Varicose veins mostly affect the venous system of the legs. External manifestations (protruding nodular blue veins, swelling) are not only a cosmetic problem, but are 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 vessels become thinner, in some places expansions (sac-like tumors) - nodules are formed.
The first case of varicose veins was recorded in a document dated 86 BC. BC: Roman general Gaius Marius complained of pain in his legs due to "blue swollen veins".
The main reason for the development of varicose veins (varicose veins, varicose veins) is an increase in pressure in the superficial vascular system. 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 are deformed, change their structure and can no longer fully transport blood.
Varicose veins can develop almost anywhere on the body, but are most often seen in the lower extremities. Therefore, when it comes to varicose veins, they usually mean the problem of the legs.
Code of varicose veins in ICD-10
The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) covers 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 inflamed lower extremities;
- I83. 2 - ulcers and varicose veins of inflamed lower extremities.
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 of other localizations:
- I86. 0 - varicose veins of sublingual veins;
- I86. 1 - varicose veins of the scrotum (anatomical formation in men - a container for the testicles and their appendages);
- I86. 2 - varicose veins of the pelvis;
- I86. 3 - varicose veins of the vulva (female external genitalia);
- I86. 4 - varicose veins of the stomach.
O22. 0 - varicose veins of the lower extremities during pregnancy.
30 million people in our country suffer from various forms of varicose veins. One third of them have complications - trophic ulcers. An open defect in the skin or mucous membrane caused by a violation of blood circulation and tissue innervation.
Mechanism of development of varicose veins
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 to understand how and why the disease develops.
How blood moves in the body
There are two types of blood vessels in the human body - veins and arteries. Blood flows from the heart through the veins to all organs and tissues. This occurs at high pressure (70-120 mm Hg) and at high speed.
Blood flows from organs and tissues through veins and is directed to the heart under low pressure (0-20 mm Hg).
The walls of veins are less thick and elastic than the walls of veins and, unlike arteries, do not contain such a developed muscle layer. Therefore, varicose veins are possible only in veins, but not in veins.
Human arterial and venous circulatory system. Veins are shown in blue, arteries in red.
In order to transport blood from the periphery to the center, a low pressure in the veins is necessary. But at the same time, blood flow on the way to the heart encounters an obstacle - gravity. This force forces the blood back through the veins.
You may often hear that varicose veins are humanity's punishment for walking upright. After all, the longest distance that blood has to travel in the body, overcoming the force of gravity, is the path from the leg to the heart. The movement of blood through the vessels is ensured by the contraction of the heart, the muscular pump of the surrounding muscles and negative pressure in the chest during inhalation.
In healthy veins, the reverse flow of blood is prevented by valves in the inner walls of the veins. The valves act like one-way swing doors—they open and allow blood to flow into the heart, and immediately close if gravity tries to push the blood back.
It is not only the valves that help the veins to deliver blood to the heart, but also the muscles that surround the veins. By contracting and relaxing, the muscles help move blood through the veins. This mechanism works only when a person moves. When standing or sitting for a long time, the muscle pump is practically inactive.
The ends of the venous valves always face the direction of blood flow - towards the heart
How failure occurs and disease occurs
An increase in pressure in the vascular system disrupts the functioning of their valve apparatus and leads to the reverse flow of blood through the veins. For this reason, as well as stagnation of excess blood, weakness of the valvular apparatus (for example, in connective tissue diseases), the lumen of the veins expands, the walls are deformed, thinned and resemble a local bag. protrusions - nodules are formed.
The process is similar to inflating a balloon: if you don't let the air out, the balloon inflates more and more.
On the left there is normal blood flow; on the right - multidirectional blood flow due to failure of venous valves, vascular deformation
There are superficial and deep veins in the legs. 85-90% of the total blood volume passes through deep blood, only 10-15% through superficial blood. The walls of the deep vessels are denser and adapt to the increased blood volume. The superficial veins of the legs are thinner and more susceptible to varicose veins.
