Varicose veins in the legs.

Varicose veins in the legs are characterized by the formation of saccular expansions of the superficial (subcutaneous) veins of the lower extremities, their serpentine tortuosity, an increase in length due to impaired blood flow through them, and stagnant changes in the lower extremities.

The term “varicose veins” comes from the Latin word varix, which means “twisted, intertwined.”

Varicose veins have been known to humanity since ancient times.When conducting archaeological investigations during the excavations of the Mastaba burial in Egypt from 1595 to 1580 BC, a mummy was found with signs of varicose veins and being treated for a venous trophic ulcer of the leg.

This disease is rightly considered the price humanity pays for being able to walk upright.On average, about 15% of men and up to 25% of women (including pregnant women) in economically developed countries suffer from varicose veins in the legs.The high-risk group includes women, overweight people, people with a profession that involves prolonged stress on the lower extremities and whose work requires them to stand or sit for long periods of time.

Classification

Taking into account the factors that predispose to the development of the disease, primary and secondary varicose veins on the legs are distinguished for various reasons.

1. Primarydevelops with varicose veins.In varicose veins, it is mainly the superficial veins that change, while the deep veins have normal structure and function.For a long time, varicose veins of superficial veins manifest themselves only as a cosmetic defect, but later, as the disease progresses, disturbances in venous flow occur, which causes painful sensations in the lower extremities, swelling of the feet and legs, darkening of the skin in the lower third of the leg, inflammatory changes and trophic ulcers.Varicose veins are a continually progressive disease.
2. SecondaryIt is a complication of deep vein disease, in particular, it develops as a result of congenital malformations of the venous system (fistulas, congenital dysplasia, etc.) or after suffering from phlebothrombosis.Phlebothrombosis is a complex process of thrombus formation in the deep main veins of the lower extremities, as a result of which blood flow through the deep veins is disturbed.Over time, the forming blood clot becomes fixed in the vein, holes appear through which limited blood flow is possible, but the venous valves at the site of the blood clot become scarred and no longer prevent the reverse flow of blood.As a result of dysfunction of the valves of the deep veins, blood begins to rise and fall through them, returns to the superficial veins, and secondary varicose veins develop.As a result, favorable conditions are created for venous stagnation, especially in the lower parts of the limb - the foot and lower leg.

Symptoms of varicose veins

In most people, varicose veins appear as a cosmetic defect and most often appear on the inner surface of the legs.Sometimes varicose veins can only appear in the form of a venous network, which is formed when small-diameter veins change, most often in the legs and less often in the face or upper extremities.Varicose veins take on a dark blue or purple color and have a tortuous course.

Symptoms of varicose veins: fatigue, feeling of heaviness, intense pain, burning and tingling sensations, shooting, itching, cramps and anxiety.Additionally, one of the symptoms may be the appearance of swelling in the legs.As a result of a pronounced expansion of varicose veins, a violation of the blood supply to the tissues of the lower extremities may develop, skin defects may appear in the form of darkening or redness and inflammation.In extremely advanced cases of varicose veins, trophic ulcers develop.

Diagnosis of varicose veins.

To establish a diagnosis, the doctor first examines the patient, paying special attention to the appearance and swelling of the lower extremities.You may also be asked a series of questions about your sensations to clarify the nature of the pain.Another important step is to perform a series of tests to evaluate the functional status of the superficial and deep veins.And finally, perform a Doppler ultrasound examination of the main veins of the lower extremities.The ultrasound examination method allows the doctor to see the structure and evaluate the function of the veins of the lower extremities, as well as identify venous blood clots.

When the first symptoms of the disease appear, it is advisable to contact doctors who deal with diseases of blood vessels and veins in particular (general surgeon, vascular surgeon and phlebologist), and if the skin is damaged, it is also advisable to visit a dermatologist.Only after visiting specialist doctors on their recommendation can you go to a cosmetology clinic.

