Varicose veins, varicose veins, varicose veins
- uneven increase in the lumen and length of the veins,
- the formation of nodes in the area of vein thinning due to pathological changes in the vein wall, thinning, stretching, decreased tone and elasticity,
- insufficiency of venous valve function and impaired blood flow.
Varicose veins are a fairly common disease. Varicose veins and their complications are diagnosed in 25% of the population, with women suffering 2-3 times more often than men. In women, the first signs of the disease are often observed at a young age, most often associated with pregnancy and childbirth. At older ages, there is an increase in incidence in men and women, and the frequency of complicated forms increases. At the age of 70, this disease occurs 6-10 times more often than at the age of 30. However, recently, the manifestation of varicose veins is often observed in very young people, even teenagers. Therefore, identifying all possible causes of the disease and preventing venous disorders becomes an increasingly urgent task.
How varicose veins arise and develop
To understand how varicose veins occur, let's briefly explain the physiology of the venous system in the lower leg. Venous outflow in the legs 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 function of the venous system in the lower part that surrounds the muscle vessels and tissues.
Early signs of varicose veins are impaired capillary circulation, swelling, heaviness in the legs, the appearance of spider veins and spider veins. These changes can be reversed, but if preventive measures are not taken in time, the problem will increase.
As a rule, more than a year passes from the initial signs of varicose veins on the lower legs to the formation of varicose nodes and the appearance of obvious varicose vein symptoms. Developing gradually, varicose veins lead to impaired blood flow and chronic venous insufficiency. Blood stagnation in the veins can cause 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 veins). skin), trophic ulcers.
Types and forms of varicose veins
There are primary (true) and secondary (symptomatic) varicose veins.
Primary varicose veins are independent diseases of the venous system (varicose veins). It develops gradually over several years. Most often, varicose dilatation of the great saphenous vein is 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 symptoms and consequences of diseases in which there is an obstruction to the outflow of blood through the veins in the lower part of the leg (post-thrombotic disease, tumors, scars, inflammatory processes, aplasia and dysplasia of deep veins, arteriovenous). fistula, etc. ). Secondary varicose veins are relatively rare.
Most often, varicose veins affect the saphenous vein in the lower leg, which is part of the great saphenous vein system. Branches of the small saphenous vein develop varicose veins more rarely.
Classification of varicose veins
Until recently, in our country, doctors classified varicose veins according to several types of classification. V. S. Savelyev's graded clinical classification is used, reflecting the degree of venous circulation disorders in the limbs and the body's ability to withstand this disorder and compensate for it, as well as classification according to the form of varicose veins and the complications caused by them.
But the main one at the moment is the CEAP international classification, based on the clinical (C - clinical), etiological (E - etiology), anatomical (A - anatomy) and pathogenetic (P - pathogenesis) characteristics of the disease.
6 clinical classes ("C") arranged in increasing disease severity from telangiectasias (TAE) to trophic ulcers.
The etiology section ("E") indicates whether the process is primary or not.
The anatomical part of the classification ("A") divides the venous system of the lower leg into 18 relatively separate segments, which makes it possible to show the localization of the affected areas of the venous system.
The pathophysiological portion ("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. at the level of changes in blood vessels and disorders of the venous system. Depending on the stage, a prognosis for the further development of the disease can be given.
Early stages of varicose veins - stage 1 varicose veins
In the early stages, when the vein pathology has not been clearly defined, visible signs of varicose veins may not be present. Patients complain of heaviness and discomfort in the legs, fatigue too quickly, feeling hot, paresthesia (numbness, burning, tingling). Symptoms worsen towards the end of the day, as well as under the influence of heat - in summer, or when wearing warm shoes indoors in winter. Swelling appeared in the feet and ankles, which disappeared after a short rest. Sometimes, calf muscle cramps at night are possible, but patients associate them with overwork.
After prolonged physical activity, veins swell and their network is easily visible through the skin. They are especially noticeable on the thighs, lower legs and feet. The number of such veins and their degree of expansion may vary. This may be a single and not very noticeable formation on the bottom of the leg, appearing more clearly in the evening or after physical activity. Also at this stage of varicose veins, the appearance of spider veins is observed.
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 2nd degree, compensation stage
At this stage of the disease, changes in the large subcutaneous vessels become noticeable. The veins become deformed, swollen, the outflow of blood is disturbed, and significant swelling appears in the legs and ankles. Swelling increases with prolonged physical activity in the legs, but disappears after a night's rest. At night, cramps in the calf muscles are common. Paresthesia is observed - temporary loss of sensitivity in the legs, numbness of the legs, burning, "goosebumps". As the disease progresses, pain appears, which increases in the evening.
