Lower extremity varicose veins in modern medicine

Modern healthcare faces many different challenges, but despite rapid advances in medicine, there are diseases that continue to affect millions of people. Varicose veins on the lower part of the legs ICD 10 - I83 is just such a problem that can be said not to be solved over time.

Prevalence in numbers

This disease has spread in various developed countries, such as the United States, France, Belgium, Germany, and others. The number of patients with this diagnosis is almost a quarter of the population of each country.

Half of all patients are over 55 years of age, but the other half are healthy workers, most often working in manufacturing. When any VD disease develops, complications form, patients lose their jobs due to disability, so the problem becomes not only medical, but also economic and social. The occurrence of varicose veins can be related to the age of the patient. In people over the age of 70, varicose veins on the lower legs are more common than in people before retirement age.

In four out of a hundred patients over 80 years of age, varicose veins take on a form aggravated by concomitant pathology, in the form of trophic ulcers, various dermatitis or eczema. Also at this age, other diseases of the cardiovascular and bronchopulmonary systems occur, thereby excluding the possibility of surgical intervention.

Important!At the first symptoms of the disease, it is better to consult a doctor; the younger the patient, the lower the risk if surgical treatment is required.

The origin of the disease

Despite the fact that the disease develops gradually, there are still etiological factors for the development of varicose veins.

So, what are the causes of varicose veins:

• descent;
• endocrinological reasons;
• mechanical factors;
• infection;
• drunk;
• non-specific inflammatory process;
• factors that contribute to venous hypertension.

Complaints and symptoms

Surprisingly, at the beginning of the disease, visible disturbances appear, which are often ignored. Considering the defect of small vessels as a small external disturbance that will "disappear by itself", the patient provokes the development of the disease.

Further symptoms develop progressively:

• feeling tired / heaviness in the legs;
• swelling in the leg area;
• night cramps;
• numbness, tingling, "pins and needles" sensation;
• pain in the varicose vein area.

Diagnosis of varicose veins is an important condition at any stage of the disease

Diseases at any stage require diagnosis; it is the diagnosis that suggests the most acceptable treatment option for the patient. Clinical and instrumental diagnostic methods are used in tandem. Depending on the course of the disease, all methods or only some of them can be used.

Clinical examination methods - examination and conversation

Clinical methods are used not only for varicose veins, but also for any other diseases:

1. History taking. Anamnesis includes all the basic facts about his life (age, heredity, bad habits, type of main occupation).
2. Definition of complaint. Complaints may indicate how many varicose veins have developed at the time of examination. The duration of the illness is an important condition. When do the first symptoms of foot disease appear?
3. Inspection.During the examination, the doctor should pay attention not only to the blood vessels, but also to the condition of the skin, to exclude the presence of complications and concomitant pathologies. It is also important to determine the degree of damage, the temperature at the location of the varicose veins, as well as the tension and elasticity of the vessel.

A phlebologist is the first doctor who should see your feet.

Instrumental examination method is a prerequisite

To prescribe treatment, one examination will not be enough. Varicose veins on the lower legs require mandatory instrumental diagnosis. During the instrumental research method, the focus of the varicose lesion, the length of the damaged vessel, the insufficiency of the venous valve, the speed of blood flow, etc. are determined.

this:

1. Ultrasound.A standard B-mode study provides a complete picture of the anatomical structure and location of vessels, as well as those adjacent to them. Ultrasound also reveals the pathology of the vein wall.
2. Doppler ultrasound. The study determines the speed of blood flow, thereby identifying valve pathology in the vessel.
3. X-ray contrast venography. A more complex type of diagnosis uses x-rays. This procedure is rarely used due to the possibility of complications.
4. Computed tomography venography. It is carried out in the same way as X-ray contrast, with the introduction of a contrast agent into the lumen of the vessel. CT images, unlike X-rays, are three-dimensional.
5. MRI.This method is reasonable and informative, and is carried out without the administration of contrast or other drugs. However, this method is still expensive, so it is rarely used.

Notes!In patients with an allergy to iodine, contrast agents should not be given, in which case MRI may be necessary.

Diagnosis according to classification

Like other diseases, varicose veins are divided into several classes, taking into account many factors:

External manifestations	Telangiectasia; Varicose veins; Edema; Hyperpigmentation; Ulcers in the healing stage; The ulcer is in an active stage.
Cause of disease	Congenital; The etiology is unknown; Acquired (injury, etc. ).
Anatomical location of veins	superficial; In; Separately, perforated varicose veins are distinguished.
Mechanism of disease	Throwing into a nearby ship; Obstruction of venous blood flow.