Prevention of varicose veins

Currently, there is no method that completely prevents the development of varicose veins.Thanks to prevention, it is possible to improve muscle tone, which helps to improve microcirculation in the tissues, as well as improve the condition and function of the veins in the lower extremities, and reduce the risk of complications.The traditional and most widespread prevention methods are the following:

1. Physical activity.Move more.Your legs must be in constant movement.During a walk, more favorable conditions are created for blood circulation in the lower extremities.Consult your doctor.He will help you choose the most optimal type and level of physical activity.
2. Control your weight.Being overweight increases the load on the circulatory system and, in particular, on the veins.In addition, with excessive salt consumption, edema increases more pronounced as a result of fluid retention in the body.
3. Pay attention to what you use.Avoid high heels.Your shoes should always be comfortable.When wearing low-heeled shoes, the muscles of the lower extremities work much better, which helps to improve venous flow.You should also avoid wearing uncomfortable, tight pants and skirts.
4. Raise your feet.When you raise your legs, venous blood flow to the lower extremities improves.Try to take a few breaks throughout the day and put your feet up.For example, lie on your back with your feet on a pillow.
5. Avoid prolonged periods of standing or walking.To improve blood circulation, try to change your body position as often as possible.Try to get up and walk every 30 minutes.
6. Don't sit cross-legged.Sitting cross-legged creates unfavorable conditions for blood flow in both lower extremities.

To prevent varicose veins, a good remedy is to wear stockings, knee-high socks and socks with a compression effect.It can also be a good addition to the main treatment (medication or surgery).These days, pharmacies offer a wide range of compression garments to choose from.

Treatment of varicose veins

There are several generally accepted methods of treating varicose veins in the legs:

1. conservative (medication and compression therapy).
2. surgical.

Conservative treatment

The most effective conservative means of treating and preventing varicose veins, doctors consider elastic compression to be the use of special compression stockings (stockings, golf, pantyhose).When wearing this knitwear, uniform pressure on the lower extremities is ensured, which promotes normal blood circulation and improves its outflow, while forming, as it were, an outer frame that supports the weakened vascular walls.As a result, the load on the veins is reduced, the outflow of venous blood is improved, the rate of further progression of the disease is reduced, and the risk of developing thrombosis is reduced.

Modern compression stockings are divided into two types: therapeutic and preventive.Each medical product is marked in mmHg, according to which it is divided into classes from I to IV.At different stages of the disease, compression of a certain force is used and it is necessary to consult a doctor, since only a doctor can prescribe and select the correct compression stockings, taking into account the nature of the pathology and in accordance with certain individual standards.

If you have a sedentary lifestyle, as well as during prolonged physical activity, during pregnancy or with a hereditary predisposition, the use of preventive compression stockings and tights is recommended.If even minor signs of varicose veins appear, you should immediately contact a specialized clinic.

Drug therapy can reduce the clinical manifestations of the disease (pain, swelling, discomfort, cramps, etc.), but cannot completely stop the progression of the disease and today is used only as part of complex therapy during the main surgical treatment.Unfortunately, most of the drugs currently offered on the pharmaceutical market for the treatment of varicose veins have a rather low effectiveness, despite the theoretically justified feasibility of use.One of the reasons for this is the low absorption by the body of the medicinal substances underlying these medications.It is possible that increasing the dose of the medication taken would help in this situation, but this is associated with an increased risk of complications and side effects.Another reason for the low effectiveness of these drugs is that their spectrum of action is relatively narrow and is directed at a particular link involved in the development and progression of the disease.And to achieve the optimal effect, a complex effect on the disease and the use of several drugs is necessary.An ideal drug for the treatment of venous insufficiency and varicose veins should affect as many pathogenic links of chronic venous insufficiency as possible, while having a minimum number of side effects and being well absorbed by the body.

Surgical treatment

Today, surgical treatment of varicose veins of the legs does not require a long hospital stay.Thanks to the use of modern invasive treatment methods, the removal of varicose veins can be performed not only under anesthesia with the patient completely disconnected, but also under local anesthesia, when the patient is fully conscious, only the pain sensitivity of the lower extremities is deactivated.Varicose veins disappear on their own within 3 months after childbirth without any treatment.

The following surgical treatment methods are available:

