
- Portal hypertension syndrome - increased pressure in the portal vein system in other gastrointestinal diseases (neoplastic tumors, thrombosis, anomalies of venous development)
Symptoms of varicose veins
In rare cases, only the aesthetic side of the disease appears - bluish veins. Most patients who suffer from varicose veins in the legs report at least one or more unpleasant symptoms.
Symptoms of varicose veins of the lower extremities:
- fatigue, pain or a feeling of heaviness in the legs - this is caused by stagnation of blood and its pressure on the surrounding tissues;
- burning, tingling or throbbing in the legs - a reaction to slowing blood flow and overflow of the venous system of the lower extremities;
- nocturnal muscle cramps in the legs - painful spasms occur due to blood stagnation and the accumulation of metabolic products in the tissues;
- swelling of the feet and ankles - due to stagnation of the veins, the liquid part of the blood leaks into the subcutaneous tissue through the altered vascular wall;
- Itchy skin around damaged veins: Dilated and altered blood vessels do not provide normal blood circulation and nutrition to the skin, making it dry and rough.
Unpleasant sensations in the legs of patients with varicose veins intensify at night, especially after sitting or standing for a long time.
The appearance of altered veins is not always proportional to the severity of the symptoms. Thus, veins that are barely noticeable to the eye and affected by varicose veins can cause serious discomfort, while nodular and thickened veins can cause minimal concern.
Varicose veins affect different veins: from small skin vessels to large saphenous veins.
The symptoms of other types of varicose veins depend largely on the underlying cause of the disease. Often, patients do not complain about anything and the doctor identifies the problem only during the examination. This occurs, for example, with varicose veins of the sublingual veins.
In some cases, as occurs with varicose veins of the esophagus or stomach, the pathology manifests itself immediately as a potentially fatal complication: bleeding.
Classification of diseases of the veins.
In clinical practice, doctors rely on the international classification of venous diseases - CEAP. This is an abbreviation formed by the initial letters of the main sections of the classification:
- C — clinical (clinical changes);
- E — etiology (origin of the disease);
- A - anatomy (anatomical location of varicose veins);
- P - pathogenesis (mechanism of venous blood flow disorders).
Complications of varicose veins in the legs.
Varicose veins themselves are usually not life-threatening. But sometimes the disease can cause complications.
Thrombophlebitis- inflammation of the walls of the veins, which is accompanied by the formation of a thrombus (blood clot) that closes the lumen of the vessel. It manifests itself as swelling and redness along the affected vein. The patient feels pain, the skin in the affected area becomes red and warm to the touch.
Thrombophlebitis is an inflammatory reaction of the skin and subcutaneous tissue along the thrombosed vein.
Venous trophic ulcer- an open defect of the skin and soft tissues due to blood stagnation, edema and impaired cellular nutrition. The ulcer occurs on the legs and ankles near areas of varicose veins. In the lower legs, the swelling is more pronounced, meaning that the tissues are compressed more than in other areas. Ulcers take a long time to heal and often contain bacteria that increase inflammation.
Trophic ulcers heal very poorly due to problems with blood circulation and tissue nutrition.
Bleeding- occurs when a vein ruptures, dilated due to varicose veins. In the later stages of the disease, the skin covering these veins is very thin and dry; A minor injury is enough for the integrity of the vessel to be compromised and bleeding to occur. Sometimes a spontaneous rupture of a vein occurs in the area of varicose nodes.
Diagnosis of varicose veins of the legs.
A phlebologist deals with the diagnosis, treatment and prevention of diseases of the veins. The doctor makes a diagnosis based on the patient's complaints, examination and instrumental studies. If the symptoms of varicose veins are pronounced, tests are usually not prescribed: a medical examination is sufficient.
The doctor may prescribe laboratory tests in preparation for surgery or to exclude concomitant diseases that affect the state of blood vessels.
One of these diseases is diabetes mellitus. It can significantly worsen the course of varicose veins and increase the risk of complications (especially trophic ulcers).
For accurate diagnosis and determination of treatment tactics, you will need duplex ultrasound - the gold standard for diagnosing vascular conditions. The method allows you to evaluate the structure, function, patency of superficial and deep veins, the consistency of the valves, and also determine the direction of blood flow.
If a secondary nature of varicose veins is suspected (it may occur after deep vein thrombosis), the doctor prescribes venography, CT or MRI.
Phlebography is an x-ray examination used to determine the patency of deep veins and valve function.
Computer or magnetic resonance venography is used to visualize the venous system in a three-dimensional projection and with very high spatial resolution.
Treatment of varicose veins in the legs.
The goal of varicose vein treatment is to reduce or eliminate symptoms, improve the appearance of the veins, and prevent complications.
The doctor chooses the treatment method depending on the affected vessels and the severity of the patient's disease with varicose veins.
