Varicose veins, varicose veins, varicose veins
- uneven increase in the lumen and length of the veins,
- the formation of knots in the areas of vein thinning due to pathological changes in the vein walls, their thinning, stretching, reduced tone and elasticity,
- functional insufficiency of venous valves and impaired blood flow.
Varicose veins are a fairly common disease. Varicose veins and their complications are diagnosed in 25% of the population, and women suffer 2-3 times more often than men. In women, the first signs of the disease are often observed at a young age, usually associated with pregnancy and childbirth. In older age, the incidence increases in both men and women, and the frequency of complicated forms also increases. At the age of 70, the 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, recognition of all possible causes of the disease and prevention of venous disorders is becoming an increasingly urgent task.
How varicose veins form and develop
To understand how varicose veins occur, let's briefly explain the physiology of the venous system of the lower extremities. Venous outflow in the legs is provided by two interconnected mechanisms - central and peripheral. The central mechanism is connected to the heart, lungs, diaphragm, and the peripheral mechanism is directly connected to the functioning of the venous system of the lower extremities, which surrounds the vessels of muscles and tissues.
The initial signs of varicose veins are disturbed capillary circulation, swelling, a feeling of heaviness in the legs, the appearance of spider veins and spider veins. These changes are reversible, but if preventive measures are not taken in time, the problems will increase.
As a rule, more than a year passes from the initial signs of varicose veins of the lower extremities to the appearance of enlarged nodes and the appearance of pronounced symptoms of varicose veins. Developing gradually, varicose veins lead to blood flow disorders and chronic venous insufficiency. Stagnation of blood in the veins can lead to phlebitis (vein inflammation), thrombophlebitis (vein inflammation with the formation of blood clots), phlebothrombosis (thrombosis with further vein inflammation), non-healing dermatitis (vein inflammation). skin), trophic ulcers.
Types and forms of varicose veins
There are primary (true) and secondary (symptomatic) varicose veins.
Primary varicose veins are an independent disease of the venous system (varicose veins). It develops gradually over several years. Varicose dilatation of the great saphenous vein is most often observed (70-85%), less often - small veins of the skin (5-12%). In varicose veins, 50-70% of vein damage is bilateral.
Secondary varicose veins are a symptom and consequence of diseases in which there are obstacles in blood flow through the deep veins of the lower extremities (post-thrombotic diseases, tumors, scars, inflammatory processes, aplasia and dysplasia of deep veins, arteriovenous fistulas, etc. ). Secondary varicose veins are quite rare.
Varicose veins most often affect the saphenous veins of the lower extremities, which are part of the large vein system. Branches of the small saphenous vein are much less likely to suffer from varicose veins.
Classification of types of varicose veins
In our country, until recently, doctors classified varicose veins according to several types of classifications. V. S. Savelyev's staged clinical classification was used, which reflects the degree of venous circulation disorders in the extremity and the body's ability to resist and compensate for these disturbances, as well as classification according to the forms of varicose veins and the complications caused by them.
But the main one at the moment is the CEAP international classification, based on clinical (C - clinic), etiological (E - etiology), anatomical (A - anatomy) and pathogenetic (P - pathogenesis) characteristics of the disease.
6 clinical classes ("C") are arranged according to the increasing severity of the disease from telangiectasia (TAE) to trophic ulcers.
The etiologic section ("E") indicates whether the process is primary or not.
The anatomical part of the classification ("A") divides the venous system of the lower extremities into 18 relatively separate segments, which makes it possible to indicate the localization of the affected area of the venous system.
The pathophysiological section ("P") is characterized by 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. about the degree of changes in the blood vessels and disorder of the venous system. Depending on the stage, a prognosis can be given for the further development of the disease.
The initial stage of varicose veins - varicose veins of the 1st degree
In the initial phase, when vein pathology is not yet clearly expressed, visible signs of varicose veins may be absent. Patients complain of a feeling of heaviness and discomfort in the legs, rapid fatigue, a feeling of warmth, paresthesias (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 appears in the foot and ankle, which disappears after a short rest. Night cramps of the calf muscles are occasionally possible, but patients attribute them to overwork.
After prolonged physical activity, the veins swell and their network is easily visible through the skin. They are especially noticeable in the area of the thighs, lower legs and feet. The number of such veins and the degree of their expansion can vary. These can be individual and not very noticeable formations on the lower leg, which appear more clearly in the evening or after physical activity. Also in this stage of varicose veins, the appearance of spider veins is observed.
If you start the simplest conservative treatment at this stage, 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 phase
At this stage of the disease, changes in large subcutaneous vessels become noticeable. Veins are deformed, swollen, blood flow is disturbed, and noticeable swellings appear on the feet and ankles. The swelling increases with prolonged physical activity on the legs, but disappears after a night's rest. Cramps in the calf muscles are common at night. Paresthesia is observed - temporary loss of sensitivity in the legs, numbness of the legs, burning, "goosebumps". As the disease progresses, pain appears, which intensifies in the evening.