The most common reason for contacting a specialist is grade 2 varicose veins on the lower legs, when the external manifestations of the disease become noticeable. Perhaps, if the disease does not manifest itself externally, then the detection of varicose veins will occur at a later stage.

Notes!The concept of "internal varicose veins of the lower leg" is used only colloquially, which means deep varicose veins, which can only be diagnosed by instrumental methods.

To treat or not to treat, that is the question

The gradual development of the disease sooner or later leads the patient to the idea that treatment is necessary. Often the doctor's task is to convince the patient to start treatment at an early stage of the disease. The direction of treatment can be different and depends on many factors (age, symptoms, stage of the disease, etc. ).

Therefore, treatment can be aimed at:

• improve quality of life; cosmetic surgery intervention.
• prevent complications; effect on microcirculation.
• elimination of symptoms; significant hemodynamic treatment.

One way or another, treatment is always chosen by a specialist (phlebologist, vascular surgeon). In the treatment of varicose veins, complexity is important, so you should not limit yourself only to surgical intervention, or only therapeutic and preventive physical exercises. It is important to follow all the doctor's instructions.

Lifestyle Tips

Varicose veins oblige the patient to leave factors that trigger complications. Sometimes such measures are necessary, because untreated varicose veins greatly affect the quality of life.

Self-treatment is a useless exercise, however, you should pay attention to your lifestyle so that varicose veins do not develop so quickly.

What to do for varicose veins:

• Women should give up high-heeled shoes;
• Leave bad habits, especially smoking;
• Move, if you have to sit or stand for a long time, then try to change your position;
• Avoid tight/tight clothing and shoes;
• Avoid exposure to high temperatures (sunbathing, hot candles, baths, saunas);
• Control your weight;
• Do not lift heavy objects;
• Contrast shower;
• Walk, run, swim more often;
• Keep your legs elevated whenever possible (sleep, rest).

Compression therapy

Regardless of etiology, patients with varicose veins should wear medical knitwear or wear elastic bandages.

1. The use of knitwear is the easiest; socks or knee socks, made of special materials, usually do not cause difficulties. The level of compression of medical socks should be recommended by a doctor. The only downside to compression garments is their price.

   Notes!Brands of medical knitwear manufacturers may vary, so you need to choose carefully. Make sure the elastic on your knee socks or stockings is not too tight.

2. Alternatively, patients often prefer to use short, medium or long stretch elastic bandages. The choice of distensibility also depends on the stage of the disease and should be recommended by the doctor. The first few uses may be a bit difficult as you have to control the tension level of the bandage yourself.

Compression therapy is used every day, wearing underwear or bandages greatly relieves the burden on the legs throughout the day.

Physical education and sports as treatment

Varicose veins require movement, so therapeutic and preventive physical education is an important component. Of course, it is better not to do exercises blindly, but choose a set of exercises with an expert. Some medical institutions offer group exercise therapy classes.

Often, exercise therapy exercises do not require special training and are available regardless of age; for clarity, a set of exercise therapy exercises:

• Tighten and relax the thigh muscles (10 times);
• Inhale, lift the abdominal wall, exhale, pull the abdomen (4 times);
• Bend and straighten your leg at the ankle (10 times);
• Inhaling, raise your arms up through the sides, while exhaling, lower them (4 times);
• Bend and straighten your toes (15 times);
• Raise your arms up as you inhale and lower as you exhale.

Even from this small set of exercises it is clear that anyone can do it, regardless of age. It is important to take your time and do everything slowly, without holding or speeding up your breathing.

Athletes can also perform this set of exercises before the main exercise. It is especially important if the patient engages in any sports that are not recommended for varicose veins.

Sports, as an alternative to exercise therapy for varicose veins on the lower legs, are also suitable, but you need to consult a doctor and a personal trainer. Some exercises need to be excluded from training.

Athletes are sometimes forced to leave their professional careers, especially in jumping, powerlifting, and heavyweight boxing. Those who like to swim, run and walk, in turn, can continue to do this.

Medicines, after prescribed by a doctor

Pharmacological objectives in the treatment of varicose veins are different, namely:

• increased vein tone;
• correction of microcirculation;
• increased lymphatic drainage;
• prevention of thrombotic complications;
• suppression of the development of complications.

That is why all medicines must be prescribed by a doctor. It is in this vein that there is a guarantee of successful resolution of the disease.