There are large venous plexuses in the pelvis and lower part of the esophagus, which can undergo varicose transformation. The mechanism of disease development in small pelvic vessels is the same as in the lower extremities. However, varicose veins of the esophagus arise for another reason: due to portal hypertension - cirrhosis of the liver, hepatitis, parasitic lesions of the liver, fatty hepatosis, etc. increased pressure in the portal vein system that develops with
Causes of varicose veins
A number of factors contribute to the development of varicose veins in the legs. The main onesvalve failureAndheredity. It is known that a quarter of patients had close relatives suffering from one of the forms of varicose veins.
Excess weight. The more extra pounds a person has, the greater the load on the venous system. Over time, the veins stop coping with such pressure: the lumen of the veins increases, and the valves in their walls stop closing completely. As a result, blood stagnates and varicose veins develop.
Pregnancy. Hormonal changes occur in a woman's body, body weight, intra-abdominal pressure and volume of circulating blood - this leads to a violation of the flow, stretching of the walls of the vessels and changes in the work of the valvular apparatus.
After childbirth, the diameter of dilated vessels decreases, but does not always return to its original value. The risk of developing varicose veins increases with subsequent pregnancies.
Age. Varicose veins often affect people after the age of 50. The older a person is, the more worn out the venous valves are, the recovery processes slow down, and the mechanism of pathological dilatation of the veins is activated - the development of varicose veins.
Venous refluxvenous reflux Backflow of blood through veins due to resistance to blood flow, from lat. refluo - "fool back. "It occurs in 10-15% of 12-13-year-old schoolchildren. Due to a sedentary lifestyle and excess weight, the disease is "rejuvenating".
Varicose veins of the lower extremities develop faster if there are additional risk factors.
Risk factors contributing to the development of varicose veins of the legs:
- lack of physical activity - when moving, the muscles stimulate blood flow through the vessels, and without movement, blood circulation in the vessels can become difficult;
- smoking - chemicals contained in tobacco smoke damage the walls of blood vessels, as a result of which their lumen narrows, blood flow becomes difficult and stagnation occurs, causing varicose veins;
- professions that involve standing or sitting for a long time - hairdressers, surgeons, cooks, waiters, drivers, office workers are at risk;
- menopause - in women aged 40-50, the production of sex hormones (estrogen and progesterone) decreases and at the same time the tone of the venous wall decreases. This increases the likelihood of varicose veins.
Women suffer from varicose veins 3-4 times more often than men. This happens due to hormonal changes (menstrual period, pregnancy, menopause).
During pregnancy, varicose veins can affect different parts of the body: legs, thighs, vulva
Varicose veins can occur not only in the lower extremities, but also in other parts of the body.
The main causes of varicose veins in different places
Varicose veins of the esophagus
Changes in the vessels of the esophagus, uneven growth in their lumen, protrusion of the wall and the development of nodular bends 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 vascular system - collect blood from the abdominal organs
Varicose veins of the scrotum (varicocele)Pathological dilatation of the vessels of the testicular pampiniform plexus. Manifested by varicose veins and blood flow disorders in the scrotum
Reasons:
- congenital insufficiency of the valves of the testicular veins (usually left)
- mechanical compression of the testicular vein (inguinal hernia)
Varicose veins of the pelvis
It is characterized by the expansion of ovarian veins and intrapelvic venous plexuses of different diameters. The condition is also known as pelvic obstruction syndrome
Reasons:
- polycystic ovary syndrome
- two or more pregnancies
- hormonal dysfunction
Varicose veins of the vulva
Varicose veins of the pelvis affecting the veins 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 veins)
Asymptomatic damage to the veins located under the tongue. It manifests itself as a slight bulging of the blood vessels and a change in color from dark blue to purple.
Reasons:
- hypertension
- cigarettes
- old age
Varicose veins of the stomach
An isolated change in the vessels of the stomach or together 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, venous developmental anomalies)
Symptoms of varicose veins
In rare cases, only the aesthetic side of the disease is visible - blue veins. Most patients suffering from varicose veins of the legs report at least one or more unpleasant symptoms.