1. Sclerotherapy.During this procedure, a solution is injected, under the influence of which a scar forms at the site of the damaged vein.This method is applicable only for small and medium-sized varicose veins.Sometimes, not one, but several injections of a sclerosing solution may be necessary for the vein to disappear completely.Sclerotherapy is quite effective when performed correctly, it is low-traumatic, produces good therapeutic and cosmetic effects and a significant advantage is that sclerotherapy is performed under local anesthesia (that is, without anesthesia), directly in the doctor's office.
2. Laser surgery.Laser radiation can be used to remove varicose veins of any diameter and, in particular, venous meshes.The essence of the method is to irradiate the inner surface of the vein with a laser beam.Through a small puncture in the skin and the wall of the vein, a special device is inserted - a light guide through which a laser beam is passed under ultrasonic control.The inner surface of the vein is irradiated with a laser and then glued.When this method is used, the doctor points a laser beam at the vein that needs to be removed, the vein slowly discolors and disappears completely.An important advantage of this method is that no incision is made in the soft tissue or skin.Using the laser method, it is possible to remove damaged veins and heal trophic ulcers of the lower leg.
3. Surgical removal of varicose veins.During surgical removal, a series of small incisions are made in the skin and soft tissues, through which the damaged vein is removed and the insufficient perforating veins in the leg are ligated.When using this technique, anesthesia is a necessary condition.This method is used to remove large varicose veins.
4. Outpatient phlebectomy (varicose vein removal).This method is suitable for removing small diameter veins.With this method, the vein is removed through several small incisions in the skin under local anesthesia.The scars that form after removal are small and almost invisible.
5. Endoscopic removal of varicose veins.This method is especially suitable for the formation of skin defects in the form of ulcers.During this method, a special micro video camera is inserted into the glass, which allows you to view it from the inside and observe the entire extraction procedure.The vein is then removed under observation through this camera.

Thanks to the use of modern treatment methods, it is possible to achieve complete healing and a good cosmetic effect.But it is worth remembering that varicose veins can appear again.

Complications of varicose veins.

Occasionally, changes from pronounced darkening to ulcerative skin defects may occur in the skin around varicose veins as a result of impaired blood microcirculation.If these changes occur, you should consult a doctor immediately.

Another more serious complication of varicose veins is the development of blood clots in the deep and superficial veins.This complication is called thrombophlebitis.When this occurs, unbearable sharp pain, swelling and redness appear.In this situation you should also consult a doctor immediately.

Causes of varicose veins

The true nature of varicose veins is not clear enough.According to most scientists, varicose veins are hereditary and genetically determined.Its main cause is weakness of the venous wall and dysfunction of the venous valves.Venous valves originate in the wall of the veins and normally have 2 leaflets facing the heart.With normal closure of the valves, blood from the overlying section of the vein cannot penetrate into the underlying section.When valve function is impaired and the valves do not close completely, blood rises and falls, causing venous stagnation and dilation of the veins located under the valve with impaired function.Initially, a varicose vein appears in the place where there is a valve with impaired function, and blood is discharged in the direction from the deep veins to the external ones, the overfilled vein stretches and expands, which leads to stretching and disruption of the function of the underlying valve, etc.Disturbances in the venous flow of blood from the lower extremities to the heart gradually develop, as a result of which blood microcirculation in the tissues of the lower extremities is disturbed, which is manifested by edema, increased pigmentation, thrombophlebitis and trophic ulcers.

Factors in the development of varicose veins.

Factors that contribute to varicose veins may include:

1. Genetic predisposition – thin, weak wall of the superficial veins.
2. Increased load on the veins: sedentary work, prolonged standing, wearing uncomfortable shoes with high heels, lifting heavy objects, lack of movement of the muscles of the lower leg.Additionally, a triggering factor for the development of varicose veins is pregnancy and childbirth.With sudden physical exertion, a sharp increase in hydrostatic pressure occurs in the veins of the lower extremities, which triggers the process of varicose veins.

Risk factors for developing varicose veins also include:

1. Age.With age, the wall of the veins, as well as the valves, become thinner, which leads to a natural impairment of their function.
2. Floor.Women are more likely to suffer from varicose veins.This may be due to a series of hormonal reactions.Female sex hormones influence the relaxation process of the venous wall.Pronounced hormonal changes occur in the female body during pregnancy and childbirth, during the menstrual cycle and during menopause, which cannot but affect the functioning of the venous system.It is also impossible to exclude the effect of taking hormonal contraceptives on the process of varicose veins.
3. Obesity.With overweight and obesity, the load on the veins of the lower extremities increases.
4. Pregnancy and childbirth.In pregnant women, the volume load on the body increases, but at the same time the speed of blood outflow from the lower extremities to the pelvic cavity to the inferior vena cava system and to the heart decreases.In this way, favorable conditions are created for the development of varicose veins.Changes in the circulatory system of a woman's body ensure the development of the fetus, but at the same time provoke the development of varicose veins.As pregnancy progresses or during childbirth, varicose veins can progress not only in the lower extremities, but also in the hemorrhoidal veins around the anus.