Varicose veins in the legs

Varicose veins in the legs are characterized by the formation of saccular expansion of the superficial (subcutaneous) veins of the lower extremities, their serpentine bends, increased length due to disruption of blood flow from them, and stagnant changes in the lower extremities.

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

Mankind has been familiar with varicose veins since ancient times.1595-1580 while conducting archaeological research during the excavations of the Mastaba burial in Egypt.BC found a mummy with symptoms of varicose veins and treatment of venous trophic ulcer of the leg.

This disease is rightly considered the price humanity paid for its ability to walk upright.In economically developed countries, on average, about 15% of men and up to 25% of women (including pregnant women) suffer from varicose veins in the legs.The high-risk group includes women, overweight people, workers who have long-term stress on the lower extremities and whose work requires standing or sitting for a long time.

Classification

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

1. Primarydevelops with varicose veins.With varicose veins, first of all, the superficial veins change, while the deep veins have a normal structure and function.For a long time, the expansion of superficial veins manifests itself only as a cosmetic defect, but later, as the disease progresses, venous outflow disorders occur, resulting in painful sensations in the lower extremities, swelling of the legs and feet, darkening of the skin in the lower third of the leg, intoxication and inflammatory processes.Varicose veins are a disease that develops continuously.
2. Secondaryis a complication of deep vein disease, especially as it develops either 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 the blood flow from the deep veins is disturbed.Over time, the resulting blood clot becomes fixed in the vein, where holes appear where 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 move up and down through them, flows back to the superficial veins, and secondary varicose veins expand.As a result, favorable conditions are created for venous stagnation, especially in the lowest parts of the limb - the leg and lower leg.

Symptoms of varicose veins

In most people, varicose veins appear as a cosmetic defect, most often on the inner surface of the legs.Sometimes varicose veins can be seen only in the form of a venous network formed by changes in small diameter veins, most often in the legs and less often on the face or upper limbs.Varicose veins turn blue or dark purple in color and have a curved course.

Symptoms of varicose veins: fatigue, heaviness, aching pain, burning and tingling sensations, throbbing, itching, cramps and restlessness.Also, one of the symptoms may be the appearance of swelling of the legs.As a result of the obvious expansion of varicose veins, blood supply to the tissues of the lower limbs may be impaired, skin defects may appear in the form of darkening or redness and inflammation.Trophic ulcers develop in extremely advanced cases of varicose veins.

Diagnosis of varicose veins

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

When the first symptoms of the disease appear, you should 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, you should also consult a dermatologist.You can go to a cosmetology clinic only after visiting specialist doctors with their recommendation.

Prevention of varicose veins

Currently, there is no method to completely prevent 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 to improve the condition and function of the veins of the lower extremities and reduce the risk of complications.The traditional and most common prevention methods are as follows:

1. Physical activity.Move more.Your feet should always be in motion.During walking, more favorable conditions are created for blood circulation in the lower limbs.Consult your doctor.It will help you choose the most optimal type and level of physical activity.
2. Control your weight.Excess weight increases the load on the circulatory system and especially on the veins.Also, with excessive salt consumption, edema is most clearly increased due to fluid retention in the body.
3. Be careful what you wear.Avoid high heels.Your shoes should always be comfortable.When wearing low-heeled shoes, the muscles of the lower extremities work better, which helps to improve venous flow.You should also avoid wearing uncomfortable and tight pants and skirts.
4. Raise your legs.When you raise your legs, venous blood flow from 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 standing or walking for long periods of time.Try to change your body position as often as possible to improve blood circulation.Try to get up and walk around every 30 minutes.
6. Do not sit cross-legged.Sitting cross-legged creates unfavorable conditions for blood flow in both lower limbs.

A good way to prevent varicose veins is to wear stockings, knee socks and compression stockings.It can also be a good adjunct to primary (drug or surgical) treatment.Nowadays, pharmacies offer a wide variety of compression garments to choose from.

Treatment of varicose veins

There are several commonly accepted methods for the treatment of varicose veins in the legs:

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

Conservative treatment

Doctors consider elastic compression to be the most effective conservative tool for the treatment and prevention of varicose veins - the use of special compression stockings (socks, stockings, tights).When wearing this knitwear, uniform pressure is provided on the lower limbs, which promotes normal blood circulation and improves its output, and at the same time, it forms an external frame that supports the weakened vascular walls.As a result, the load on the veins decreases, venous blood flow improves, the rate of further progression of the disease decreases, and the risk of developing thrombosis decreases.

Modern compression stockings are divided into two types: therapeutic and preventive.Each medical product is marked in mmHg, so it is divided into classes from I to IV.Compression of a certain strength is used at different stages of the disease, and it is necessary to consult a doctor, because only a doctor can determine and choose the right compression stockings, taking into account the nature of the pathology and according to certain individual standards.

It is recommended to wear preventive compression stockings and tights if you have a sedentary lifestyle, as well as during prolonged physical activity, during pregnancy or if you have a genetic predisposition.If even small signs of varicose veins appear, you should immediately contact a specialized clinic.