Symptoms of varicose veins of the lower extremities:
- feeling of fatigue, pain or heaviness in the legs - this is caused by blood stagnation and pressure on the surrounding tissues;
- burning, tingling or pulsation in the legs - a reaction to the slowing down of blood flow and the overflow of the venous system of the lower extremities;
- night muscle cramps in the legs - painful spasms occur due to blood stagnation and the accumulation of metabolic products in the tissues;
- swelling of the legs and ankles - due to stagnation in the vessels, the liquid part of the blood leaks through the altered vessel wall into the subcutaneous tissue;
- itching of the skin around damaged vessels - enlarged and altered blood vessels do not provide normal blood circulation and nutrition to the skin, so it becomes dry and rough.
In patients with varicose veins, unpleasant sensations in the legs intensify in the evening, especially after sitting or standing for a long time.
The appearance of altered veins is not always proportional to the severity of 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 discomfort.
Varicose veins affect various vessels: from the small veins of the skin to the large saphenous veins
Symptoms of other types of varicose veins mainly depend on the underlying cause of the disease. Often, patients do not complain about anything, and the doctor determines the problem only during the examination. This happens, for example, with varicose veins of the sublingual veins.
In some cases, as in the case of varicose veins of the esophagus or stomach, the pathology immediately manifests itself as a life-threatening complication - bleeding.
Classification of vascular diseases
In clinical practice, doctors rely on the international classification of venous diseases - CEAP. This is an abbreviation formed by the first letters of the main parts of the classification:
- C — clinic (clinical changes);
- E - etiology (origin of the disease);
- A - anatomy (anatomical localization of varicose veins);
- P - pathogenesis (mechanism of violation of venous blood flow).
Aggravation of varicose veins in the legs
Typically, varicose veins themselves are not life-threatening. But sometimes the disease can cause complications.
Thrombophlebitis- inflammation of the vessel walls 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 a thrombosed vessel.
Venous trophic ulcer- an open defect of the skin and soft tissues due to blood stagnation, edema and disruption of cell nutrition. It occurs in the legs and ankles near the varicose veins. Swelling is more obvious in the lower legs, which means 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 impaired blood circulation and tissue nutrition
bleeding- rupture of a vein occurs due to varicose expansion. In the later stages of the disease, the skin on such vessels is very thin and dry - a small injury is enough to break the integrity of the vessel and cause bleeding. Sometimes spontaneous rupture of a vein occurs in the area of varicose veins.
Diagnosis of varicose veins of the legs
A phlebologist deals with the diagnosis, treatment and prevention of vascular diseases. The doctor makes a diagnosis based on the patient's complaints, examinations and instrumental studies. If the symptoms of varicose veins are pronounced, tests are generally not prescribed: a doctor's examination is sufficient.
The doctor can prescribe laboratory tests in preparation for surgery or to rule out concomitant diseases that affect the condition of blood vessels.
One of these diseases is diabetes. It can significantly worsen the course of varicose veins and increase the risk of complications (especially trophic ulcers).
In order to determine the exact diagnosis and treatment tactics, you will need a duplex ultrasound scan - the gold standard for diagnosing vascular diseases. The method allows to evaluate the structure, function, patency of superficial and deep vessels, the consistency of valves, as well as to determine the direction of blood flow.
If you suspect the secondary nature of varicose veins (may occur after deep vein thrombosis), the doctor prescribes venography, CT or MRI venography.
Phlebography is an X-ray examination used to determine patency and valve function of deep veins.
Computer or magnetic resonance venography is used to visualize the venous system in three-dimensional projection and with very high spatial resolution.
Treatment of varicose veins in the legs
The goal of treating varicose veins is to reduce or eliminate symptoms, improve the appearance of the veins, and prevent complications.
The doctor chooses the treatment method depending on which veins are affected and how serious the condition of the patient with varicose veins is.