This phase of subcompensation, as a rule, lasts for several years, and at this moment the development of the disease can be stopped even if treatment is started in time. Otherwise, the disease will inevitably progress to a more severe stage.
Symptoms of varicose veins of the 3rd degree - decompensation phase
In this stage of varicose veins, there is a significant intensification of symptoms, increasing pain, heaviness in the legs, and there is also a disturbance of the peripheral circulation of blood and lymph (chronic venous insufficiency). The swelling does not disappear even after a long rest and spreads to the lower leg. Patients suffer from itchy skin. The skin on the legs becomes dry, loses elasticity, the skin is easily injured, loses the ability to regenerate quickly, which is why 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 leg (hyperpigmentation due to subcutaneous bleeding).
All these complaints are constant. In the future, complaints of pain in the heart area, difficulty breathing, headaches and deterioration of the musculoskeletal function of the affected limb may appear.
Although the stage 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 long time, maintaining work ability and preventing the transition to the complication stage.
Varicose veins of the 4th degree - stage of complications
This phase of the disease is characterized by pronounced disorders of venous circulation. Swelling of the legs becomes almost constant, itching of the skin intensifies, and trophic disorders appear on the skin of the lower legs. Advanced varicose veins are often accompanied by eczema, dermatitis and long-term injuries, and as the regenerative abilities of the skin with varicose veins are noticeably reduced, even a small wound can turn into a persistent trophic ulcer. The condition of the skin and vein walls are easily injured, leading to extensive bleeding. Damaged soft tissues and open ulcers become a gateway for infection.
The most common complications of varicose veins:
- phlebitis - vein inflammation;
- thrombosis - formation of a blood clot (thrombus) in a vein, which can lead to clogging of the vessel;
- trophic ulcers - occur in a place where the affected vein cannot ensure sufficient blood flow from the skin, due to which tissue nutrition (trophism) is disturbed.
Varicose veins can be complicated by acute (sometimes purulent) thrombophlebitis
At this stage, it is no longer possible to restore the condition of the venous system, 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 of the lower extremities. The development of this disease is usually caused by several factors. But all the painful symptoms of varicose veins are associated with structural changes in the tissue of the venous walls of blood vessels and dysfunction of the venous valves.
What causes these violations?
You can often come across the claim that one of the most important physiological reasons for the occurrence of diseases such as varicose veins is upright posture. Indeed, in humans, by its very nature, the load on the vascular system of the lower extremities is very high. The flow of blood from the veins and its rise to the heart is prevented by the pressure caused by gravity, as well as by the high pressure in the abdominal cavity. However, not everyone develops varicose veins. What factors cause the development of varicose veins?
It has been established that the main risk factors for varicose veins are:
- genetic predisposition (inheritance) - congenital weakness of the venous wall, disorder of the venous valves;
- female gender - women suffer from varicose veins 4-6 times more often than men;
- hormonal disorders;
- hormonal contraception;
- pregnancy, especially multiple pregnancy;
- 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 sitting work, sudden temperature changes, prolonged contact with high or low temperatures;
- overweight, obesity, which creates increased stress on the legs and increased pressure in the pelvic area;
- lack of vitamin C and other useful substances necessary for the vascular system;
- sedentary lifestyle, bad habits that destroy blood vessels and cause additional tension in them.
Diagnosis of varicose veins
Diagnosing varicose veins is often not difficult. Clinical examination, including physical examination (examination and palpation), examination of the patient, collection of complaints and anamnesis (data on the course of the disease, life and work characteristics, past and present diseases) for severe varicose veins usually makes it possible to make a diagnosis without an instrumental examination. Exceptions are situations when, with excessive development of subcutaneous fatty tissue of the lower extremities, varicose changes can be difficult to see.
Currently, duplex ultrasound scanning (USDS) has become widely used to study the veins of the lower extremities. This method allows you to determine the localization of changes in the veins and the nature of venous blood disorders. However, you must know that the results of an ultrasound scan are largely subjective and depend a lot not only on the experience and knowledge of the researcher, but also on the tactical approaches to the treatment of venous diseases adopted in a given medical institution. When determining treatment tactics, they are primarily guided by clinical examination data.
A duplex scan is performed when invasive treatment of varicose veins of the lower extremities is planned. Additionally, X-ray contrast venography, MRI venography and CT venography can be used.
All these methods make it possible to clarify the location, nature and extent of venous lesions, to clearly observe disorders of venous hemodynamics, to evaluate the effectiveness of the 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:
- removal or reduction of symptoms that cause particular discomfort in patients - pain, swelling, spasms;
- restoring and improving the work of blood vessels - from capillaries to deep veins, improving the work of valves, restoring damaged vascular walls, increasing their elasticity and strength;
- improving the rheological properties of blood, reducing its viscosity;
- improving the functioning of the lymphatic system.