This stage of subcompensation, as a rule, lasts several years, and during this time the progression of the disease can also be stopped if treatment is started on time. Otherwise, the disease will definitely progress to a worse stage.
Varicose veins symptoms of the 3rd stage - decompensation stage
At this stage of varicose veins, there is a significant increase in symptoms, pain, heaviness in the legs is more intense, and there are disturbances in peripheral blood and lymph circulation (chronic venous insufficiency). The swelling does not go away even after a long rest and spreads to the lower part of the leg. The patient is bothered by itchy skin. The skin on the feet becomes dry, loses elasticity, the skin is easily injured, loses the ability to quickly regenerate, 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 legs (hyperpigmentation due to subcutaneous bleeding).
All these complaints persist. In the future, complaints of pain in the heart area, shortness of breath, headache, and deterioration in the musculoskeletal function of the affected limb may appear.
Although the level of decompensation is already a very significant manifestation of the disease, with appropriate treatment, the patient's condition can be maintained at a satisfactory level for a relatively long time, maintaining the ability to work and preventing the transition to the complication phase.
Varicose veins of the 4th degree - complication level
This phase of the disease is characterized by obvious venous circulation disorders. Swelling of the legs becomes almost constant, itching of the skin intensifies, and trophic disorders appear on the skin of the lower part of the legs. Advanced varicose veins are often accompanied by eczema, dermatitis, and long-term injuries, and because the regenerative abilities of the skin with varicose veins are significantly reduced, even small wounds can develop into persistent trophic ulcers. Thinned skin and vein walls are easily injured, resulting in profuse bleeding. Damaged soft tissue and open ulcers become entry points for infection.
The most common complications of varicose veins:
- phlebitis - inflammation of veins;
- thrombosis - the formation of a blood clot (thrombus) in the vein, which can cause blockage of the vessel;
- tropic ulcers - formed in places where the affected veins cannot provide sufficient blood outflow from the skin, as a result of which tissue nutrition (trophism) is disturbed.
Varicose veins can be complicated by acute (sometimes purulent) thrombophlebitis.
It is not 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 on the lower legs. 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 wall of blood vessels and dysfunction of the venous valves.
What caused this violation?
You can often find the fact that one of the most important physiological reasons for the development of diseases such as varicose veins is upright posture. Indeed, in humans, by nature, the load on the vascular system of the lower leg is very high. The flow of blood from the veins and up to the heart is impeded by the pressure caused by gravity, as well as the high pressure in the abdominal cavity. However, not everyone has varicose veins. What factors trigger the development of varicose veins?
It has been established that the main risk factors for the development of varicose veins are:
- genetic predisposition (heredity) - congenital weakness of the venous wall, venous valve disorders;
- female gender - women suffer from varicose veins 4-6 times more often than men;
- hormonal disorders;
- hormonal contraceptives;
- pregnancy, especially multiple pregnancies;
- heavy physical activity (heavy physical work, strength sports);
- conditions and diseases that lead to increased intra-abdominal pressure (chronic respiratory diseases, constipation, etc. )
- diseases that negatively affect blood vessels (high blood sugar, diabetes, pressure spikes, etc. );
- work characteristics - standing or sedentary work, sudden changes in temperature, prolonged contact with high or low temperatures;
- overweight, obesity, which causes increased pressure on the legs and increased pressure in the pelvic area;
- lack of vitamin C and other beneficial substances necessary for the vascular system;
- inactive lifestyle, bad habits that destroy blood vessels and create additional tension in them.
Diagnosis of varicose veins
Diagnosing varicose veins is usually not difficult. Clinical examination, including physical examination (examination and palpation), patient survey, collection of complaints and anamnesis (information about the course of the disease, characteristics of life and work, past and current diseases) for severe varicose veins usually make it possible to make a diagnosis without an examinationinstrumental. An exception is the situation when, with excessive development of subcutaneous fat tissue on the lower part of the leg, varicose changes may be difficult to notice.
Currently, duplex ultrasound scanning (USDS) has been widely used to study the veins of the lower leg. This method allows you to determine the localization of changes in the vein and the nature of the disturbance in venous blood flow. However, you should know that the results of an ultrasound scan are largely subjective and largely depend not only on the experience and knowledge of the researcher, but also on the tactical approach to the treatment of venous diseases adopted in certain medical institutions. When determining treatment tactics, they are guided primarily by clinical examination data.