Non-invasive treatments
Non-invasive treatment of varicose veins includes compression therapy, medication and lifestyle changes.
Compression therapy involves wearing special socks, stockings and tights. The choice of the model, the type of fabric and the degree of compression depends on the symptoms. The doctor will help you choose the right knitwear.
A compression jacket on the lower legs compresses more than the upper legs - thereby pushing blood towards the heart and relieving congestion.
The effect of compression therapy for varicose veins:
- symptoms decrease - heaviness, leg fatigue, night cramps, burning sensation or pain;
- due to the improvement of blood circulation, the severity of edema decreases;
- The healing of trophic ulcers is accelerated because elastic compression improves blood circulation and tissue nutrition.
Drug therapy - the doctor can prescribe phlebotropic Phlebotropic drugs (phleboprotectors, venotonics) biologically active substances that increase venous tone and reduce the severity of venospecific symptoms. (venotropic) drugs.
The main groups of phlebotropic drugs used for varicose veins:
- angioprotectors: improves microcirculation, normalizes increased capillary permeability, reduces blood viscosity and the likelihood of blood clotting;
- antithrombotic substances: reduce the risk of formation of dangerous blood clots (thrombus) 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 progression of the disease and help stop the pathological process, along with other recommendations of the attending physician.
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 veins, eliminate venous stagnation and edema;
- weight control: due to the normalization of body weight, the load on the blood vessels is reduced and the return of blood to the heart is facilitated through the vessels;
- giving up bad habits: nicotine and alcohol damage the inner walls of blood vessels and disrupt the regulation of vascular tone. Quitting smoking and drinking alcohol improves the condition of the vessels and valve function.
Invasive methods for the treatment of varicose veins
Invasive treatments include medical procedures that affect the integrity of the skin or mucous membranes. Sclerotherapy is a procedure using 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 separated from the blood circulation and over time its function is taken over by the neighboring veins; Sclerotherapy is performed without hospitalization - after the procedure, the patient can go home.
The sclerotherapy procedure takes 5 to 30 minutes, depending on how many varicose veins need to be filled with sclerosant and how large they are.
Endovenous laser thermoobliteration (EVLO). A catheter with a laser light guide is inserted into the vein through a small incision. The thermal energy of the laser heats the vein and it is removed - "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 micropuncture, a catheter is inserted into the vein and connected to a device that generates radiofrequency pulses. Inside the vessel, the radio wave is converted into heat energy that "seals" the vessel.
With EVLO, the vein is exposed to high temperature for a short time, with RFO, the temperature is lower, but the session is longer. Both procedures are effective and safe.
NTNT obliteration or non-thermal swelling methods:
- venous obliteration using cyanoacrylate glue;
- mechanochemical obliteration, in which mechanical and chemical effects on the vessel occur simultaneously.
NTNT obliteration is the most modern, low-traumatic method of treating varicose veins with a short rehabilitation period.
Phlebectomy is the removal of saphenous veins suffering from varicose veins. It can be used as an independent operation or combined with other methods. Varicose veins are removed through small punctures under local anesthesia.
Prevention of varicose veins of the legs
If you follow simple prevention rules in everyday life, you can prevent the development of varicose veins.
A combination of provoking factors - sitting for a long time with legs crossed, wearing uncomfortable shoes - increases the risk of varicose veins in the legs.
Prevention of varicose veins - what you need to know:
- moderate physical activity (walking, swimming, leg exercises) and rest with raised legs improve free movement of blood vessels and prevent stagnation in vessels;
- rational nutrition and weight normalization lead to strengthening of blood vessels;
- wearing loose clothing that does not restrict movement helps to improve blood circulation;
- a cool shower in the hot season helps to tone the veins;
- comfortable shoes with low heels (no more than 3 cm) allow you to avoid improper foot loading and blood flow disorders;
- A reasonable approach to visiting saunas and steam baths allows you to maintain normal blood flow (long-term heating procedures greatly expand the vessels, so blood flow slows down).