Treatment with drugs is used at different stages: when preparing the patient for the upcoming operation, in the postoperative period, as well as in cases of clear contraindications to surgery. Medicines can be systemic or local and used simultaneously and separately.

Phlebosclerosing treatment

Phlebosclerosis also refers to pharmacological treatment methods, however, its use is often inappropriate, because the positive effect does not apply to all patients. For the most part, this method is used for correction in an aesthetic sense.

It should be noted that the use of this method is fraught with relapses and complications, so the procedure is performed by a surgeon who has undergone special training.

Physiotherapy in the treatment of varicose veins

Physiotherapeutic methods are not the main ones in the treatment of varicose veins, but are successfully used to relieve the symptoms of the disease. D'arsonval, electrophoresis, barotherapy, magnetic therapy for varicose veins on the lower legs are used only under the supervision of a doctor, because any physiotherapy has some indications and contraindications.

All physiotherapy procedures are not used continuously, but in a course of 10-20 days. In most cases, physiotherapy provides a delay in the development of the disease, but is not the main treatment method, and certainly cannot be used as monotherapy.

Surgical treatment

Although there are many methods of therapy, surgery remains the most basic and important practice. Vascular surgeons perform successful operations on many patients.

Traumatic venectomies became a thing of the past when modern minimally invasive methods became available. Brunner's approach, Müller's dissection and mini-phlebectomy with a Varadi hook all simplify the management of patients with varicose veins and often take place within a day.

Of course, there are also contraindications for surgical intervention; the main group is patients over 75 years of age who show tissue trophic disorders, microcirculation and/or lymphatic drainage disorders, or excessive lesions on venous vessels. There are special instructions for carrying out operations on such patients. Sometimes you have to leave the operation altogether, and sometimes the doctor still operates through combined phlebectomy.

Drug treatment

The treatment regimen for varicose veins is determined by the doctor. For this, conservative methods and surgical methods are used, all depending on the stage of development of the disease, as well as the presence of complications.

The simultaneous use of drugs and ointments allows you to relieve pathological symptoms and achieve good results in treatment. Currently, there is a large selection of drugs on pharmacy shelves, they are effective in combating pathology in the early stages of its development.

Drug treatment for varicose veins in the legs is effective.

Important!Only a doctor can prescribe the drug, dosage and course of its use.

Sclerotherapy

Sclerotherapy is one of the best ways to treat varicose veins today. A specially given medicine allows you to destroy the stagnation of veins inside. After some time, it will begin to stick and dissolve, and blood circulation will be transferred to healthy veins.

Treatment is carried out in courses, which include up to six sessions for each sore leg. You can see positive results no earlier than two weeks. However, patients should be prepared to experience pain and tingling.

Soon the unpleasant symptoms will disappear, the diseased veins will disappear. The dosage of the drug is selected taking into account the individual characteristics of the patient.

Complications and side effects are very rare. Procedures performed correctly provide a high chance of recovery.

Echosclerotherapy is the same as sclerotherapy, the difference is in the use of an ultrasound scanner. This method is better because the movement of the syringe can be monitored, and the medicine will be distributed evenly.

Foam sclerotherapy is another type of sclerotherapy. The medicine is given in the form of microfoam, so the procedure allows you to achieve better results. The problem is that the drug is closer to the vein wall and does not mix with the blood.

Surgical treatment methods

Surgical treatment of varicose veins is only used if conservative methods do not achieve the desired results. Patients are given local anesthesia, and after a few hours they can go home.

There is practically no hematoma, and there is no intoxication characteristic of general anesthesia. The results obtained last for several years.

Phlebectomy is a type of operation performed under local surgery. Two small punctures are made to remove the affected vein. Sometimes this method can replace sclerotherapy. After just a few weeks, the patient will be able to return to a normal lifestyle.

Laser treatment is the gentlest treatment method and can only be carried out by a qualified specialist. Using an ultrasound scanner, a light guide is inserted into the vein.

This procedure is controlled by a special device. The laser beam causes the plasma to boil, the diseased vein closes and does not participate in blood circulation. The price of such an intervention is high, so it is not available to everyone.

Darsonvalization

With the help of the D'arsonval tool, it is possible to normalize blood circulation, as well as remove congestion in diseased veins. The increased tone gradually decreases, the vein tone increases. Patients get relief from pain and itching.

Full circulation of lymph, as well as full blood circulation, allows tissues to receive sufficient nutrition, and the amount of oxygen in them increases. Veins are either narrow or dilated; gymnastics can improve its elasticity.

The device moves from bottom to top. Lymph and blood flowed out from the ankle to the thigh, and the congestion stopped. To achieve the desired result, you need to undergo a full treatment, which includes at least twenty procedures.