Non-invasive treatments
Non-invasive treatments for varicose veins include compression therapy, drug therapy, and lifestyle changes.
Compression therapy involves the use of special socks, stockings and tights. The choice of model, type of fabric and degree of compression depends on the symptoms. The doctor will help you choose the right knitwear.
The compression shirt on the lower legs compresses more than on the upper legs, thus pushing blood towards the heart and eliminating stagnation.
Effects of compression therapy for varicose veins:
- the manifestations of symptoms decrease: heaviness, fatigue in the legs, night cramps, burning sensation or pain;
- the severity of edema is reduced due to better blood circulation;
- Healing of trophic ulcers is accelerated because elastic compression improves blood circulation and tissue nutrition.
Drug therapy: The doctor may prescribe phlebotropics. Phlebotropic drugs (phleboprotectors, venotonics), biologically active substances that increase venous tone and reduce the severity of venospecific symptoms. medications (venotropic).
The main groups of phlebotropic drugs used for varicose veins:
- angioprotectors - improve microcirculation, normalize increased capillary permeability, reduce blood viscosity and the likelihood of blood clot formation;
- antithrombotic agents - reduce the risk of formation of dangerous blood clots (thrombi) in the lumen of blood vessels and promote the dissolution of existing ones;
- bioflavonoids: natural plant compounds that improve venous tone and reduce venous congestion.
Lifestyle changes for varicose veins significantly slow down the development of the disease and, in combination with other recommendations of the treating doctor, help stop the pathological process.
Important directions for changing the lifestyle of patients with varicose veins:
- Moderate intensity exercises: walking, swimming, water aerobics, leg exercises, yoga. Strengthening the muscles will help normalize blood circulation in the vessels, relieve venous stagnation and edema;
- weight control: thanks to the normalization of body weight, the load on blood vessels is reduced and the return of blood through the veins to the heart is facilitated;
- abandon bad habits: nicotine and alcohol damage the internal walls of blood vessels and disrupt the regulation of vascular tone. Quitting smoking and drinking alcohol improves the condition of the veins and the functioning of the valves.
Invasive methods to treat varicose veins.
Invasive treatments include medical procedures that affect the integrity of the skin or mucous membranes. Sclerotherapy is a procedure that uses a special sclerosing solution (sclerosant). The solution is injected into the problem vein through a thin needle, which causes its sclerosis - "sticking". The vein is disconnected from the bloodstream and over time becomes invisible; its function passes into the hands of neighboring veins. Sclerotherapy is carried out without hospitalization; After the procedure, the patient can go home.
The sclerotherapy procedure lasts 5 to 30 minutes, depending on how many varicose veins need to be filled with sclerosant and their size.
Endovenous laser thermoobliteration (EVLO). A catheter with a laser light guide is inserted into the vessel through a small incision. The thermal energy of the laser heats the vein and it is obliterated: "sealed. "After a few months, the vessel is replaced by connective tissue and disappears. The procedure is performed on an outpatient basis.
Radiofrequency vein obliteration (RFO) is the effect of high-frequency current on the inner surface of blood vessels. Through a micropuncture, a catheter is introduced into the vein, which is connected to a device that generates radiofrequency pulses. Inside the glass, the radio wave is converted into thermal energy, which "seals" the vein.
With EVLO, the vein is briefly exposed to high temperature; with RFO, the temperature is lower, but the session is longer. Both procedures are effective and safe.
NTNT obliteration or non-thermal non-tumescent methods:
- venous obliteration with cyanoacrylate glue;
- Mechanochemical obliteration, in which mechanical and chemical effects occur simultaneously in the container.
NTNT obliteration is the most modern and low-traumatic method of treating varicose veins with a short rehabilitation period.
Phlebectomy is the removal of saphenous veins that have suffered varicose veins. It can be performed as an independent operation or combined with other techniques. The varicose vein is removed under local anesthesia using small punctures.
Prevention of varicose veins of the legs.
You can prevent the development of varicose veins if you follow simple prevention rules in everyday life.
A combination of provoking factors (sitting for long periods of time with legs crossed, wearing uncomfortable shoes) increases the risk of developing varicose veins in the legs.
Prevention of varicose veins: what you need to know:
- moderate physical activity (walking, swimming, leg exercises) and rest with legs elevated improves the free circulation of blood through the vessels and helps avoid stagnation in the veins;
- rational nutrition and normalization of weight lead to strengthening blood vessels;
- wearing loose clothing that does not restrict movement helps improve blood circulation;
- a cold shower in the warm season helps keep veins toned;
- comfortable shoes with low heels (no more than 3 cm) allow you to avoid inadequate load on the foot and disruption of blood flow;
- A reasonable approach to visiting saunas and steam baths allows you to maintain normal blood flow (prolonged thermal procedures greatly dilate the veins, which is why blood flow slows down).