Drug therapy reduces the clinical manifestations of the disease - pain, swelling, discomfort, cramps, etc.can reduce, but cannot completely stop the course of the disease, and today it is used only as part of complex therapy during the main surgical treatment.Unfortunately, most of the drugs offered on the pharmaceutical market today have rather low effectiveness, despite the theoretically justified expediency of their use for the treatment of varicose veins.One of the reasons for this is the low absorption of the medicinal substances that form the basis of these drugs by the body.In this case, increasing the dose of the drug taken can help, 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 they are directed at a specific relationship involved in the development and progression of the disease.To achieve an optimal effect, a complex effect on the disease and the use of several drugs are necessary.An ideal drug for the treatment of venous insufficiency and varicose veins should affect as many pathogenetic links of chronic venous insufficiency as possible, have a minimum number of side effects and be well absorbed by the body.

Surgical treatment

Today, surgical treatment of varicose veins in the legs does not require a long hospital stay.Thanks to the application of modern invasive treatment methods, the removal of varicose veins can be performed not only under anesthesia, but also under local anesthesia, when the patient is clearly conscious, only the pain sensitivity of the lower extremities is turned off.Varicose veins disappear on their own within 3 months without any treatment after delivery.

The following surgical treatment methods are available:

1. Sclerotherapy.During this procedure, a solution is injected, under the influence of which a scar is formed at the site of the damaged vein.This method is used only for small and medium-sized varicose veins.Sometimes, more than one injection of sclerosing solution may be required to completely destroy the vein.Sclerotherapy is quite effective when performed correctly, is less traumatic, leads to good therapeutic and cosmetic effects, and a significant advantage is that sclerotherapy is performed directly in the doctor's office under local anesthesia (that is, without anesthesia).
2. Laser surgery.Laser radiation can be used to eliminate varicose veins of any diameter and especially venous meshes.The essence of the method is to irradiate the inner surface of the vessel with a laser beam.A special device - a light guide through which a laser beam passes under ultrasound control - is inserted through a small puncture of the skin and vessel wall.The inner surface of the vein is irradiated with a laser and then glued together.When using this method, the doctor directs a laser beam at the vein to be removed, it slowly changes color and the vein disappears completely.An important advantage of this method is that no incision is made on 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 tissue, through which the damaged vein is removed and the insufficiently perforating veins in the leg are closed.Anesthesia is a necessary condition when using this technique.This method is used to eliminate large varicose veins.
4. Ambulatory phlebectomy (removal of varicose veins).This method is suitable for removing veins of small diameter.With this method, the vein is removed through several small incisions in the skin under local anesthesia.Scars after removal are small and almost invisible.
5. Endoscopic removal of varicose veins.This method is especially suitable for skin defects in the form of ulcers.During this method, a special video micro camera is inserted into the vessel, which allows you to see the vessel from the inside and observe the entire extraction procedure.Then the vein is removed under observation through this camera.

Thanks to the use of modern treatment methods, it is possible to achieve complete recovery and a good cosmetic effect.However, it is important to remember that varicose veins can reappear.

Complications of varicose veins

Sometimes, as a result of blood microcirculation disorders, changes in the skin around varicose veins can occur, from light darkening of the skin to ulcerated defects.If these changes occur, you should immediately consult a doctor.

A more serious complication of varicose veins is the development of blood clots in deep and superficial veins.This complication is called thrombophlebitis.When it occurs, sharp unbearable pain, swelling and redness appear.In this case, 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, genetically determined.Its main reason is the weakness of the vascular wall and dysfunction of the venous valves.Venous valves are formed from the wall of the veins and usually consist of 2 leaflets directed towards the heart.With normal closure of the valves, blood from the upper part of the vein cannot penetrate into the lower part.When the valves are dysfunctional and the valves don't close completely, blood moves up and down, resulting in venous stasis and dilation of the veins beneath the dysfunctional valve.First, where there is a dysfunctional valve, a varicose vein forms and blood flows outwards from the deep veins, the overfilled vein stretches and dilates, causing the underlying valve to become taut and dysfunctional, etc.Violation of the venous flow of blood from the lower limb to the heart gradually develops, as a result of which the microcirculation of blood in the tissues of the lower limbs is disturbed, which is manifested by edema, increased pigmentation, thrombophlebitis and trophic ulcers.

Factors leading to the development of varicose veins

Factors that contribute to varicose veins may include:

1. Genetic predisposition - thin and weak wall of superficial vessels.
2. Increased load on veins: sedentary work, standing for a long time, wearing uncomfortable shoes with high heels, lifting heavy objects, inactivity of lower leg muscles.Also, the triggering factor for the development of varicose veins is pregnancy and childbirth.With sudden physical overload, there is a strong increase in hydrostatic pressure in the veins of the lower extremities, which triggers the process of varicose veins.

Risk factors for the development of varicose veins include:

1. Age.With age, the wall of the vessels, as well as the valves, become thinner, which causes a natural disruption of their activity.
2. Floor.Women suffer more from varicose veins.It is possible that this is due to a number of hormonal reactions.Female sex hormones affect the relaxation process of the venous wall.Open hormonal changes in the female body occur during pregnancy and childbirth, during menstruation and menopause, which cannot affect the work 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 rate of blood flow from the lower extremities to the pelvic cavity, the inferior vena cava system, and the heart decreases.Thus, favorable conditions are created for the development of varicose veins.Changes in the circulatory system in a woman's body ensure the development of the fetus, and at the same time lead to the development of varicose veins.As pregnancy progresses or during childbirth, varicose veins can develop not only in the lower extremities, but also in the hemorrhoidal veins around the anus.