Home treatment

Advice!Varicose veins can also be treated effectively using home remedies.

The most common method is the use of medicinal herbs. You can buy it at the pharmacy or collect it yourself in the summer.

White acacia

Alcoholic tincture is prepared based on the flowers of the plant. Soak a cotton ball in it and wipe the affected area several times a day.

Sagebrush

Collect fresh herbs and grind them in a mortar. Separate a spoonful of herbs and mix with the same amount of sour cream. Apply the resulting mixture to the sore spot and apply a bandage on top. After two hours, remove the compress. Repeat the manipulation for five days, take a short break, and then repeat the course of treatment again.

Kalanchoe

Wash Kalanchoe leaves, place them on a paper towel and let them dry. Cut the leaves and put them in a glass jar. Pour alcohol over it and let it brew for seven days, stirring occasionally. Strain the tincture and lubricate the painful veins for several months in a row.

Apple cider vinegar

Dissolve two spoons of vinegar in a glass of water and drink twice a day. It is recommended to rub undiluted apple cider vinegar on the affected area twice a day. After a month, the veins will begin to shrink.

cream

Grind part of the garlic, add two parts of butter. In pure form, put the resulting cream on the sore spots, cover with parchment paper on top and apply a bandage. Leave the compress overnight, wash off in the morning, and wrap your feet with an elastic bandage. Repeat the procedure throughout the month.

garlic

To consolidate the results of the treatment, you can take garlic internally. Mix 250 grams of chopped garlic and 350 grams of honey, let it brew for five days. Take one tablespoon three times a day.

tomatoes

Cut fresh tomatoes into slices, apply to the problem area and wrap with a bandage. Keep the compress for four hours, then remove and wash your feet. The duration of the treatment course is two weeks, then a ten-day break is taken, and it is repeated.

Prevention

It is easier to prevent disease than to fight it later, which is why prevention is necessary. If you have a hereditary predisposition to the development of varicose veins, you need to pay double attention to your health.

First of all, you need to abandon bad habits and follow the recommendations listed above. Your diet should include foods rich in vitamins.

Vitamin E

This vitamin is found in many foods: salad, vegetable oil, beans. It is necessary to strengthen the vein wall, as well as increase its elasticity. Vitamin C has similar properties.

Copper

Elastin synthesis is aided by foods rich in copper. Seafood is included here. To maintain your weight, you need to give up sugary foods.

To avoid varicose veins, you must follow the following rules:

1. It is not recommended to put a lot of pressure on your feet during the day. People who work in a standing position should spend a few minutes every hour in a sitting position. Ideal: take a horizontal position, raise your legs above your head and hold for twenty minutes.
2. If you work in a sitting position, you need to get up for a few minutes once an hour and spend this time standing. Therefore, the speed of blood movement through the veins will increase. Rotate your legs periodically in different directions.
3. It is not recommended to lift heavy objects.
4. Massage your feet daily using a stream of cold water.
5. Do not overuse visits to saunas and baths.

Effective methods of treating varicose veins can achieve good results. Patients quickly return to full life.

How complicated is the disease?

Complications of varicose veins are always unpredictable, even if they develop gradually. Without medical supervision and therapeutic treatment, the risk of complications becomes many times higher.

1. Trophic ulcers with ascending and descending varicose veins.They are most often located on the lower third of the foot on the inside, however, they can also be observed on the outside, although this manifestation occurs quite rarely. The deeper the trophic ulcer, the higher the risk of bleeding.
2. Thrombophlebitis.It can occur with any type of varicose veins; the occurrence of such complications directly depends on the nature of blood clotting. These complications can be avoided by using laboratory monitoring.
3. Eczema.Occurs due to violation of tissue trophism. Eczema and trophic ulcers can occur together and separately.
4. Bleeding from varicose veins on the lower leg.Complications of this type can appear against the background of deep trophic ulcers, as described above; such bleeding will occur externally. Internal (subcutaneous) bleeding is observed with prolonged varicose veins.

What is important to know about varicose veins

Varicose veins become a test for patients, because the more they ignore them, the more aggressive the disease will behave. The course of varicose veins depends not only on the doctor's instructions, but also how carefully the patient follows them. Varicose veins are a chronic disease, so even after surgery, treatment often does not end.

What the doctor advises must be done and followed, whether it is magnets for varicose veins of the lower legs, medications or exercise therapy. It is a complex treatment that gives positive results, and you should not neglect even one, the least important thing.