- prevention of further development of diseases and complications;
- improving the patient's quality of life.
Depending on the stage of the disease and the degree of vascular damage, the doctor can prescribe the most optimal treatment methods for the given situation, such as:
- conservative treatment- recommendations for prevention and lifestyle change, pharmacotherapy, compressive therapy;
- non-surgical invasive procedures- sclerotherapy, echosclerotherapy, foam sclerotherapy (foam therapy), etc. ;
- operation- phlebectomy, thermal obliteration, stripping, combined methods and operations of increased complexity for complications of varicose veins and treatment of trophic ulcers of the lower extremities.
These methods make it possible to improve blood circulation in the lower extremities, including microcirculation, remove many cosmetic defects caused by varicose veins and free the patient from a significant part of the painful manifestations of the pathology.
Conservative methods of treatment of varicose veins
Modern conservative therapy of varicose veins provides an integrated approach to treatment and includes several areas:
- lifestyle changes;
- pharmacological therapy;
- compression therapy.
It is no coincidence that lifestyle changes are in the first place. It is necessary, if possible, to eliminate sludge at least to reduce the impact of unfavorable factors.
One of them is long-term static loads in a standing or sitting position, which lead to blood stagnation. In order to activate the musculo-venous pump of the lower leg, you need to regularly stretch your legs and walk more. During work, you can occasionally perform exercises with alternating contractions and relaxation of the calf muscles (rising on the toes).
It is recommended that you find time to do outdoor sports that are not associated with the risk of leg injuries (athletic or Nordic walking, exercise bikes, treadmills, swimming, cycling and walking).
If you have varicose veins, you should not overheat your legs, you will have to avoid visiting baths and saunas.
Patients with varicose veins must monitor their body weight. It is known that with a body mass index greater than 27 kg/m2the probability of varicose veins increases by 30%. Excess body weight is often associated with elevated sugar levels, which leads to problems with the healing of venous ulcers and the risk of their recurrence.
The effectiveness of compression therapy is explained by the possibility of reducing reverse blood flow, a certain reduction of the pathological capacity of varicose veins, which leads to a reduction of swelling, improvement of capillary blood flow and reduction of symptoms of varicose veins.
In addition to bandages and knitwear, there is also hardware compression therapy, which is particularly effective in 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, by elastic compression. Medicines are also prescribed to prepare for surgical treatment or in the postoperative period in order to speed up rehabilitation 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;
- means for the regeneration of blood vessels.
Venotonics and angioprotectors based on bioflavonoids, rutin derivatives, saponins, etc. are mainly used for the systemic treatment of varicose veins. These drugs increase the elasticity and tone of veins, increase the strength of blood vessels, improve the outflow of lymph and reduce lymphatic pressure. If there is a risk of thrombosis, anticoagulants are prescribed. Anti-inflammatory and painkillers are used for complications of varicose veins - inflammation of the veins, severe pain, trophic lesions of the veins.
In addition to systemic drugs, local drugs are used - ointments and gels based on venoactive active substances, heparin, nonsteroidal 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 the capillary or problematic vein with a thin needle. The vessel is then compressed using a latex pad or an elastic bandage. The vessel walls "stick", the blood flow in the vessel stops. The glued walls usually grow together, create a scar, and the scar recedes. It is used to treat varicose veins of small superficial veins. The method is effective in the early stages of the disease, only in cases where the varicose veins are localized only in small veins, and allows the removal of cosmetic defects. A series of treatments may be required to achieve results.
It is characterized by a special sclerosant. As with sclerotherapy, a sclerosing substance is injected into the damaged vein in the form of a fine foam, which quickly "closes" the large affected veins. The method does not require numerous procedures and gives high results. It is important to know that the procedure - although rare - can have side effects - visual impairment. It is also dangerous for the sclerosant to enter the arteries and nerve tissue. The 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, as well as if conservative methods cannot stop the development of the disease.
Varicose vein surgery has the following goals
- removal of cosmetic defects;
- reduction of subjective symptoms (pain, burning sensation, paresthesia, feeling of heaviness in the legs, etc. );
- prevention of deterioration of saphenous veins;
- 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 relapse of venous trophic ulcers.
According to the Clinical Guidelines, the goals of surgical treatment are:
- elimination of pathological vertical and/or horizontal reflux;
- elimination of enlarged saphenous veins.
Before performing surgical operations 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:
Vein suturing is the placement of multiple stitches on a damaged vein, which prevent blood flow through the vein. As a result, blood clots form and the vein gradually degenerates.
It is important to remember that surgery is not the final cure, but the removal of symptoms. After the operation, conservative treatment is also necessary, and that for life, and this must be explained to the patients.
Depending on the stage of varicose veins, symptoms, accompanying diseases and general health of the patient, the doctor chooses specific recommendations in order to achieve the maximum possible improvements as quickly as possible.