Duplex scanning is performed when planning invasive treatment of varicose veins on the lower leg. 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 disturbances in venous hemodynamics, to evaluate the effectiveness of 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:
- eliminate or reduce the severity of symptoms that cause certain discomfort in the patient - pain, swelling, cramps;
- restoration and improvement of blood vessel function - from capillaries to deep veins, improving valve function, restoring damaged vascular walls, increasing their elasticity and strength;
- improve the rheological properties of blood, reduce its viscosity;
- improve the function of the lymphatic system.
- prevent further development of diseases and complications;
- improve the patient's quality of life.
Depending on the stage of the disease and the degree of vascular damage, the doctor may prescribe the most optimal treatment method for a particular condition, such as:
- conservative treatment– recommendations for prevention and lifestyle changes, pharmacotherapy, compression therapy;
- non-surgical invasive procedures- sclerotherapy, echosclerotherapy, foam sclerotherapy (foam therapy), etc. ;
- surgery- phlebectomy, heat removal, stripping, combined methods and operations that increase the complexity for complications of varicose veins and treatment of trophic ulcers on the lower legs.
This method makes it possible to improve blood circulation in the lower part of the legs, including microcirculation, eliminate many cosmetic defects caused by varicose veins, and relieve patients from most of the painful pathological manifestations.
Conservative methods of treating varicose veins
Modern conservative therapy for varicose veins provides an integrated approach to treatment and includes several areas:
- lifestyle change;
- pharmacological therapy;
- compression therapy.
It is no coincidence that lifestyle changes are prioritized. It is necessary, if possible, to eliminate sludge at least to reduce the influence of unfavorable factors.
One of them is long-term static load in a standing or sitting position, which leads to blood stagnation. To activate the muscle-vena pump of the lower leg, you need to regularly stretch your legs and walk more. While working, you can periodically perform exercises with the contraction and relaxation of the muscles of the lower leg alternately (raising your 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 bike, treadmill, swimming, cycling and walking).
If you have varicose veins, you should not heat your legs; you should refuse to visit the bathhouse and sauna.
Varicose vein patients need to monitor their weight. It is known that with a body mass index of more than 27 kg/m2the possibility of varicose veins increases by 30%. Being overweight is often associated with high sugar levels, which leads to problems with the healing of venous ulcers and the risk of recurrence.
The effectiveness of compression therapy is explained by the possibility of reducing reverse blood flow, some reduction in the pathological capacity of dilated veins, which leads to a decrease in swelling, better capillary blood flow and a decrease in varicose symptoms.
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. Pharmaceuticals are also prescribed to provide surgical treatment or in the postoperative period to speed up recovery and prevent complications.
The following groups of drugs are used to treat vein disease:
- phlebotonics and angioprotectors;
- anticoagulants and thrombolytics;
- anti-inflammatory and pain relievers;
- vascular regeneration agent.
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 veins, increase the strength of blood vessels, increase lymph outflow and reduce lymph pressure. . If there is a threat of thrombosis, anticoagulants are prescribed. Anti-inflammatory and painkillers 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 ingredients, heparin, non-steroidal anti-inflammatory drugs, corticosteroid ointments.
Non-surgical invasive 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 thin needle. The container 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 glued wall usually grows together, scars, and scars disappear. Used to treat varicose veins of small superficial veins. This method is effective in the early stages of the disease, only in cases where varicose veins are localized only in small veins, and allows cosmetic defects to be eliminated. A series of treatments may be required to achieve results.
It is distinguished by a special sclerosant. Like sclerotherapy, a sclerosing substance is injected into the damaged vein in the form of a fine foam, which quickly "closes" the large affected vein. This method does not require many procedures and gives high results. It is important to know that the procedure - although rare - may have a side effect - visual impairment. It is also dangerous for the sclerosant to get into the arteries and nerve tissue. This procedure should be performed by an experienced phlebologist.
Absolute contraindications for sclerotherapy - drug allergy, deep vein thrombosis, pregnancy, breastfeeding
Surgical treatment of varicose veins
As a rule, surgical treatment is recommended in severe, advanced cases, and also if 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, heaviness in the legs, etc. );
- prevention of deterioration of the saphenous vein;
- prevention of bleeding from varicose veins;
- prevention of thrombophlebitis;
- reduction and prevention of the development of venous edema;
- reduction of manifestations and prevention of 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 varicose saphenous veins.
Before performing a surgical operation 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 several stitches on a damaged vein, which prevents blood flow through the vessel. As a result, blood clots form and the veins gradually deteriorate.
It is important to remember that surgery is not the final cure, it is the elimination of symptoms. After surgery, conservative treatment is also required, and for life, and this must be explained to the patient.
Depending on the stage of varicose veins, symptoms, concomitant diseases and general health of the patient, the doctor chooses specific recommendations to achieve the maximum possible improvement as soon as possible.